Wednesday, May 31, 2006

Patent Foramen Ovale Study at the Mayo Clinic



Dr. Omar Sanchez, cardiologist/diver from Buenos Aires sends us this recent abstract of an article in the Mayo Clinic Proceedings debunking the bunk about relating cerebrovascular ischemic events [CIE] with large patent foramen ovale. The article, "Population-Based Study of the Relationship Between Patent Foramen Ovale and Cerebrovascular Ischemic Events", by a large group with the Department of Neurology at the Mayo Clinic has the following conclusions:

"Patent foramen ovale is not a risk factor for cryptogenic ischemic stroke or transient ischemic attack in the general population. The PFO’s importance in the genesis of cryptogenic CIE may have been overestimated in previous studies because of selective referral of cases and underascertainment of PFO among comparison groups of patients referred for echocardiography for clinical indications other than cryptogenic CIE."

Mayo Clin Proc. 2006;81(5):602-608

Implications for divers with PFO are not readily apparent, but might explain the highly unpredictive nature of right to left shunts across a PFO in divers.

More about PFO at http://www.scuba-doc.com/pfo.htm .

Diving With Disabilities - Adaptive Scuba Association

Bryan St. Germain writes:
"I saw Ernest S Campbell's "diving with disabilities" page at scuba-doc.com.
If you're interested in updating it, here's a more-recently-published article on adapted diving. Click the embedded link.

Under The Sea

By Barbara McDermott

“Awesome!” “Diving is like being in space. I can float in one spot, and swim wherever I want to go.” These enthusiastic sentiments are from disabled SCUBA divers."


I expect there will be much more in the press soon--a large group of
adapted divers are meeting in Nassau June 1-5. I'll be there as an
instructor who specializes in adaptive scuba, and there are some video and
print reporters attending as well. One of the sponsors of the event is
SSI's Platinum Pro Foundation - you can see their article on the event by clicking the embedded link.


You may already know that mainstream certifying agencies are adding
adaptive scuba certifications to their programs, thanks primarily to the
long-term efforts of Gain Wong and the Adapted Scuba Association (Toronto,
Canada - 416-534-2527). SSI and YMCA have programs in place, and I hope to
see both PADI and CMAS make announcements soon.

Best regards,
Bryan

Tuesday, May 30, 2006

World Communication Center Offers Free DAN Membership with Satellite Phone Rental


Chandler, Ariz. World Communication Center(WCC),
a leading provider of global satellite voice and data communications, in
partnership with Divers Alert Network (DAN), will offer new divers free DAN memberships valued at $29 when they rent a 9505A Iridium satellite phone for one week or more through June 30, 2006

Current DAN members benefit from the rental of the same phone kit by receiving a $30 gift certificate to use toward the purchase of DAN merchandise.

The WCC rental program allows DAN members to rent satellite equipment at weekly rates and pay for minutes they use at a fraction of what most international phone calls cost. Additionally, WCC¹s rental phones come pre-programmed with a simple speed dial direct to DAN¹s emergency hotline. DAN's medical staff is on call 24 hours a day, 365 days a year, to handle diving emergencies such as decompression sickness, arterial gas embolism, pulmonary barotrauma or other serious diving-related injuries. Each year, DAN answers more than 2,000 calls on its Diving Emergency Hotline from its members and divers.

WCC¹s satellite communications provide the ideal communications solution for divers who typically travel in areas where landlines and cellular service are not available both on land and offshore. In emergency situations, DAN members receive 24-hour TravelAssist benefits; up to $100,000 of evacuation assistance coverage; prescription and medical assistance; emergency messaging; and insurance claims assistance. Other membership benefits include pre-trip information; Alert Diver Magazine; the DAN Dive & Travel Medical Guide; and discounts on DAN dive and related products.

Sam Romey, WCC president, said WCC has always recognized the value of emergency satellite communications in the diving industry. ³Many divers already use WCC¹s equipment and services, but a DAN membership will provide them with valuable benefits to ensure their ongoing safety,² Romey said.

Tony Bacci, vice president of marketing and new business development at DAN, said DAN encourages divers to take advantage of this promotion so they can travel and dive while enjoying peace of mind.

Sunday, May 28, 2006

Complimentary copy of new edition of Ocean Realm Journal



Complimentary copy of new edition of Ocean Realm Journal
In case you missed this offer in one of our previous Ten Foot Stop mailings, we felt it to be important enough to send this out again.

Seldom do we get 'free' offers that are worthwhile - but here is a chance for you to receive a complimentary copy of an extremely well done magazine, "Ocean Realm Journal ", published by the Ocean Realm Society. This is being offered exclusively to our Ten Foot Stop mailing list subscribers by Richard Stewart, Publisher/Editor in chief, and is for US residents only. [Subscribers outside the US can receive the magazine but must prepay the air mail postage, which is $12.] The new edition of Ocean Realm is off the press but will not arrive in the US until June.

Ocean Realm Journal brings it's member readers a variety of informative and entertaining articles covering ocean sports, ecology, travel, education, ocean art, adventure, science, antiquities, exploration and world expeditions.

Ocean Realm Journal combines a vast mix of tantalizing stories and large breathtaking color images that take you to the far corners of the world's oceans from the comfort of your easy chair.

With the publishing of the Ocean Realm Journal like-minded people are brought together, from all over the globe, who believe to play on and in the ocean's realm you must adhere to the concept of Respect and Protect!

The Ocean Realm Society invites you to reserve your complimentary copy of the new edition of the Ocean Realm Journal. Now with over 100+ pages of high quality images and articles the Journal is the leading publication for Ocean and Dive Adventures.

To preview the new addition simply visit http://www.OceanRealmJournal.com and click on PREVIEW N2. This is a complete PDF version of the print edition.

To reserve your complimentary edition, send your name and address to ComplimentaryEdition@OceanRealmJournal.com. PLEASE NOTE again that this offer is for U.S. residents only. As the international air mail postage is $12, anyone outside of the U.S. can receive a complimentary copy by pre-paying the postage. Payment options will be provided upon receipt of order.

Best regards:

scubadoc
Diving Medicine Online
http://scuba-doc.com/
* Scubadoc's Diving Medicine Online has no relationship with Ocean Realm. This notice is being sent out as a public service to our subscribers.

"From Sea to Space" Symposium

Michael A. Zinszer, Director, Advanced Science Diving Program, Florida State University - Panama City writes to tell us about a free symposium that many of you would be very interested in attending. See below.


FSU at Panama City Florida Presents
A symposium discussing how ocean research is helping the
advancement of space exploration


FREE and open to the public!
Thursday, June 15
2 p.m. - 6 p.m.
FSU Panama City Auditorium

Please call 522-2097 for more information

Please call 522-2090 to RSVP
---------------------------------------------------------------------------------

Lt. Cmdr. Joseph Dituri
United States Navy
“Inner to Outer Space: A Pathway to Success”
----------------------------------------------------------------------------------

Bill Todd
Simulation Supervisor/Project Lead, Johnson Space Center
“The NEEMO Undersea Analog: Another Type of Deep Space Exploration”
---------------------------------------------------------------------------------

Phil Nuytten, Ph.D.
President and Founder, Nuytten Research Ltd.
“Use of Small Submersibles for NASA Research and Rocket Recovery”
---------------------------------------------------------------------------------

Michael Gernhardt, Ph.D.
NASA Astronaut/Aquanaut
Johnson Space Center
Craig Cooper
Florida Operations Director, Aquarius
“Underwater Habitats at 300 fsw: A thing of the past, or still viable today?”

===================================================================================

DAN News - New Resuscitation Guidelines Will Require Reconfiguring AEDs



DAN News
New Resuscitation Guidelines Will Require Reconfiguring AEDs
Last Updated: 5/9/06 1:52:25 PM

Some automated external defibrillators (AEDs) require updating, according to the American Heart Association/International Liaison Committee on Resuscitation. These changes are needed in order to remain consistent with recent changes to the Emergency Cardiac Care Guidelines.

To update the Philips FR2+ or Philips OnSite AED, which DAN sold between 2002 and 2005, visit the Philips website at the following the link: http://www.medical.philips.com/us/products/resuscitation/2005_Guidelines.html and selecting “Product Reconfiguring Information.”

Before making any changes, you must consult the physician who provides medical oversight for your AED. Most states and provinces require that all AEDs, including those available as over-the-counter models, have physician oversight. Owners of other AEDs should contact the manufacturers for more information.

BIOTECHNOLOGIES TECHNICAL REPORT AWARENESS INTERNET LINKS

Here are some interesting Biotechnology Reports from

TECHNICAL REPORT AWARENESS INTERNET LINKS (TRAIL)
A Defense Technical Information Center (DTIC) Product
March 6, 2006
BIOTECHNOLOGIES
Includes Human Factors Engineering (HFE) and Human Systems Integration (HSI)

===================================================================================
Click this link to get the full PDF: ADA442752

FIELDS GROUPS: ESCAPE, RESCUE AND SURVIVAL
CORPORATE AUTHOR: NAVY EXPERIMENTAL DIVING UNIT PANAMA CITY FL
TITLE: Oxygen-Accelerated Decompression of Submarine Rescue and Diving Recompression System (SRDRS) Operators and Tenders
DESCRIPTIVE NOTE: Technical rept. Jan 2001-Apr 2005
PERSONAL AUTHORS: Gerth, Wayne A.
REPORT DATE: APR 2005
PAGINATION: 137 PAGES
REPORT NUMBER: NEDU-TR-05-04
MONITOR ACRONYM: XB
MONITOR SERIES: NAVSEA
DESCRIPTORS: *SEA RESCUE EQUIPMENT, OXYGEN, RESPIRATION, SUBMARINES, DECOMPRESSION, DIVER EQUIPMENT
IDENTIFIERS: SRDRS(SUBMARINE RESCUE AND DIVING RECOMPRESSION SYSTEM), HOTP(HYPERBARIC OXYGEN TREATMENT PACK) LIMITATIONCODE: 01 00 00
ABSTRACT: The objective of the present study was to develop and man-test oxygen-accelerated decompression schedules for repetitive sub-saturation air exposures by SRDRS PRM Operators and SDC Tenders in pressurized DISSUB rescue scenarios. A secondary objective was to evaluate the performance of the MBS 2000 Hyperbaric Oxygen Treatment Pack (HOTP) (Dive Systems International),2 a lightweight closed-circuit breathing apparatus planned to support oxygen breathing requirements of decompression schedules in actual DISSUB rescue scenarios. This study was undertaken under Naval Sea Systems Command Task Assignment 01-1 & as the final phase of development of oxygen-accelerated decompression procedures for personnel involved in DISSUB rescue scenarios.
SOURCE CODE: 253650
------------------------------------------------------------------------------------
Click this link to get the full PDF: ADA442786
FIELDS GROUPS: LIFE SUPPORT SYSTEMS
CORPORATE AUTHOR: NAVY EXPERIMENTAL DIVING UNIT PANAMA CITY FL
TITLE: Evaluation of the KMS 48 Replacement Full Face Mask with the Emergency Breathing System for Use with MK 16 MOD 1 Underwater Breathing Apparatus
DESCRIPTIVE NOTE: Technical rept. Jan 2001-Dec 2002
PERSONAL AUTHORS: Hedricks, C. S. Stanek, S. J.
REPORT DATE: DEC 2002
PAGINATION: 20 PAGES
REPORT NUMBER: NEDU-TR-02-17
MONITOR ACRONYM: XB
MONITOR SERIES: NAVSEA
DESCRIPTORS: *BREATHING APPARATUS, *BREATHING MASKS, EMERGENCIES, HUMAN FACTORS ENGINEERING, RESPIRATION, DIVING
IDENTIFIERS: UBA(UNDERWATER BREATHING APPARATUS), EBS(EMERGENCY BREATHING SYSTEM), FFM(FULL FACE MASK) LIMITATIONCODE: 01 00 00
ABSTRACT: Navy Experimental Diving Unit (NEDU) was tasked by references (1) and (2) to test and evaluate the MK 16 MOD 1 underwater breathing apparatus (UBA) for use as an emergency breathing system (EBS) in conjunction with the KMS 48 full face mask (FFM). Testing was designed to assess the abilities of the KMS 48 FFM and the MK 16 MOD 1 to perform as an EBS during unmanned and manned open water dives to the maximum operational working depths for each breathing medium: 190 feet of seawater (fsw) [58.2 meters of seawater (msw)] with nitrox (N2O2), and 300 fsw (91.9 msw) with heliox (HeO2).
SOURCE CODE: 253650
----------------------------------------------------------------------------------
Click this link to get the full PDF: ADA442801

FIELDS GROUPS: PROTECTIVE EQUIPMENT
CORPORATE AUTHOR: NAVY EXPERIMENTAL DIVING UNIT PANAMA CITY FL
TITLE: Evaluation of the Joint Service General Purpose Mask, XM50
DESCRIPTIVE NOTE: Technical rept. Jun-Jul 2004
PERSONAL AUTHORS: Hyde, Dale Garigan, Meave Johnson, Dennis
REPORT DATE: JUL 2005
PAGINATION: 74 PAGES
REPORT NUMBER: NEDU-TR-05-10
MONITOR ACRONYM: XA
MONITOR SERIES: ECBC
DESCRIPTORS: *PROTECTIVE MASKS, BIOLOGICAL AGENTS, STRESS(PHYSIOLOGY), AMMONIA, PERSPIRATION, FOG, CHEMICAL AGENTS, ACCUMULATION
IDENTIFIERS: JSGPM(JOINT SERVICE GENERAL PURPOSE MASK), XM50 LIMITATIONCODE: 01 00 00
ABSTRACT: The Joint Service General Purpose Mask (JSGPM) is the next generation chemical protective mask intended to replace the MCU-2 and M-40 series masks. Developmental testing and user assessment of the XM5O, a variant of the JSGPM, indicated that the XM5O lacked sufficient fogging mitigation1 and sweat reduction capabilities. Lens fogging and sweat accumulation in the mask degrade user confidence, impose a physiological burden upon the user, and can seriously degrade operational effectiveness. These performance shortcomings resulted in joint service concern,2 and design changes to the mask were made. In 2003, a field evaluation3 indicated that the sweat reduction issues had been resolved, but the evaluation was limited and did not challenge the XM5O's ability to mitigate fogging.
SOURCE CODE: 253650
------------------------------------------------------------------------------------
Click this link to get the full PDF: ADA442819
FIELDS GROUPS: LIFE SUPPORT SYSTEMS
CORPORATE AUTHOR: NAVY EXPERIMENTAL DIVING UNIT PANAMA CITY FL
TITLE: Carbon Dioxide Washout of an Emergency Breathing System Mask Modified for Use in the Advanced Seal Delivery System (ASDS) Trainer
DESCRIPTIVE NOTE: Technical rept.
PERSONAL AUTHORS: Carlson, N. A. Warkander, D.
REPORT DATE: AUG 2005
PAGINATION: 17 PAGES
REPORT NUMBER: NEDU-TR-05-13
MONITOR ACRONYM: XB
MONITOR SERIES: NAVSPECWARCO
DESCRIPTORS: *BREATHING MASKS, SLOTS, CARBON DIOXIDE, RESPIRATION, HOSES, EXHALATION, BREATHING APPARATUS, INHALATION
IDENTIFIERS: ASDS(ADVANCED SEAL DELIVERY SYSTEM), EBS(EMERGENCY BREATHING SYSTEM) LIMITATIONCODE: 01 00 00
ABSTRACT: A modified emergency Breathing System full face mask was evaluated for use in the Advanced SEAL Delivery System trainer. The mask contained an oral-nasal cup and two spiral-wound plastic hoses on its inhalation and exhalation openings. Each hose was six feet long with an inside diameter of 1.25 inches and had six rectangular slots cut through the hose wall. The slots were approximately eight inches from one end of each hose. Testing was conducted in an unpressurized hyperbaric chamber that was well ventilated with air. Carbon dioxide (CO2) washout volume - averaged inspired CO2 - was calculated at a respiratory minute ventilation of 22.5 liters per minute (1.min(exp -1). The mask was ventilated with a mechanical breathing simulator. One hundred per cent CO2 was injected at 0.9 1.min(exp -2) into the breathing loop. Mean CO2 washout was determined for two configurations: normal, with both hoses positioned so that the slotted ends are near the mask; and reversed exhaust, with inhalation hose positioned with its slots near the mask and exhalation hose positioned with the slots away from the mask. By our normalizing for the actual end-tidal CO2 level, the volume-averaged CO2 in the normal configuration was 0.71% and 0.75% with the exhaust reversed. Carbon dioxide washout of the modified emergency breathing system mask with exhaust hose in either configuration is acceptable for use in the ASDS trainer.
SOURCE CODE: 253650

-----------------------------------------------------------------------------------
Click this link to get the full PDF: ADA442920

FIELDS GROUPS: LIFE SUPPORT SYSTEMS
CORPORATE AUTHOR: NAVY EXPERIMENTAL DIVING UNIT PANAMA CITY FL
TITLE: Evaluation of the KMS 48 Full Face Mask with the Viper Very Shallow Water Underwater Breathing Apparatus
DESCRIPTIVE NOTE: Technical rept. Jan-Mar 2003
PERSONAL AUTHORS: Stanek, S. J. Hedricks, C. S.
REPORT DATE: APR 2003
PAGINATION: 17 PAGES
REPORT NUMBER: NEDU-TR-03-06
MONITOR ACRONYM: XB
MONITOR SERIES: NAVSEA
DESCRIPTORS: *BREATHING APPARATUS, *BREATHING MASKS, HUMAN FACTORS ENGINEERING, SHALLOW WATER, UNDERWATER EQUIPMENT, DIVER EQUIPMENT
IDENTIFIERS: KMS 48 FULL FACE MASK, FFM(FULL FACE MASK), VSW(VERY SHALLOW WATER), UBA(UNDERWATER BREATHING APPARATUS) LIMITATIONCODE: 01 00 00
ABSTRACT: Navy Experimental Diving Unit (NEDU) was tasked(1) to test and evaluate the KMS 48 full face mask (FFM) with the VIPER very shallow water (VSW) underwater breathing apparatus (UBA). Testing was designed to assess the abilities of the KMS 48 FFM to operate properly with the VIPER VSW UBA to the UBA's maximum certification depth, 50 feet of sea water (fsw).
SOURCE CODE: 253650
----------------------------------------------------------------------------------

Hyperbaric Rx of Interstitial Cystitis

Interstitial Cystitis is a painful and difficult to treat malady affecting the urinary bladder. Here is a report of efficacy from treatment with HBO.
Hyperbaric oxygen treatment of IC
http://www.medpagetoday.com/Surgery/Urology/tb/3419

Arndt Van Ophoven and his group from Muenster, Germany presented an interesting study of hyperbaric oxygen therapy for treatment of IC at the AUA meeting. (abs 278)

They reported results of a randomized, double-blind, sham controlled study of 21 patients with IC. Patients were randomized to 1.3 atmospheres or 2.4 atmospheres for 90 minutes and a total of 30 sessions. There were 2 dropouts in the active treatment group.

None of the control patients had benefit as per their global response assessments, but 8 of 12 active patients achieved benefit.

At one year of follow-up, 5 of the 12 patients still perceived benefit from the intervention. Pain and urgency seemed to improve more than absolute frequency.


Kidney Problems on our web site.

UHMS Information from Don Chandler


Included in this email is information on the following:

1. Election Results.
2. Annual Award Recipients.
3. Our Annual Scientific Meeting in Orlando.
4. Forty Years of UHMS History.


1. Election Results.

President-Elect: Dr. Laurie Gesell
Vice President: Dr. Simon Mitchell
Secretary: Dr. Takkin Lo
Members-At-Large: Dr.'s R.W. "Bill" Hamilton, Kevin Hardy, and Thomas Bozzuto
Treasurer: Dr. Bob Warriner will remain in office another year because our members voted (this year) to change the term of office from one year to three years.

2. Annual Award Recipients.
Albert Behnke Award: Dr. David Pendergast
Charles W. Shilling Award: Dr. Eric Kindwall
Carolyn Sue Ray Memorial Award: Jim and Susan Joiner
Paul Bert Award Dr. Neil Hampson
Craig Hoffman Memorial Award: (Will publish this recipient's name after he is informed)
Oceaneering International Award: (No Nominees)
The Link Foundation Stover-Link Award: (No Nominees

3. Our Annual Scientific Meeting in Orlando. Thanks to many of you, we have exceeded our block of rooms at the Hilton at Disneyworld in Orlando. We have just over three weeks before activity begins for us so there's still plenty of time for you who have not registered for the meeting to do so and to arrange for lodging. Even though the deadline for the reduced rate at our two hotels is past, I suggest that if you try to make reservations at either the Hilton or the Grosvenor and are told the blocked rooms are full, let Lisa know before you try other places and she may be able to work some "magic" for you. You can telephone Lisa at (410) 257-6606 Ext 104.

As all of you know our outgoing President and our incoming President pass the gavel in a symbolic gesture of passing the leadership of our Society from one to the other. This usually happens at the awards banquet, but this year it appears that there will be a passing of the gavel underwater. If arrangements can be made, it will take place in the Disney aquarium and Dr. Lin Weaver will pass the gavel to Dr. Bret Stolp. Donna Uguccioni from DAN is setting it up. We don't know just when the dive will take place, but we will place an announcement on our board for such things at the meeting...check it if you would like to witness the dive. Passing the gavel underwater will make a great photo! I hope I can attend.

For those of you who will be attending the meeting, don't forget that, in addition to three days of scientific presentations, we have two great pre-courses, another class on preparing for facility accreditation, a post course sponsored by ATMO, and a Medical-Legal post-course that addresses Medical Fitness to Dive and the Practice of Hyperbaric Medicine. Surely, you won't want to miss these!

4. Forty Years of UHMS History. I am putting together a booklet that summarizes our forty years as a Society to pass to each of you who attend our 40th anniversary meeting next year in Maui. I have 36 pages of information so far, thanks to several who have contributed and to some of our old files. Dr. Weaver has asked our Past Presidents to provide a paragraph of what they deem as the most significant event during their term of office. I plan to take the paragraph and paste it beside their picture. Thus our Past Presidents will be highlighted in the booklet. I thing such is appropriate because it has been their leadership that has molded us into what we are as a Society...oh, sure, they didn't do it alone, but if you remember your leadership classes, "Delegation is the first sign of good leadership." Our Past Presidents were not only outstanding in their own right, they had good leadership qualities as well.

What I would like to get from any of you is this: If you know of a bit of history associated with our Society, whether serious or otherwise, please send it to me to include in this booklet. Normally, I identify the persons who wrote bits and pieces, but if you don't want to be identified as the author, please let me know and I will list your input as "anonymous author." Please send me your memories and anecdotes about the Society.
------------------------------------------

That's it for now, members. I hope to see you in Orlando!

Don

Outstanding Web Page About Diving the Oriskany


Your attention is directed to an outstanding web page about the sinking of the aircraft carrier, Oriskany off of Pensacola Beach Florida. The site has links to photos and videos, provides references and offers some information about the risks of diving the newly made artificial reef.

Safety key as Oriskany begins life as reef
Training and equipment necessary to dive to ship

Polyana da Costa
@PensacolaNewsJournal.com

Saturday, May 27, 2006

Hemodynamic Changes Induced by Recreational Scuba Diving

Dr. Howard Homler writes to let us know about an interesting article that he found in the Journal "Chest" concerning Hemodynamic Changes Induced by Recreational Scuba Diving* by Boussuges, Blanc and Carturan. The entire article cannot be seen without a subscription to the Journal or purchasing the material so we have published the abstract given below - since it is public record on Medline. The article pretty much supports what is already known about the cardiovascular effects of immersion, nitrogen saturation and bubbles upon decompression.

(Chest. 2006;129:1337-1343.)
© 2006 American College of Chest Physicians

Alain Boussuges, MD, PhD; François Blanc, PhD and Daniel Carturan, PhD

* From Institut de Médecine Navale du Service de Santé des Armées (Dr. Boussuges), Toulon Armées; and Université de la Méditerranée (Drs. Blanc and Carturan), Laboratoire de Physiopathologie et Action Thérapeutique des Gaz sous Pression, Faculté de Médecine Nord, Marseille, France.

Correspondence to: Alain Boussuges, MD, PhD, IMNSSA, B.P.610, 83800 Toulon; Toulon Armées, France; e-mail: alainboussuges@libertysurf.fr

Abstract

Objective: Cardiac changes induced by scuba diving were investigated using Doppler echocardiography.

Material and methods: Ten healthy scuba divers dove to a mean depth of 34.3 ± 2.7 m of sea water (113 ± 9 feet) and a mean duration of 25.3 ± 3.5 min.

Results: One hour after the dive, microbubbles could be detected in the right-heart chambers of all subjects. Left atrial and left ventricular (LV) diameters significantly decreased after the dive. Cardiac output, assessed by aortic blood flow, remained unchanged. Heart rate increased and stroke volume (SV) decreased after the dive. LV filling was assessed on transmitral profile. An increase of the contribution of the atrial contraction to LV filling was observed. Right cavity diameters were unchanged, but an increase of the right ventricular/right atrial gradient pressure was found.

Conclusion: The diving profile studied promotes a rather important bubble grade in all volunteers. A significantly reduced cardiac diameters and SV was found by our hemodynamic study 1 h after diving. Two factors can explain these results: low volemia secondary to immersion, and venous gas embolism induced by nitrogen desaturation. Consequently, restoration of the water balance of the body should be considered in the recovery process after diving.

Key Words: cardiac function • decompression • diving • Doppler • immersion • ultrasonography
==============================================================================



Heart Problems and Scuba Diving on our web site.

Saturday, May 20, 2006

PSDiver Monthly - Issue 27 - Swiftwater Rescue

Mark Phillips, Editor/Publisher of the PS Diver Monthly Newsletter sends the following that will allow you to subscribe and read his free newsletter.


PSDiver Monthly - Issue 27 - Swiftwater Rescue - NEW Continuing Education Program and more in this issue!

PDF File 1.2MB - Requires Adobe Reader 5.0 or newer to view!

If you have training ideas or unique experiences to share, send us your stories!

Greetings!

Welcome - If you are a new subscriber, please take a moment to read this. PSDiver is sent almost exclusively to Underwater Recovery and Swift Water Rescue Teams and team members. This includes Fire Department, Police Department, EMS, Independents, Military and a few others.

Our magazine is NOT a discussion group and we do not send out email frivolously. If you wish to join our discussion group, go to: http://groups.yahoo.com/group/PSDivers-PublicSafetyDiversForum/

Those of you who are subscribers through the PSDM Yahoo Group will receive another notice through the Yahoo system. This will be an announcement only and will NOT include an attached file.

If you cannot receive the attachment you can go to the PSDiver Monthly Yahoo Group Site (http://health.groups.yahoo.com/group/PSDiverMonthly ) and access the latest issue from there as a download. Or you can reach the same file at the PSDiverMonthly.com web site.

You will receive the attachment with PSDiver Monthly Issue 27 only from this delivery system. Some archived issues will be available at
http://www.psdivermonthly.com/.

We will continue to build the http://www.psdivermonthly.com/ web site as funds and time become available. Please feel free to share the site and if you have a web site of you own, please add a link to PSDM.

We value your time as much as our own. If at any time you decide you do not wish to subscribe to PSDiver anymore, just reply to the email with UNSUBSCRIBE in the subject line.

Stay Safe!
Mark Phillips
Editor / Publisher
PSDiver Monthly

Fire Extinguisher Recall

Most divers either have boats or get to and from dive sites on boats. Safety equipment is vital to the operation of any dive operation - but works only if the equipment is in good condition or is not defective. We ran across this information which at least a few of you might be affected.

"FIRE EXTINGUISHER RECALL
Recently the U.S. Coast Guard has become aware of a recall notice for some U.S.C.G. approved fire extinguishers made by the Strike First Corporation of America. Strike First has determined that the valve stem seats in a number of its 2.5 and 5 lb. dry chemical fire extinguishers assembled between December 2002 and February 2004 may prevent the extinguisher from discharging properly when the lever is activated. As a result of this condition, Strike First has initiated a fire extinguisher retrofit program for these units. Retrofit kits are available free of charge by contacting your Strike First distributor, or by contacting First Strike directly. The Coast Guard recommends that vessel operators verify the manufacturer of their fire extinguishers, and if applicable, take the action recommended by the manufacturer." For details visit: http://www.strikefirstusa.com/serv_bull_002.htm

Thursday, May 11, 2006

Astronaut, Diver?



In the April 2006 Journal, Aviation, Space and Environmental Medicine there is an article exploring the possible benefit of performing cardiac screening studies on prospective astronauts in an effort to prevent the possible catastrophe of a coronary event while on board the space station. Due to the limited treatment and return capabilities of most space vehicles, an in-flight cardiac event could result in significant mission impact or even failure. The current literature supports including electron-beam computed tomography (EBCT) and highly selective C-reactive protein (hsCRP) for diagnosis of coronary artery disease (CAD) in asymptomatic, low-pretest probability cohorts.

Divers Alert Network has reported for several years now the high risk of death from an untoward coronary event while diving. Since the diver is in an alien environment and basically is an astronaut for that brief period that s/he is underwater, it seemed apropos to me that a similar screening could be done for divers - given the cost could be made reasonable. As a screening tool for divers, the EBCT would probably be out of the question - but a highly selective CRP [hsCRP] when correlated with other known risk factors would be inexpensive and would serve to keep divers out of the water while further diagnosis and treatment was done.
===================================================================================

Aviat Space Environ Med. 2006 Apr;77(4):377-87.

Cardiac health for astronauts: coronary calcification scores and CRP as criteria for selection and retention.

Hamilton DR, Murray JD, Ball CG.

Wyle Laboratories, Houston, TX 77058, USA. dhamilton@wylehou.com

Due to the limited treatment and return capabilities of most space vehicles, an in-flight cardiac event could result in significant mission impact or even failure. The current literature supports including electron-beam computed tomography (EBCT) and highly selective C-reactive protein (hsCRP) for diagnosis of coronary artery disease (CAD) in asymptomatic, low-pretest probability cohorts. This paper will examine the issues surrounding adding these tests to astronaut retention and selection algorithms. An evidenced-based literature review was performed and consensus obtained from subject-matter experts to create novel cardiac screening algorithms for astronaut applicants and the current astronaut corps. The main focus of this paper is to derive an evidenced-based approach for improving the diagnosis of significant CAD using EBCT and hsCRP testing. The recommended initial astronaut selection and long-duration mission assignment screening algorithms use EBCT-derived calcium scores and serum hsCRP levels to screen for CAD and predict individual cardiac risk. The current medical evidence is compelling for the international space medicine community to consider: (1) Astronaut candidates with a coronary artery calcium score >0 should be disqualified from initial selection; (2) Astronauts with a coronary artery calcium score >100 should be disqualified from selection for long-duration missions; (3) Elevated hsCRP is a reliable risk factor for helping predict future cardiac events that should warrant primary prevention but not necessarily medical disqualification.

Further Reading:
Coronary Artery Disease

Thermoregulatory responses to exercise in the heat: chronic caffeine intake has no effect.



A group at the UCONN Human Performance Lab has reported a study in the Journal, Aviat Space Environ Med. 2006 Feb;77(2):124-9 showing that chronic caffeine intake has no effect on fluid-electrolyte, exercise endurance or thermoregulatory responses during EHT when compared with no caffeine.

Divers are usually admonished against drinking beverages that might be diuretic and which might cause dehydration - a known and proven risk factor for the development of decompression illness. The abstract of the article is below.

Authorities advise individuals to refrain from caffeine intake before or during exercise, especially when performed in the heat, due to potential fluid-electrolyte imbalances that exaggerate physiological strain. Yet, military personnel are often deployed to hot environments and must perform under sleep-deprived conditions where caffeine would be an ideal intervention strategy to enhance physical and cognitive performance.

PURPOSE: To assess the effects of controlled chronic and acute caffeine ingestion on fluid-electrolyte, physiological and thermoregulatory responses during an exercise heat tolerance test (EHT).

METHODS: Subjects were 59 active, college-aged males (mean +/- SE 21.6 +/- 0.4 yr, 177.9 +/- 0.8 cm, 75.4 +/- 1.0 kg, 11.1 +/- 0.7% body fat) who were randomized and stratified by age, bodyweight, and body composition into three groups. All subjects equilibrated caffeine intake at 3 mg x kg(-1) x d(-1) for days 1-6. On days 7-12, they consumed a treatment dose of either 0 (G0), 3 (G3), or 6 (G6) mg x kg(-1) x d(-1). Fluid-electrolyte and physiological measures were made on day 12, 1 h after caffeine intake, during the EHT (90 min walking, 1.56 m x s(-1), 5% grade; dry bulb temperature, 37.7 +/- 0.1 degree C; relative humidity, 56.3 -1.5%).

RESULTS: There were no between-group differences (p > 0.05) in plasma, urinary, thermoregulatory, cardiovascular, and perceptual variables across time (pre- vs. post-EHT), although some of these variables increased significantly over time (p < 0.05). EHT time was significantly greater in G3 (86 +/- 2.0 min) vs. GO (75 +/- 3.3 min, p < 0.05).

DISCUSSION: Acute caffeine ingestion, in chronically consuming subjects (3 and 6 mg x kg(-1) x d(-1)) did not alter fluid-electrolyte, exercise endurance or thermoregulatory responses during EHT when compared with G0.

This will come as welcome news for those divers who have been holding off on their morning 'cuppa' prior to diving.

Wednesday, May 10, 2006

Stingray injury (and how not to manage it!)




Dr. Bruce Miller, diving dermatologist, sent us this report about how not to treat a stingray injury. [Photo by Kris Judish]

"A good friend was in Mexico wading and stepped on a small stingray. It nailed him (large red dot). The 3 smaller ones are xylocaine injection sites. He's a big tough dude and said that it was by far the most excruciatingly painful thing he's ever experienced.

He was sent to the doc at the hotel who hooked him up to a monitor and started an IV. Told his assistant to pour hot water on the wound so this guy pours BOILING water on it. Stopped the venom pain but caused a 2nd degree burn with a large blister. I saw him 3 days later. The area was red and somewhat tender but no streaks. I put him on cipro just in case. Apparently the doc also explored the wound but no sheath remnants.

We hear about encounters such as this at all the dive med meetings but rarely do we see it.

More about stingray injuries


STINGRAY
Phylum Chordata, Class Chondrichthyes. These possess a serrated bony spine at the base of the dorsal surface of the tail. An integumentary sheath discharges venom when ruptured.


Most injuries occur when the ray is stepped on, the tail is thrust upward and forward and fired into the foot or leg. The venom is thermolabile (deactivated with heat) and induces severe vasoconstriction.

Symptoms: Intense pain is felt at the site; there is local ischemia (loss of blood supply), and edema. Edges are jagged, may contain pieces of spine and secondary infection is common. Systemic effects include salivation, sweating, vomiting, diarrhea, cramps, hypotension (low blood pressure), and cardiovascular collapse.

Treatment: Irrigate and remove remaining spine. Immerse in hot (50 C) water until pain subsides. Give local or systemic pain relief. Cleanse, debride and suture the wound. Give tetanus protection, infection prophylaxis and monitor / support cardio-respiratory system as indicated.

Dr. Carl Edmonds sends us the following good information about the temperature of the water for relief:
"Notice in your 10 foot stop that you recommend 50 degrees C for stingray injury.

We did say, in the 70s that the temperature can go up to 50 degrees, but we were adding hot water to cold and doing it slowly. We later changed to 45 degrees because of 3 reasons

1. If you immediately immerse a limb into 50 degrees, many people find this exceptionally painful, and jump off the examination couch
2. There is a suggestion that this temperature may do tissue damage
3. It is not needed. 45 degrees works just fine."
===================================================================================

If you don't have a way to measure the temperature - one would suppose that it can be tested on one's self on the back of the hand, as in testing an infants milk bottle. A rule of thumb would be "as hot as you can stand it on the back of the hand!"
===================================================================================
Re water temp for spine injuries ( including stingray)- I advise my nurses to have the water as hot as can be tolerated by the unaffected limb ( ie put both feet in!!)- usually 40-45C
Regards,
Dr Neil Banham
Emergency Physician


See also:
http://www.scuba-doc.com/hazard.htm

Monday, May 08, 2006

Note from Don Chandler, Executive Director, UHMS




To all--

In this email you will find information on the following topics:

1. Group rate for rooms at the Hilton and Grosvenor will soon expire.
2. Subject matter for the post-course about legal issues.

--------------------------------------------------

1. Discounted group rate for rooms at the Hilton and Grosvenor will soon expire. You can still get the group rate discount at our host hotel, the Hilton, until May 22nd. After that there is no guarantee you can get the discount. If you are told all the blocked rooms have been booked, let Lisa know and she might be able to get the discount for you through our on-site convention manager. If you want to stay in our overflow hotel, The Grosvenor, (across the street from the Hilton) you can get our discounted group rate there only until the 19th. Keep these dates in mind if you have not already made your reservations. Please go to our website www.uhms.org and click on "Annual Meeting" from the menu on the left side of the opening page and you will get all the information you need for arranging a very enjoyable stay in Orlando during our annual meeting.

2. Subject matter for the post-course about legal issues. I have been asked what the topics will be during our post-course on the Medical-Legal Aspects of Medical Assessment for Fitness to Dive and on The Practice of Hyperbaric Medicine. Bobby Delise, our lawyer faculty member for our Fitness to Dive course plans to cover the following topics. After reading this, I think you will agree that you won't want to miss this course. Here are the topics:

MORNING SESSION

I. Introduction - Why Address Legal Issues in a Medical Assessment of Fitness to Dive Course?

II. Legal Issues in Diving Law
A. Workers' Rights and Remedies
1. Maritime Personal Injury Claims
a. The Jones Act
b. The Right to Maintenance and Cure
c. Third Party Claims - Claims by the maritime worker against non-employers
d. Defenses Available to Employers and Non-employers
2. Non-maritime Worker's Personal Injury Claims
a. Causes or action - Negligence and Products Liability
b. Defenses Available
B. Recreational and Technical Divers Personal Injury Claims
1. Causes of action
a. Improper Instruction
b. Improper Supervision
c. Charterer Error
d. Products Liability
2. Defenses Available
a.. Assumption of the Risk
b. Comparative/Contributory Negligence
c. Liability Releases (Waivers)
C. Medical Fitness Assessment Legal Issues
1. Physicals and Investigative Protocol
a. Commercial Divers
i. Yearly Physical
ii. Post Injury Medical Assessment - Return to Work
b. Recreational Diver and Technical Divers
i. Entry Physical
ii. Post Injury Medical Assessment - Return to Diving
c. Autopsy Protocol
2. Medical Examiner's Legal Exposure
D. Testifying as an Expert Witness
1. Legal Responsibilities as a treating Physician
2. Testifying as an Expert Witness for a Party in Litigation

III. Conclusion - The Importance of Looking at the Medical Assessment of Fitness to Dive Through Proactive Legal Lenses

AFTERNOON SESSION

I. General Overview of the Practice of Law

A. Civil Law

B. Administrative Law

C. Alternative Dispute Resolution



II. Standard of Care for Hyperbaric Physicians

A. Case Law

B. Hypothetical Cases

C. Response to Questions



III. Dealing with the ‘Guys and Gals in the Suits – Literally and Figuratively’

A. Depositions, subpoenas and other inconveniences provided by lawyers.

B. Legal Ethics. No, that’s not a typo…lawyers do have ethics.

That's all for now, folks. If you haven't yet registered for our annual meeting, do it, do it, do it. Hope to see you in Orlando!

Don

Web Stuff, from Larry "Harris" Taylor, PhD



Larry "Harris" Taylor, PhD, Diving Safety Coordinator, University of Michigan maintains a web site that contains about 8000 links to pages that he has visited and found worthy of interest. Part of these are diving links and he sends out 'Web Stuff' periodically.

Here are the diving related links in his latest mailing.

( the dive only links section of this list is at: http://www-personal.umich.edu/~lpt/mlinks.htm )

Diving

Scuba Dates: http://scubadates.com/

TopKayaker: http://www.sit-on-topkayaking.com/Articles/FishDive/Dive.htm

WikiScuba: http://www.wikiscuba.com/

CenSeam: http://censeam.niwa.co.nz/

Dolphins: http://www.earthtrust.org/wlcurric/dolphins.html


Northeast Dive News: http://www.nedivenews.com/

RNZN - Navy Hyperbaric: http://www.navyhyperbaric.mil.nz/

Lynn Seldon: http://www.lynnseldon.com/index.html

Sunday, May 07, 2006

So you think you know Jack about diving and gases?

Here's a jerk back into reality - take this quiz about diving problems with gases and see what you really know. Go to our quiz developed specifically for our web site about problems with gases, take the quiz and go to the referenced sites for an update on this easy to forget subject.
http://www.scuba-doc.com/quizgases.html

References

# Partial Pressure Physics Download [PDF]
# Nitrogen Narcosis Download [PDF]
# O2 Toxicity Download [PDF]
# CO2 Retention
# Free Diving and Shallow Water Blackout (Latent Hypoxia)
# Breathhold Diving: Taravana
# High Pressure Nervous Syndrome [HPNS]
# FAQ-Physics and Problems With Gases

Pressure & the Body

From a very broad point of view, nearly all diving accidents are related to the effects of increased pressure on the body at depth. This is not to understate the importance of initiating factors – such as poor physical conditioning, inadequate training, underlying medical condition inimical to diving, a panic attack or poor planning with an out of air situation. The final outcome of fatal diving accidents is often written off as drowning, but the underlying cause of the drowning is most often related to a progression of events that end with the effects of pressure, i.e., nitrogen narcosis, gas embolism, decompression illness or oxygen toxicity.

Terminology and Definitions

Compression-That part of a dive that increases pressure upon a diver. The deeper a diver goes-the more the pressure.

Decompression -That part of a dive when the diver ascends toward the surface, decreasing the pressure. In a chamber dive, that part of a dive when the pressure is being lowered.

Recompression - a return to compression after ascent to the surface on a water dive; a return to surface pressure from altitude; a term used to describe medical treatment of decompression sickness.

Hyperbaric - a word used to describe increased pressure over the pressure in one atmosphere [surface] .

Pressure Concepts

Pressure - a force acting on a unit of area; Pressure = Force divided by Area

Atmospheric Pressure - pressure exerted by the weight of the atmosphere; this varies with the altitude. [The higher the altitude – the lower the pressure].

Barometric pressure - a measurement of atmospheric pressure; one atmosphere of pressure is equal to 760 mm Hg or 1.03 kg/cm2 or 14.7 psi (pounds per square inch).

Hydrostatic pressure - the force of a column of water acting upon a body immersed in the water, equal in all directions at a specific depth. During descent, pressure increases 0.445 psi per foot of depth in salt water or one atmosphere per 33 feet of salt water (FSW).

Gauge pressure - the difference between absolute pressure and atmospheric pressure. This can be converted to absolute pressure by adding 14.7 psi or 1.03kg/cm2.

Absolute pressure - this is the sum of all pressures acting on an object. In diving this is the sum of the atmospheric pressure (14.7 psi + the hydrostatic pressure).

Some Characteristics of Gases

Oxygen, the gas that is capable of supporting life, exists in the atmosphere on the surface of the earth at a concentration of 21%. There are specific ranges of human tolerances and toxicity can occur when concentrations exceed 30%. Oxygen also supports combustion and creates hyperbaric chamber safety problems. The maximal allowable concentration in multiplace chambers is 23%.

Carbon dioxide is a direct product of metabolism and is found at a maximum level of 1.5% at the surface. It is the gas that determines our rate of ventilation and is implicated in shallow water blackout with consequent drowning. The concentration of CO2 determines ventilation schedules in multiplace chambers.

Carbon monoxide is the product of incomplete combustion of fuel, usually caused by faulty compressors. Its' toxicity is caused by its' affinity for hemoglobin and the poisonous effect on our cytochrome A3 system. The maximum allowable level is 10 ppm (0.001%), which is about what we get on a city street.

Nitrogen is an inert gas consisting about 79% of the air we breathe. It produces nitrogen narcosis in humans at a depth of 100 fsw, causes decompression sickness on ascent due to bubbles that form on reduction of pressure. It is the gas that determines our decompression schedules.

Helium - this is an inert gas present in air in very small quantity (0.0005%) and is used to prevent nitrogen narcosis. It is also used as an emergency breathing gas but results in body heat loss, creates communication difficulties and increases the chance of decompression sickness.

Gas Laws and their Physiological Significance

Boyle’s Law

At a given temperature the volume of a given mass of gas will vary inversely with the absolute pressure.

PV=K

Boyle's Law -This law of physics determines the volume of gases and accounts for the major portion of diving medical problems. Stated simply - the volume of gases are reduced when pressure is increased (diver descending) and the volume is increased on reduction of pressure (diver ascending). Bubbles are reduced in size when chamber pressures are increased and air-containing spaces (lungs, middle ears, sinuses) try to expand when chamber pressures are decreased or when the diver surfaces.

Charles' Law

At a constant pressure the volume of a mass of gas is proportional to the absolute temperature

V1/T1=V2/T2
Or T x P = V

This states that volume varies with the temperature, explaining why compressing gases increases heat and decompression cools. Tank fills need to be done under water in order to keep the tanks cool; release air from a scuba tank and you'll notice that it becomes cold.

Dalton’s Law

Total pressure exerted by a mixture of gases is the sum of the partial pressures that would be exerted by each gas alone as if it alone occupied the total volume. This is the law that explains oxygen toxicity, nitrogen narcosis and the danger of even minute quantities of contaminant gases, e.g., carbon monoxide. It's the law of partial pressures, in which all the individual partial pressures of gases are totaled into one partial pressure.

Graham's Law -This states that gases flow to areas of lesser pressure and explains oxygenation between tissue compartments and the movement of inert gases through out the body.

Henry's Law

In fluid, dissolved gas is directly proportional to the partial pressure of the gas to which the fluid is exposed.
This rule explains O2 transport, inert gas transport and the evolution of bubbles in a solution. It states that the volume of a gas is directly proportional to the pressure above a liquid.

Pascal’s Law

P = FORCE/AREA

Pressure at any point in a body or solution has that pressure transmitted equally throughout the solution. This is the reason that deep tissue compartments and internal bubbles experience the pressure changes that occur outside the body.

How gases move about

Perfusion - the flow of liquids in the body (blood or lymph), through an organ or tissue during which gases and/or chemical substances are exchanged and/or redistributed.

Absorption -The process of moving a gas into the liquid phase in the body.

Solubility -This process determines the amount of gas that will dissolve at a given pressure.

Diffusion - The movement of dissolved substances from higher concentrations to lower concentrations.

Gradient -The amount of change of one quantity of substance with respect to another; a gas in solution will diffuse across a gradient, from an area of higher concentration to one of less concentration.

Conversion Factors

Pressure Conversion Factors for One Atmosphere of Pressure

10.08 meters sea water
33 feet sea water
101.3 kilopascals/square meter
1.033 kg/square cm
1.013 BARS
760 mmHg
1034 cm H2O

1 ATM=The weight of all the air above the surface of the earth=33 feet sea water (fsw)=14.7 pounds per square inch(psi)=0.445psi/fsw=2.25 fsw/psi=0.0303 ATM/fsw
One pint=one pound

Saturday, May 06, 2006

Space Station Users Guide

While researching a topic I found this very interesting web site concerned with routine and emergency medical management on the International Space Station. Management of simple problems become quite complicated in the zero gravity and pressurized environment of the station. The web site can be accessed from the link above and each diagnostic item can be downloaded in PDF.

International Space Station Integrated Medical Group (IMG) Medical Operations Book All Expedition Flights, Mission Operations Directorate, Operations Division, JSC-48511-E1, 24 August 2000 [Acrobat]
This 371 page document describes various procedures ISS crew members follow in the operation of crew health systems and the routine sampling of the ISS environment for chemcial and biological contaminants.

--------------------------------------------------------------------------------
Routine Medical Procedures


Pregnancy Test
Cough
Ear problems
Dental: toothache
Dental: dislodged tooth
Dental: tooth extraction
Dental: temporary filling
Dental: injection technique
Dental: exposed pulp
Dental: crown replacement
Abrasions
Back pain
Ear /sinus blockage
Kidney bladder infection
Motion sickness
Mouth ulcers - stomatitis
Nasal congestion
Pain relief
Sinus problems
Skin infection
Skin rash
Insomnia
Upset stomach
Vaginal yeast infection
Headache
Nosebleed
Sore throat
Strains and sprains
Urinary retention
Urinalysis
Diarrhea
Constipation
Nausea and vomiting
Hearing assessment

--------------------------------------------------------------------------------
Specific Emergency Medical Procedures

Behavioral: Suicidal - Emergency
Behavioral: Suicidal
Behavioral: Acute Psychosis
Behavioral: Acute Psychosis Emegency
Choking
Chest pain
Collapsed lung
Toxic spill
Abdominal injury
Analphylaxis /severe alleric response
Burns
Breathing difficulty
Chest Injury
Contaminant cleanup
Eye - toxic exposure
Head and neck injury
Skin: toxic exposure
Decompression sickness
Eye - chemical burn
Eye - corneal burn
Eye - bacterial infection
Eye- herpetic infection
Eye - object abrasion
Eye - object penetration
Broken bone
Kidney stones
Shock - circulatory collapse
Sleeping medication overdose
Smoke inhalation
Suture and staple removal
Laceration repair
Seizures
Russian medicine side effects
CHeCS medicine side effects
Abdominal pain
Altitude sickness

Friday, May 05, 2006

DAN Awards Instructor Trainer Dan King for Excellence in Training

Dan Leigh sends this information from DAN:

The 2006 recipient of the DAN Excellence in Training Award is Dan King,
owner of Diver Dan's in Santa Clara, Calif. Long an advocate of DAN training
programs, King has issued more than 600 Instructor and Provider
certifications since he became a DAN Instructor Trainer in 1996. He amassed
134 certifications in 2005 alone.

King also stresses the importance of DAN Training to his entire staff by
requiring them all to be recognized as Diving Emergency Specialist (DES)
Instructors.

"DAN programs have become the standard of safety and care for scuba divers
worldwide," King said. "Every instructor, divemaster, boat operator or dive
professional should be trained in each of the DAN programs. Given the
inherent risks of scuba diving, there is absolutely no reason for dive
professionals to needlessly increase their risks of liability by not being
trained in the programs that are viewed as the standard of safety.

"At our facility in California we require all our Instructors to teach all
of the DAN programs and offer them regularly. If you are a store owner or
chief instructor this should be your standard as well. Join the philosophy
of 'Divers Helping Divers.'"

This is the third year for this award. All DAN Instructors and Instructor
Trainers are eligible to receive the Excellence in Training Award. Previous
recipients of the award include Sam Godley and Jim Brandt.

In addition, three DAN Instructor Trainers and Instructors were recognized
for achieving training milestones. Robert Murray has issued more than 750
certifications and Scott Taylor and Michael Steidley have both issued more
than 500 certifications. Annually, DAN awards Trainers and Instructors who
reach a milestone in the previous year. Awards are given for 1000, 750 and
500 certifications.

In February DAN Training sent out 128 certificates, recognizing DAN
Instructor Trainers and Instructors who issued more than 25 certifications
at the Instructor and Provider levels in 2005.

All these award numbers are based on course rosters submitted to DAN. For
more information on this award, contact DAN Training at 1-800-446-2671 in
the U.S. and Canada or call +1-919-684-2948 ext. 555.

----------------------------------------------------------------------------

For more information on this release, contact DAN Communications at
+1-919-684-2948 ext. 626.

Wednesday, May 03, 2006

Ten Most Recent Postings on Scuba Clinic

Our Scuba Clinic Forum, ably administered by docVikingo, is open to guests for visits and for posting. Interesting questions and answers to esoteric problems experienced by the diver. Registration is preferred but not required.

The latest ten postings can be seen here:
http://scuba-doc.com/clinic/index.php?action=recent

Important Additions to Information in our Brazilian Hyperbaric facilities web page

Your attention is called to the changes to our web site about Hyperbaric facilities in Brazil. See http://www.scuba-doc.com/divbraz.htm . There is a comprehensive list of hyperbaric facilities sent to us by Dr. Iriano da Silva Alves former Presidente of the Hyperbaric Medicine Brazilian Society.

Please note that we rely heavily on your support and information about facilities in regions that we could not possibly visit. We are most appreciative of all support that you can provide.

======================================================================================

Undercurrent Online Update for Subscribers, April 28 e-mail

Undercurrent Online Update for Subscribers

Undercurrent -- Consumer Reporting for The Serious Scuba Diver since 1975

www.undercurrent.org

--------------------------------------------------------------------------------

Dive News

April 28 email:

Those Equipment Warranties: We're doing a piece on warranties and wonder how valuable they are to our fellow divers. So would you be so kind as to email me with your thoughts? Do you consider warranties when you decide between brands? Have you found requirements to keep the warranties effective difficult? Have you ever had service or repair of equipment under warranty rejected? Have you bought on line and had problems getting a warranty honored? Please send any thoughts to me at Bendavison@aol.com

Get Your Fish Photo on an Official US Postage Stamp: And you don't have to win a contest to do it. The US Postal Service has teamed up with private enterprise to allow you to create 39 cent stamps with any image you want (well, no body parts, no Hitlers, no smut). But, they're pricey: $17.99 for a sheet of twenty, nearly a 300 percent markup. Still, they're fun. Upload any shot you want at

http://photo.stamps.com/PhotoStamps/learn-more/real

and let that favorite angelfish photo wing a letter to your family or friends.

We Need Your Help to Stop Poaching: In southern Belize, the 133-island marine reserve is managed by a small nongovernmental organization with private funds. A ranger station there has led to a decrease in the illegal poaching of manatees and other marine species, but rogue fishermen -- some from Honduras -- target these reserves under the cover of darkness. The reserve is underfunded and fuel costs are making it impossible to patrol the area regularly. The rangers say they can stop the poachers if they get money to repair and outfit their sailboat for silent overnight patrols; they can catch gill-netters illegally fishing the breeding grounds, arrest and prosecute them. The rangers would even overnight on the cays to nab the poachers. You can help them launch their boat by going to www.undercurrent.org and clicking where it says donate. Your donation is fully tax deductible and you will receive a letter thanking you for the specific amount donated to keep with your IRS records. Every penny you give will go directly to the rangers. Stop the slaughter of manatees and gamefish. If divers don't save the reefs, who will? Thanks for your support.

The DAN/SSS Chamber Legal Dispute. The two parties have just reached a settlement in their recent legal action. DAN America insurance is once again accepted at SSS network chambers as a result of the resolution of the outstanding claims that were the basis for the lawsuit. The terms of the settlement remain confidential.

Milking Frequent Flyer Programs: Sometimes, whether we take a dive trip, especially beyond the Caribbean, depends on whether we can get a free airline frequent flyer ticket -- or get an inexpensive ticket and upgrade. Trouble is, programs are complex, seats are limited, and you might not have enough miles. I found the new book, Mileage Pro, the Insiders Guide to Frequent Flyer Programs, very useful, with plenty of new tips: like how to move miles from one airline into a hotel program than back into another airline program. Why not pay for a cheap flight (and get more miles) and use the miles for another reward? How and where to find the most available seats. Last minute strategies. And how plain old charm can get you what may not seem available. $19.95. Click http://www.mileageprobook.com/ for more information and to order. Undercurrent gets 10% of the purchase price, which will go to the Belize antipoaching program.


Coming Up in the May Issue : Wind Dancer, Tobago; Camp Kri, Papua, Indonesia, Saba Banks, Treated like a novice on Grand Cayman, Great diving on Christmas Island, Fine new beach hotel with own dive operation on Grand Turk, and the Spirit of the Solomons; Nekton Pilot plays reservation roulette; Aging aluminum tank explodes -- many still in service; Cayman coral crises; Reverse diving profiles reconsidered; Computers that penalize properly for reverse dives; Medical tests of drugs divers take reveal underwater hazards; When divers get benched for medical reasons and how to avoid it; Divers, the Internet and the Industry -- why online scuba shopping is popular ( Part I); Drink beer to save the reefs, Alabama court lays claim to river artifacts, Cruise ships overwhelm Belize waters, dive shop owner convicted of being a peeping tom, and much, much more.

To get the May issue and the 2006 all new, 450 page Travelin' Diver's Chapbook, you can subscribe by going to www.undercurrent.org.

Note: Undercurrent is a not-for-profit organization. Our travel writers never announce their purpose, are unknown to the destination, and receive no complimentary services or compensation from the dive operators or resort.

Ben Davison, editor/publisher


editor@undercurrent.org

HELP A BUDDY OUT: forward this message to another diver, so they can get this special offer, too!

Residents of countries other than the US or Canada can sign up to receive the Undercurrent newsletter here:

https://www.undercurrent.org/secure/UCnow/nlsub_cc.html

NOAA/UHMS/USRF Physicians' Training in Diving Medicine Course: July 10-21, 2006

Lisa Wasdin, UHMS, sends us the following information:

"We still have space available in our NOAA/UHMS/USRF Physicians' Training in Diving Medicine Course: July 10-21, 2006 to be held at the NOAA Center in Seattle, WA.

The goal of this course is to fully train physicians to be capable to handle complex diving medical emergencies. After completing the course, the diving physician should be able to manage diving emergency cases and to safely operate the hyperbaric chamber and its support equipment.

The course will include practical "hands on" experience operating and working inside recompression chambers, and the use of commercial and military diving equipment. Training facilities will include 72", 60", and 42" diameter therapeutic recompression chambers and a 30-foot deep diver-training tower. Chambers will be equipped to demonstrate recent technological advances developed by USRF and NOAA.

Instructional content covered by the faculty experts include:

Physical and physiological effects of pressure

Hypothermia and hyperthermia in undersea and hyperbaric systems

Physiological effects of gases
High pressure nervous syndrome

Life support parameters/systems
Diving in polluted water

Fundamentals of gas exchange
Tunnel and caisson workers

Decompression theory and procedures (air/oxygen/mixed gases)
Chamber safety

Diagnosis & treatment of diving casualties
Oxygen toxicity

Recompression therapy
Saturation diving

Ear, nose and throat problems
Recreational diving

Patent Foramen Ovale
Hyperbaric technology

Hyperbaric oxygen therapy

-----------------------------------------------------------------------------------

The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The Undersea and Hyperbaric Medical Society (UHMS) takes responsibility for the content, quality, and scientific integrity of this CME activity.

The Undersea and Hyperbaric Medical Society designates this continuing medical education activity for 82 hours in Category 1 of the Physician’s Recognition Award of the American Medical Association.

All faculty participating in continuing medical education programs sponsored by the Undersea and Hyperbaric Medical Society are expected to disclose to the program audience any real or apparent conflict(s) of interest related to their presentation(s). Full disclosure will be made at the program.


More information on this course can be found at: http://www.uhms.org/Courses/NOAA01/noaa.asp

===================================================================================

Hyperbaric therapy for bilateral visual loss during hemodialysis

Here is a case report sent in by Patrick Rodriguez.

Hyperbaric therapy for bilateral visual loss during hemodialysis
Clin Exp Nephrol (2006) 10:82–84 © Japanese Society of Nephrology 2006
Yoav Keynan · Yoav Yanir · Avi Shupak


Abstract

Bilateral vision loss during hemodialysis is a rare but devastating entity, with grim prognosis for sight. The etiologies are diverse but share ischemia as a common mechanism. This is a report of a patient with bilateral sight loss during hemodialysis, with early hyperbaric treatment and return of visual acuity to baseline. Hyperbaric treatment should be considered, where early administration is possible, for bilateral blindness during hemodialysis.

Introduction

Sudden bilateral blindness during hemodialysis has previously been described in a number of case reports and small case series.

Although it is a rare occurrence during hemodialysis, the consequences of bilateral blindness are devastating.

Several syndromes culminating in loss of sight have been described, including anterior ischemic optic neuropathy, bilateral occipital infarcts, Purtscher's-like retinopathy, and uremic amaurosis.

We present a case of bilateral blindness during hemodialysis treated by hyperbaric oxygen, with the return of the patient's visual acuity to its predialysis level.

The patient was a 69-year-old man with diabetes mellitus, hypertension, and end-organ damage including background diabetic retinopathy, ischemic heart disease, and a history of cerebrovascular accident 7 years before his present illness. He was suffering from endstage renal disease and had been treated with hemodialysis for several years; he was not taking sildenafil.

During a hemodialysis session, bilateral loss of sight occurred. There were no documented hypotensive episodes during treatment. Visual acuity was limited to finger counting from a distance of 0.5 m bilaterally, with no improvement after 4.5 h. There was no relative afferent pupillary defect, and fundus examination revealed arterial narrowing, (A-V) crossing, silver wiring, and hard exudates, but no edema or cherry red spot. The suspected diagnosis was retinal artery occlusion, considered an indication for hyperbaric therapy; the patient was referred to the hyperbari unit. Computerised tomography (CT) was performed and revealed an old occipital infarction.

The patient was treated with hyperbaric oxygen (HBO) at 2.8 atmospheres absolute (ATA) of oxygen according to United States Navy Table 6 (which entails cycles of oxygen breathing followed by intervals of air breathing to avoid oxygen toxicity), commenced within 4h of presentation, and a repeat HBO treatment at 2.5 ATA on the following day. Seven minutes after the initiation of therapy, the patient's sight began to improve, continuing to do so during the subsequent HBO session. Vision remained stable, close to baseline function of 6/15, recorded before the hemodialysis session, and HBO was not continued. The patient declined to undergo further evaluation, including contrast echocardiography and follow-up CT. On follow-up 3 months after treatment his sight remained at baseline level and no further episodes occurred.

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Complimentary copy of new edition of Ocean Realm Journal



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Monday, May 01, 2006

May Humor

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IF MY BODY WERE A CAR

If my body were a car, this is the time I would be thinking about trading it in for a newer model. I've got bumps and dents and scratches in my finish and my paint job is getting a little dull, but that's not the worst of it. My headlights are out of focus and it's especially hard to see things up close. My traction is not as graceful as it once was. I slip and slide and skid and bump into things even in the best of weather. My whitewalls are stained with varicose veins. It takes me hours to reach my maximum speed. My fuel rate burns inefficiently.

But here's the worst of it --

Almost every time I sneeze, cough or sputter.......either my radiator leaks or my exhaust backfires!

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Sexes

WOMEN'S REVENGE
"Cash, check or charge?" I asked, after folding items the woman wished to purchase. As she fumbled for her wallet, I noticed a remote control for a television set in her purse. "So, do you always carry your TV remote?" I asked. "No," she replied, "but my husband refused to come shopping with me, and I figured this was the most evil thing I could do to him legally."

UNDERSTANDING WOMEN
(A MAN'S PERSPECTIVE)
I know I'm not going to understand women. I'll never understand how you can take boiling hot wax, pour it onto your upper thigh, rip the hair out by the root, and still be afraid of a spider.

MARRIAGE SEMINAR
While attending a Marriage Seminar dealing with communication, Tom and his wife Grace listened to the instructor, "It is essential that husbands and wives know each other's likes and dislikes." He addressed the man, "Can you name your wife's favorite flower?" Tom leaned over, touched his wife's arm gently and whispered, "It's Pillsbury, isn't it?

WIFE VS. HUSBAND
A couple drove down a country road for several miles, not saying a word.

An earlier discussion had led to an argument and neither of them wanted to concede their position. As they passed a barnyard of mules, goats, and pigs, the husband asked sarcastically, "Relatives of yours?" "Yep," the wife replied, "in-laws."

WORDS
A husband read an article to his wife about how many words women use a day... 30,000 to a man's 15,000. The wife replied, "The reason has to be because we have to repeat everything to men... The husband then turned to his wife and asked, "What?"

CREATION
A man said to his wife one day, "I don't know how you can be so stupid and so beautiful all at the same time. "The wife responded, "Allow me to explain. God made me beautiful so you would be attracted to me; God made me stupid so I would be attracted to you!

WHO DOES WHAT
A man and his wife were having an argument about who should brew the coffee each morning. The wife said, "You should do it because you get up first,and then we don't have to wait as long to get our coffee. The husband said, "You are in charge of cooking around here and you should do it, because that is your job, and I can just wait for my coffee." Wife replies, "No, you should do it, and besides, it is in the Bible that the man should do the coffee." Husband replies, "I can't believe that, show me." So she fetched the Bible, and opened the New Testament and showed him at the top of several pages, that it indeed says .......... "HEBREWS"

The Silent Treatment
A man and his wife were having some problems at home and were giving each other the silent treatment. Suddenly, the man realized that the next day, he would need his wife to wake him at 5:00 AM for an early morning business flight. Not wanting to be the first to break the silence (and LOSE), he wrote on a piece of paper, "Please wake me at 5:00 AM." He left it where he knew she would find it. The next morning, the man woke up, only to discover it was 9:00 AM and he had missed his flight. Furious, he was about to go and! see why his wife hadn't wakened him, when he noticed a piece of paper by the bed. The paper said, "It is 5:00 AM. Wake up." Men are not equipped for these kinds of contests.

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Winter Morning in Ohio

One winter morning in Ohio a couple was
listening to the radio while eating breakfast.
They heard the announcer say, "We are going
to have 8 to 10 inches of snow today. You must
park your car on the even-numbered side of
the street, so the snowplows can get through."

Norman's wife went out and moved her car.

A week later while they were again eating breakfast,
the radio announcer said, "We are expecting 10 to
12 inches of snow today. You must park your car on
the odd-numbered side of the street, so the snowplows
can get through."

Norman's wife went out and moved her car again.

The next week they were again having breakfast,
when the radio announcer said, "We are expecting
12 to 14 inches of snow today. You must park... "
Then the electric power went off. Norman's wife was
very upset, and with a worried look on her face
she said, "Honey, I don't know what to do.
Which side of the street do I need to park on so
the snowplows can get through?"

With the love and understanding in his voice
that all men who are married to blondes exhibit,

Norman said ..

"Why don't you just leave it in the garage this time."

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Men Are Just Happier People

What do you expect from such simple creatures?

Your last name stays put.
The garage is all yours.
Wedding plans take care of themselves.
Chocolate is just another snack.
You can be President.
You can never be pregnant.
You can wear a white T-shirt to a water park.
You can wear NO shirt to a water park.
Car mechanics tell you the truth.
The world is your urinal.
You never have to drive to another gas station restroom because this one is just too icky.
You don't have to stop and think of which way to turn a nut on a bolt.
Wrinkles add character.
Wedding dress $3,000. Tux rental-$100.
People never stare at your chest when you're talking to them.
The occasional well-rendered belch is practically expected.
New shoes don't cut, blister, or mangle your feet.
One mood all the time.
Phone conversations are over in 30 seconds flat.
You know stuff about tanks, guns, and bazookas.
A five-day vacation requires only one suitcase.
You can open all your own jars.
You get extra credit for the slightest act of thoughtfulness.
If someone forgets to invite you, he or she can still be your friend.
Your underwear is $8.95 for a three-pack.
Three pairs of shoes are more than enough.
You never have strap problems in public.
You are unable to see wrinkles in your clothes.
Everything on your face stays its original color.
The same hairstyle lasts for years, maybe decades.
You only have to shave your face and neck.
You can play with toys all your life.
Your belly usually hides your big hips.
One wallet and one pair of shoes in one color for all seasons.
You can wear shorts no matter how your legs look.
You can "do" your nails with a pocket knife.
You have freedom of choice concerning growing a mustache.
You can do Christmas shopping for 25 relatives on December 24 in 25 minutes.

No wonder men are happier.



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The spoon

Last week, we took some friends out to a new restaurant, and noticed that the waiter who took our order carried a spoon in his shirt pocket.

It seemed a little strange. When the busboy brought our water and utensils, I noticed he also had a spoon in his shirt pocket. Then I looked around and saw that all the staff had spoons in their pockets.

When the waiter came back to serve our soup I asked, "Why the spoon?"

"Well," he explained, "the restaurant's owners hired Andersen Consulting to revamp all our processes. After several months of analysis, they concluded that the spoon was the most frequently dropped utensil. It represents a drop frequency of approximately 3 spoons per table per hour. If our personnel are better prepared, we can reduce the number of trips back to the kitchen and save 15 man-hours per shift."

As luck would have it, I dropped my spoon and he was able to replace it with his spare. "I'll get another spoon next time I go to the kitchen instead of making an extra trip to get it right now."

I was impressed. I also noticed that there was a string hanging out of the waiter's fly. Looking around, I noticed that all the waiters had the same string hanging from their flies. So before he walked off, I asked the waiter, "Excuse me, but can you tell me why you have that string right there?"

"Oh, certainly!" Then he lowered his voice. "Not everyone is so observant. That consulting firm I mentioned also found out that we can save time in the restroom. By tying this string to the tip of you know what, we can pull it out without touching it and eliminate the need to wash our hands, shortening the time spent in the restroom by 76.39 percent."

"After you get it out, how do you put it back?"

"Well," he whispered, "I don't know about the others, but I use the spoon.",


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Amish Ticket

An Amish lady is trotting down the road in her horse and buggy when she is pulled over by a cop.

"Ma'am, I'm not going to ticket you, but I do have to issue you a warning. You have a broken reflector on your buggy."

"Oh, I'll let my husband, Jacob, know as soon as I get home."

"That's fine. Another thing, ma'am. I don't like the way that one rein loops across the horse's back and around one of his balls. I consider that animal abuse. That's cruelty to animals. Have your husband take care of that right away."

Later that day, the lady is home telling her husband about her encounter with the cop. "Well, dear, what exactly did he say?"

"He said the reflector is broken."

"I can fix that in two minutes. What else?"

"I'm not sure, Jacob,... something about the emergency brake."

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Gender Issues

You may not know that many non-living things have a gender.

For Example ...

1) Freezer Bags
Male, because they hold everything in, but you can see right through them.

2) Photocopiers
Female, because once turned off, it takes a while to warm them up again. They are an effective reproductive device if the right buttons are pushed, but they can wreak havoc if the wrong buttons are pushed.

3) Tires
Male, because they go bald and they are often over-inflated.

4) Hot Air Balloons
Male, because, to get it to go anywhere, you have to light a fire under it, and of course, there's lots of hot air.

5) Sponges
Female because they're soft, squeezable and retain water.

6) Web Pages
Female, because it's always getting hit on.

7) Railway Stations
Male, because they use the same old lines to pick people up.

8) Hourglass
Female, because over time, the weight shifts to the bottom.

9) Hammer
Male, because it hasn't changed much over the last 5,000 years, but it's still handy to have around.

10) Remote Control
Female...... Ha! You thought it would be male, but consider this They give a man pleasure, and he'd be lost without one. And, while he doesn't always know the right buttons to push, he keeps trying.

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IRISH SMILES

Into a Belfast pub comes Paddy Murphy, looking like he'd just been run over by a train. His arm is in a sling, his nose is broken, his face is cut and bruised and he's walking with a limp..

"What happened to you?" asks Sean, the bartender.

"Jamie O'Conner and me had a fight," says Paddy.

"That little shit, O'Conner," says Sean, "He couldn't do that to you, he must have had something in his hand."

"That he did," says Paddy, "a shovel is what he had, and a terrible lickin' he gave me with it."

"Well," says Sean, "you should have defended yourself, didn't you have something in your hand?"

"That I did," said Paddy... "Mrs. O'Conner's breast, and a thing of beauty it was, but useless in a fight."

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An Irishman who had a little too much to drink is driving home from the city one night and, of course, his car is weaving violently all over the road. A cop pulls him over. "So," says the cop to the driver, where have ya been?"

"Why, I've been to the pub of course," slurs the drunk.

"Well," says the cop, "it looks like you've had quite a few to drink this evening."

"I did all right," the drunk says with a smile.

"Did you know," says the cop, standing straight and folding his arms across his chest, "that a few intersections back, your wife fell out of your car?"

"Oh, thank heavens," sighs the drunk. "For a minute there, I thought I'd gone deaf." ========================================

Brenda O'Malley is home making dinner, as usual, when Tim Finnegan arrives at her door. "Brenda, may I come in?" he asks. "I've somethin' to tell ya".

"Of course you can come in, you're always welcome, Tim. But where's my husband?"

"That's what I'm here to be telling ya, Brenda." There was an accident down at the Guinness brewery...."

"Oh, God no!" cries Brenda. "Please don't tell me."

"I must, Brenda. Your husband Shamus is dead and gone. I'm sorry."

Finally, she looked up at Tim. "How did it happen, Tim?"

"It was terrible, Brenda. He fell into a vat of Guinness Stout and drowned."

"Oh my dear Jesus! But you must tell me true, Tim. Did he at least go quickly?"

"Well, Brenda... no. In fact, he got out three times to pee."
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Mary Clancy goes up to Father O'Grady after his Sunday morning service, and she's in tears. He says, "So what's bothering you, Mary my dear?"

She says, "Oh, Father, I've got terrible news. My husband passed away last night."

The priest says, "Oh, Mary, that's terrible. Tell me, Mary, did he have any last requests?"

She says, "That he did, Father."

The priest says, "What did he ask, Mary? " She says, "He said, 'Please Mary, put down that damn gun...'

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AND THE BEST FOR LAST A drunk staggers into a Catholic Church, enters a confessional booth, sits down but says nothing. The Priest coughs a few times to get his attention but the drunk continues to sits there. Finally, the Priest pounds three times on the wall. The drunk mumbles, "ain't no use knockin; there's no paper on this side either."