Dive  Accident

When you land at the airstrip in San Pedro , Ambergris Caye, you may notice an white building on the north/west side of the airstrip behind the Maya Air Terminal.
The building houses a Double-Lock Recompression Chamber owned by Subaquatics of Belize Ltd. It is the only recompression chamber in Belize.

Dive Accident

Symptoms

• Pain
• Bladder Problem
• Dizziness
• Extreme fatigue
• Headache
• Itching
• Nausea
• Numbness
• Personality change
• Paralysis
• Reflex change
• Restlessness
• Skin Rash

Signs

• Blotchy skin rash
• Altered mental status
• Coughing spasms
• Shortness of breath
• Staggering
• Weakness

First Aid

• put diver in a supine position, if diver lost consciousness: put diver in the recovery position.
• give 100% oxygen (start as soon as possible),
  a) if breathing sufficiently: via face mask with - demand valve or -
      closed circuit oxygen re-breathing system with CO2-scrubber, if
      not available: with constant flow (15-25 ltr./min, non
      re-breathing mask with oxygen reservoir)
  b) if not breathing sufficiently perform artificial respiration: -
      Ambu bag with 100% constant O2 flow (15-25 ltr./min)
      or - Ambu/Laerdal bag with demand valve or - closed circuit
      oxygen re-breathing system with CO2-scrubber.
  Give oxygen without breaks until reaching treatment chamber, give highest possible oxygen concentration even if oxygen supply is limited (no air-mix, no constant flow below 15 ltr./min).
• fluids
  a) if victim is conscious with stable neurology and intact
      swallowing reflex: give fluids orally in small sips (0.5-1.0 ltr./h,
      no hypertonic fluids, no alcohol, no caffeine)
  b) if victim has impaired consciousness or swallowing reflex: do
      not give oral fluids
  
• perform orientating neurological examination
• if hypothermic: protect against further heat loss, no active re-warming
  
• consult hyperbaric chamber on Ambergris Caye on marine radio
  or with your cellphone.
  Dive emergency  Service  24  houres daily
  Phone:  +501 226 31 95
  Fax:      +501 226 28 52
  Email: sssbelize@aol.com
  Emergency Number:     +501 226 28 51
  Dr. Otto Rodríguez: +501 226 28 54
  Antonia Guerrero:   +501 226 34 42

Transport to Hyperbaric Treatment Chamber

Treatment

A decompression chamber is a steel tank that can be pressurized Throughout treatment a specially trained helper stays with the diver in the chamber.

Control panel for adjusting the air / gas mix and the dive depth.

After treatment

Diving after an accident

After treatment for decompression sickness, a diver should take a rest from diving. The length of this rest should be discussed with a specialist in divers' medicine "Diving Medicine Physician EDTC".

Chamber Access Program

Diving Medicine

• Don't dive into a submerged pool or into the shallow end of a pool.  Nine of ten diving injuries occur in six feet of water or less.  
• Don't dive off the side of a diving board--dive straight ahead
• Don't dive from the edge across the narrow part of a pool without having at least 25 feet of clear dive path in front of you.
• Don't run and dive.  That can give you the same impact as a dive from a board
• Don't do a backdive
• Don't try fancy dives or dives with straight vertical entry
• Don't dive at or through objects such as inner tubes
• Don't put diving equipment on a pool that wasn't designed for it.
• Don't dive from retaining walls, ladders, slides, or other pool equipment.
• Don't dive into unfamiliar bodies of water.  Remember, 3 of 4 diving accidents happen in natural bodies of water like lakes and rivers.
• Don't swim and dive alone
• Don't drink and drive.  The slowing effects of alcohol or drugs on reaction time can be extremely dangerous in diving.

Decompression Sickness  (DCS)

The label 'decompression sickness' (DCS) was introduced in place of "Caisson disease". Decompression sickness can be classified as either Type 1 or Type 2. The different classification reflects the effect, and therefore the severity, of the condition. Diagnosing DCS as one (or both) of just two categories does not enable proper identification or discrimination. However, for the sake of completeness, the two types are described here.

Type 1 DCS can occur when bubbles affect the tissues around skeletal joints. Symptoms usually include unilateral (on one side of the body) discomfort or pain in one or more joints. The areas most often affected are the knees, elbows and shoulders.

Decompression sickness might also present as a skin (cutaneous) disorder. Nitrogen bubbles can cause mottling, lumps or a rash. "Skin bends", as they are colloquially termed, are more common during hyperbaric chamber 'dives' and when diving using a dry suit. Although not usually in themselves serious, skin symptoms may indicate the presence of problems elsewhere. A particularly serious cutaneous sign of DCS is 'cutis marmorata' marbling, in which an area of skin becomes pale with dark mottling. This is associated with considerable development of inert gas bubbles within the body.

If left untreated, Type 1 DCS may progress to Type 2.

Type 2 decompression sickness reflects involvement of the Central Nervous System (CNS) and / or the cardio-respiratory system. More than half of those diagnosed with DCS will be classified as Type 2.Cerebral symptoms arise from interruption of the blood supply to the main part of the brain, and include confusion, reduced mental function and unconsciousness. Involvement of the cerebellum may lead to tremors, loss of balance ("staggers") and a lack of co-ordination (ataxia). Balance may also be affected by damage to the vestibular part of the inner ear.

Spinal DCS may present as back pain, paresthesia (pins and needles), paralysis and loss of urinary sphincter control - resulting in either incontinence or retention.

As discussed already, the formation of small inert gas bubbles does not necessarily lead to the development of DCS. Likewise, when bubbles become trapped in the tiny blood vessels around the lungs' alveoli (air sacs), problems do not always arise. In fact, it is thought that their accumulation in this area may increase the rate that the gas is excreted from the body (Edmonds et al, 1993). However, if too many bubbles collect, breathing will become adversely affected ("chokes"). Symptoms include breathlessness, tachypnoea (increase in breathing rate), chest pain and coughing. Although symptoms may resolve, this should be regarded as a life-threatening condition as it may progress to fatal respiratory collapse.
 

Foramen Ovale

PFO (Patent foramen ovale) is a persistent opening in the wall of the heart which did not close completely after birth (opening required before birth for transfer of oxygenated blood via the umbilical cord).

This opening can cause a shunt of blood from right to left , but more often there is a movement of blood from the left side of the heart (high pressure) to the right side of the heart (low pressure).

People with shunts are less likely to develop fainting or low blood pressure with diving than are obstructive valve lesions (such as mitral valve stenosis or aortic stenosis), but are more likely to develop fluid accumulation in the lungs from heart failure and severe shortness of breath from the effects of combined exercise and water immersion.

Ordinarily, the left to right shunt will cause no problem; the right to left shunt, if large enough, will cause low arterial O2 tension (hypoxia) and severely limited exercise capacity. In divers there is the risk of paradoxical embolism of gas bubbles (passage of bubbles into the arterial circulation) which occur in just about all divers in the venous circulation during decompression.

Blood can flow in both directions with Intra-atrial shunts at various phases of the cardiac cycle and some experts feel that a large atrial septal defect (PFO) is a contra-indication to diving. In addition, a Valsalva maneuver, used by most divers to equalize their ears during descents and ascents, can increase venous atrial pressure to the point that it forces blood containing bubbles across the PFO into the arterial circulation. Thus the usual filtering process of the lungs is by-passed.

Nitrogen narcosis

Nitrogen narcosis is a dangerous condition that can affect scuba divers, especially when diving deeper than 30 meters. The exact mechanisms behind nitrogen narcosis are still to be explored, but it has to do with nitrogen gas affecting the nerve transmissions in the body during high pressure. Since the air inhaled by scuba divers contains a large amount of nitrogen (just like the air that we breathe above the surface every day), nitrogen narcosis was the first type of gas narcosis experienced by scuba divers, hence the name. The effects of nitrogen narcosis are similar to the effects of anesthetic gas or alcohol. It can be hard for the effected diver to realize that he or she is developing nitrogen narcosis, since the level of intoxication will increase gradually. If you suspect that you or your buddy is suffering from nitrogen narcosis, you should immediately begin your ascent to shallower depts. The effects of nitrogen narcosis will usually wear of as soon as you reach shallower depths, even if they are far from the surface.

Swimmer's Ear

1. 1 Bottle (I used a condiment bottle purchased in the WalMart kitchen aisle for 97¢)
2. Label bottle with handy dandy label maker (optional)
   
3. Place equal parts vinegar & rubbing alcohol in bottle
4. Give bottle a little shake & turn yourself about
   (again, turning is optional)
   
5. Place a couple drops in each ear after swimming
6. That's it - easy peasy!

Jellyfish

Portugese man on war Although it resembles a jellyfish, the Portuguese man-of-war is actually a colony of sea animals. Mainly found in tropical regions, the Gulf stream current can carry it as far as Europe. It is also found as far south as Australia. The Portuguese man-of-war resembles a large pink or purple balloon floating on the sea. The floating portion of the man-of-war may be as small as 15 centimeters, but the tentacles can reach 12 meters in length. The huge tentacles are actually colonies of stinging cells. These tentacles inflict a painful and incapacitating sting, but the sting is rarely fatal.