In diving, a hyperbaric chamber (CHB) is an element that in the event of any accident or symptoms of decompression sickness will allow us to correct it without any side effect as long as we act as soon as possible, is the reason for this article, to raise awareness that it is better to activate the protocol for a possible ED to wait in case the symptoms disappear, in which case we will only aggravate it and that by omission or ignorance is more common than desired within the low accident rate of sport diving in any of its modalities.
But what specifically is a hyperbaric chamber?
It is a container, usually metallic and cylindrical, designed to withstand pressures higher than atmospheric and that allows the breathing of therapeutic mixtures (generally oxygen) at said pressures.
A LITTLE HISTORY
1662 Henshaw, first known hyperbaric chamber (compressed air)
Chamber built by Forlanini in 1875
1774 Priestley discovers oxygen
1789 Lavosier describes the toxicity of oxygen under pressure
1834 Junod uses a hyperbaric chamber to treat lung conditions
1837Pravaz builds a hyperbaric chamber with a capacity for 50 people
1878 PAUL BERT publishes “THE BAROMETRIC PRESSURE” details the effects of the toxicity of oxygen breathed at high pressures.
El Timkin’s tank, an airtight, huge steel ball designed as a hospital, in which “patients suffering from diabetes and other ills will live under 30 pounds of air pressure, which is forced into the steel ball by powerful compressors” ( Cleveland, Ohio, 1928)
1937 Behnke and Shaw use hyperbaric oxygen as a treatment for ED
1956 Boerema begins work in a hyperbaric environment
Boerema 1956 Pressurized operating room
1967 The UHMS (underwarter & hiperbaria medical society) is created
In1923, hyperbaric chambers began to be used in Spain with clinical applications, belonging to the defense staff so most are in coastal areas, it was not until 1970 when the first hyperbaric chamber for civil use was acquired, being the one installed in the hospital Santo y Real Hospital de la Caridad in Cartagena in 1976 the first.
Caridad hospital chamber, Cartagena
(took advantage of the dismantling of some chimneys)
Hyperbaric chamber treatments are not only applied to diving accidents, there are many pathologies treated, some of them and covered by the social security published in the BOE are:
- Soft tissue necrosis.
- Necrotizing soft tissue infections by germs.
- Varicose ulcers.
- Diabetic foot.
- Other processes.
TYPES OF CAMERAS
They can be portable.
No access to the patient.
Lower risk of deflagration.
Contact with patient.
Antechamber / locks.
Risk of ED for the companion
OTHER CAMERAS IN SPAIN
CLÍNICA EL ÁNGEL-MÁLAGA
NUESTRA SEÑORA DEL ROSARIO-IBIZA
CBA (Centro de Buceo de la Armada Española)
Hospital El Ángel (Málaga), pruebas de tolerancia al oxígeno
When should I consider going to a hyperbaric chamber?
In the event of any symptoms of the statements below, whether we have missed a stop, exceeded the ascent rate or not, we must start the oxygen treatment and activate our insurance, by law we must guarantee the availability, as well as the provision of a functioning hyperbaric center at a distance and altitude that allows it to be used within a maximum period of 2 h. from the beginning of the evacuation of the dive site by any feasible means of transport, not exceeding 300 meters of altitude if it is done by non-pressurized plane, these protocols are active in your dive center so you should not worry.
SYMPTOMSOF DECOMPRESSIVE DISEASE
ED TYPE I (MILD)
ED formation of inert gas bubbles in the body
- Musculoskeletal Forms (Bends) is the most common form of ED
- Mono or oligoarticular pain, not symmetrical. Large joints improve when compressing the area, they are usually more frequent in shoulders, elbows and hips
- Mild swelling of the face and neck, subcutaneous air bubbles in the upper part of the trunk (subcutaneous emphysema) and possible voice change.
- Itching or skin rash (benign), redness of specific areas of the skin with itching and punctures in these areas
- Disproportionate asthenia, can evolve to ED II
ED TYPE II (SERIOUS)
Spinal, neuronal, pulmonary, inner ear, mixed.
- If there is brain involvement, headaches and the following symptoms may appear, although not necessarily all,
- Appearance of paralysis
- State of mental confusion
- Decreased reflexes
- Loss of vision
- Nausea and stomach pain, possible bleeding
- Cough and feeling of shortness of breath, shallow breathing, chest pain, change of color in lips, nails and skin to a purple tone.
When do symptoms appear?
Type II ED can appear before reaching the surface, it would be a very serious case, practically unlikely in sport diving, it would be necessary to commit a serious recklessness to reach this situation
The symptoms of decompression sickness usually appear after the dive and in the following 24 hours, there are studies, such as the one presented by the diving research unit of the Navy and the University of Murcia, which encrypt 70% of the cases that appear within the 1st hour after the dive, in the six hours following the dive in 85% of cases, the onset of the picture after 24 hours after surfacing are exceptional cases, another study by the navy of the USA leaves us that 42% appear in the first hour, in the next three hours 60%, eight hours after the immersion 83% of the cases present symptoms being in the following 24 hours practically the total one 98%, although the two studies differ somewhat, the two agree that after 24 hours it is very unlikely that symptoms will appear, the first hours being the most critical.
HOW DOES HYPERBARIC CHAMBER TREATMENT WORK?
The therapeutic effects of a HBO treatment are as follows:
- DIRECT EFFECT
Increase in the blood supply of oxygen to the tissues, arterial venous and tissue hyperoxia, especially, a great increase in the transport and availability of plasma oxygen.
- INDIRECT EFFECT
Decrease in bubble volume
O2 window effect
The increase in Pp O2 and the reduction to zero of the Pp of nitrogen accelerate the reabsorption of the gas emboli down the gradient until they are eliminated.
In summary, the treatments at CHB are usually relaxing and pleasant, reduce muscle fatigue, increase energy at the cellular level, it is suggested to stay at the CHB with comfortable clothes, barefoot and bring something to liven up the stay such as music, books etc …
The time to act before a symptom of ED is very important, Most of the cases treated within a reasonable time are no more than an anecdote since the benign contributions described do not leave any sequelae, the problem appears if, given these symptoms, we omit the visit to a hyperbaric center and its treatment, that we must have covered by compulsory insurance in Spain and recommended in countries where it is not.
SALVADOR BLANCO DIAZ
MSDT 353188 PADI