Catch Up with Diving Safety

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August 29, 2013


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The Florida Keys sees a million dives into the ocean waters every year as certified scuba divers don tanks of compressed air and explore reefs, wrecks and sea life.

The sport is mostly a safe one, with about 30 to 35 divers a year running into trouble and requiring immediate treatment for decompression sickness — or “the bends” — at Mariners Hospital in Tavernier. Mariners is home to the only hospital-based hyperbaric chamber in the Florida Keys.

Being in good health and being properly trained are essential for scuba divers because diving accidents can be catastrophic, especially when decompression sickness from surfacing to quickly attacks the spinal cord and leads to paralysis.

“It’s important to get certified and stay physically fit,” said Dennis Holstein, director of the hyperbaric chamber at Mariners. “A big percentage of people who got certified years ago haven’t been diving in a long time and they may be out of shape or overweight. These things can make decompression sickness more prevalent.”

Even those divers who are well-trained and physically fit need to be alert.

“If you went out drinking the night before diving, you could be dehydrated or you could suffer from a lack of sleep,” Holstein said. “It is a safe sport, but you have to take care of yourself.”

Newbie divers should be cleared by their physicians. And those with certain respiratory conditions or diabetes, should not be scuba diving, Holstein said.

Mariners uses hyperbaric oxygen therapy to treat a variety of patients, about 15 percent of which are divers experiencing some degree of decompression sickness.

You’ve probably seen the condition acted out in the movies, when the diver/actor surfaces too quickly out of fear, anxiety or avoiding a looming danger.

Decompression sickness is caused by a build up of nitrogen bubbles in the blood and tissues following a sudden drop in the surrounding pressure, as when ascending rapidly from a dive. It can result in severe pain in the joints and chest, skin irritation, cramps, and even paralysis.

“It depends where the bubbles form in the body,” Holstein said. “Weakness, tingling sensation, and dizziness can be the result. A couple of our patients got a buildup of bubbles in the inner ear. Everything was spinning. The longer you stay down, and the deeper the dive, the more nitrogen is absorbed. As you go up, it is expelled through the lungs. But if nitrogen bubbles build up somewhere in the body, it can cause damage.”

The Hyperbaric Medicine Department at Mariners Hospital uses hyperbaric oxygen therapy to treat many wound injuries and conditions, including decompression sickness.

During this therapy, patients breathe 100 percent oxygen in a high-pressure environment. In a hyperbaric oxygen-therapy room, the air pressure is raised up to three times higher than normal. At this level, your lungs can gather up to three times more oxygen than would be possible by breathing pure oxygen at normal air pressure.

The treatment for decompression sickness can last several hours. Hyperbaric treatment for wounds or other conditions can take 30 to 40 treatments, five days a week, sometimes two hours at a time in the chamber.

Hyperbaric services at Mariners are provided in conjunction with the wound care and hyperbaric medicine services at South Miami Hospital, under the direction of James Loewenherz, M.D.

Other conditions treated with hyperbaric oxygen therapy at Mariners and South Miami include serious infections, bubbles of air in blood vessels and tissue, and wounds that won’t heal as a result of diabetes, crush injuries, or radiation tissue damage.

“Hyperbaric oxygen therapy promotes new capillaries (the smallest blood vessels), and helps to restore circulation to damaged tissue,” Holstein said. “It has a very good rate of recovery.”

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