Diving and Subaquatic Medicine

741 Pages·25.475 MB·English

by  Edmonds C., Lowry Ch., Pennefather J., Walker R.

Diving and Subaquatic
Medicine
Diving and Subaquatic
Medicine
Fourth edition
Carl Edmonds M.B., B.S. (Sydney), M.R.C.P. (Lond.) F.R.A.C.P., F.A.F.O.M., D.P.M., M.R.C Psych.,
F.R.A.N.Z.C.P., Dip. D.H.M.
Director, Diving Medical Centre, Sydney, 1970-2001. Formerly Officer in Charge Royal Australian Navy School
of Underwater Medicine, 1967-75. Formerly President of South Pacific Underwater Medicine Society, 1970-75.
Consultant in Underwater Medicine to the Royal Australian Navy, 1975-1991
Christopher Lowry M.B., B.S., (Sydney), Dip D.H.M, F.F.A.R.A.C.S.
Director, Diving Medical Centre, Sydney, 1973-1991. Formerly Deputy Medical Officer in Charge, Royal
Australian Navy School of Underwater Medicine, 1973-74. Visiting Anaesthetist, Royal North Shore Hospital,
Sydney, 1980-1991. Visiting Anaesthetist, Lismore Base Hospital, 1991-present. Consultant in Diving
Medicine, Far North Coast, NSW.
John Pennefather B.SC. (Hons.)
Scientific Officer at the Royal Australian Navy Submarine and Underwater Medicine Unit 1972-2001
Robyn Walker M.B., B.S., Dip. D.H.M.
Formerly Officer in Charge, Royal Australian Navy Submarine and Underwater Medicine Unit 1995-2001.
President, South Pacific Underwater Medicine Society, 2000-01
A member of the Hodder Headline Group
LONDON • NEW YORK • NEW DELHI
First published in Great Britain in 2002 by
Arnold, a member of the Hodder Headline Group,
338 Euston Road, London NW1 3BH
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© 2002 Arnold
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London W1P 9HE.
Whilst the advice and information in this book are believed to be true and
accurate at the date of going to press, neither the authors nor the publisher
can accept any legal responsibility or liability for any errors or omissions
that may be made. In particular (but without limiting the generality of the
preceding disclaimer) every effort has been made to check drug dosages;
however it is still possible that errors have been missed. Furthermore,
dosage schedules are constantly being revised and new side-effects
recognized. For these reasons the reader is strongly urged to consult the
drug companies' printed instructions before administering any of the drugs
recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN 0 340 80630 3
1 2345678910
Publisher: Joanna Koster
Development Editor: Tim Wale
Production Editor: James Rabson
Production Controller: Bryan Eccleshall
Cover design: Terry Griffiths
Typeset in 10/12pt Minion and Ocean Sans MT by
J&L Composition Ltd, Filey, North Yorkshire
Printed and bound in Italy by Giunti
Contents
Preface ix
Preface (Excerpts from earlier Editions) x
Acknowledgments xi
DIVING
1 History of diving 1
J. Pennefather
2 Physics and physiology 11
J. Pennefather
3 Free diving 23
C. Lowry
4 Diving equipment 33
J. Pennefather
5 Undersea environments 47
C. Edmonds
DYSBARIC DISEASES
BAROTRAUMAS
6 Pulmonary barotrauma 55
R. Walker
7 Ear barotrauma 73
C. Edmonds
8 Sinus barotrauma 93
C. Edmonds
9 Other barotrauma 103
C. Edmonds
DECOMPRESSION SICKNESS
10 Decompression sickness: history and physiology 111
R. Walker
11 Decompression sickness: pathophysiology 131
R. Walker
12 Decompression sickness: clinical 137
R. Walker
vi Contents
13 Decompression sickness: treatment 151
R. Walker
14 Dysbaric osteonecrosis 167
C. Lowry
ABNORMAL GAS PRESSURES
15 Inert gas narcosis 183
C. Lowry
16 Hypoxia 195
C. Edmonds
17 Oxygen toxicity 207
C. Lowry
18 Carbon dioxide toxicity 223
C. Edmonds
19 Breathing gas contamination 233
J. Pennefather
20 High-pressure neurological syndrome 243
C. Lowry
AQUATIC DISORDERS
THE DROWNING SYNDROMES
21 Drowning syndromes: drowning 249
C. Edmonds
22 Drowning syndromes: near-drowning 257
C. Edmonds
23 Drowning syndromes: the management of near-drowning 263
C. Lowry
24 Drowning syndromes: saltwater aspiration syndrome 273
C. Edmonds
25 Drowning syndromes: why divers drown 277
C. Edmonds
26 Seasickness (motion sickness) 285
J. Pennefather
27 Thermal problems and solutions 289
J. Pennefather
28 Cold and hypothermia 293
J. Pennefather
29 Local infections 305
C. Lowry
30 General infections 317
C. Lowry
31 Trauma from marine creatures 325
C. Edmonds
32 Venomous marine animals 335
C. Edmonds
33 Fish poisoning 353
C. Edmonds
34 Underwater explosions 359
J. Pennefather
Contents vii
SPECIFIC DIVING DISEASES
THE EAR AND DIVING
35 The ear and diving: anatomy and physiology 365
C. Edmonds
36 The ear and diving: investigations 371
C. Edmonds
37 The ear and diving: hearing loss 379
C. Edmonds
38 The ear and diving: vertigo and disorientation 385
C. Edmonds
39 Cardiac problems and sudden death 399
C. Lowry
40 Neurological disorders of diving 409
R. Walker
41 Psychological and neuropsychological disorders 417
C. Edmonds
42 Miscellaneous Disorders 433
C. Edmonds
Carotid sinus syndrome
Caustic cocktail
Cold urticaria
Dental disorders
Hyperthermia
Musculoskeletal problems
Ocular disorders
Pulmonary oedema and dyspnoea
Skin reactions to equipment
Trauma
43 Drugs and diving 445
C. Lowry
44 Long-term effects of diving 457
R. Walker and C. Edmonds
THE DIVING ACCIDENT
45 Stress responses, panic and fatigue 465
C. Edmonds
46 Why divers die: the facts and figures 473
C. Edmonds
47 Unconsciousness 491
C. Edmonds
48 First aid and emergency treatment 497
R. Walker
49 Oxygen therapy 503
C. Edmonds
50 Investigation of diving accidents: equipment 511
J. Pennefather
51 Investigation of diving fatalities 517
C. Edmonds
viii Contents
MEDICAL STANDARDS FOR DIVING
52 Medical standards for snorkel divers 531
C. Edmonds
53 Medical standards for recreational divers 533
R. Walker
54 Medical standards for commercial divers 553
R. Walker
55 Asthma 559
C. Edmonds
56 Cardiac disease 575
R. Walker
57 Insulin-dependent diabetes mellitus 581
The pros - C. Edge and P. Bryson
The cons - C. Edmonds, C. Lowry and R. Walker
58 Age and diving 597
C. Edmonds
59 Diver selection 603
R. Walker
SPECIALIZED DIVING AND ITS PROBLEMS
60 Female divers 607
R. Walker
61 Breath-hold diving 615
C. Edmonds
62 Technical diving 619
J. Pennefather
63 Technical diving problems 625
C. Edmonds
64 Handicapped divers 635
R. Walker
65 Occupational groups 639
C. Edmonds and J. Pennefather
66 Diving in contaminated water 645
J. Pennefather
67 Deep and saturation diving 647
J. Pennefather
68 Deep and saturation diving problems 653
J. Pennefather
69 Hyperbaric equipment 657
J. Pennefather
70 Submarine medicine 665
R. Walker
APPENDICES
A Decompression Tables. BSAC (UK), US Navy, NOAA, DCIEM (Canadian) 671
B Recompression Therapy Tables, US Navy 687
C Recompression Therapy Options, COMEX, Australian, Duke 695
D Diving Medical Library 699
E Diving Medical Training 701
F Diving Medical Organizations, Contacts and Internet 702
INDEX 703
Preface
I take full responsibility for the decision to produce a the problems of free divers, divers with disabilities,
fourth edition of this text. There have been many and technical divers.
changes in diving medicine over the past decade, and I no longer promise that this will be the last edi-
some of these have been worthy of inclusion. tion. What I do promise is that it will be the last edi-
The problems of diver safety, and the causes of tion for the original three authors. Already we have
deaths while diving, have not altered appreciably had to enlist the assistance of a younger, but very
over the past thirty-five years. The lessons from the experienced and skilled co-author, Dr Robyn Walker.
past have not been well learnt. Hopefully, and because of the enthusiasm, expert-
Nevertheless, the scope of diving medicine has ise and skills of our younger colleagues, we can with
increased, partly due to the wider range of divers - confidence pass the baton to them. Our legacy and
both psychologically and medically. It is also due to intent is that they will experience as much excite-
the extension of the diving envelope, including the ment, achievement, camaraderie and fun from div-
diving exposures and equipment available. ing as we have.
The final reason for producing a new edition is
the admission that the previous texts were incom- Carl Edmonds
plete in that they did not pay adequate attention to
Pretace (Excerpts from earlier Editions)
This book is written for doctors and paramedics who aspects of diving medicine from ancient history to
are called upon to minister to the medical needs of the latest research, in a concise and authoritative
those divers who venture on or under the sea. manner. Each disorder is dealt with from an histori-
The very generous praise given by reviewers to the cal, aetiological, clinical, pathological, preventative
first edition of Diving and Subaquatic Medicine, and and therapeutic perspective. Summaries, case histo-
its surprising acceptance outside the Australasian ries and revision aids are interspersed throughout.
region, inspired us to prepare further editions of this For the doctor who is not familiar with the world of
text. diving, introductory chapters on physics and physi-
Diving accidents are now better defined, investi- ology, equipment and the diving environments have
gated and treated, than when we commenced writing been included.
on this subject, some 30 years ago. It is our intent to In the later editions, we attempted to be less insu-
present, as completely as possible, an advanced and lar. Instead of an Australian book for Australians, we
informative book on clinical diving medicine. We sought the advice and guidance of respected friends
have avoided the temptation to write either a sim- and colleagues from other countries, and from other
plistic text or a research tome. disciplines, especially in the UK, USA, Canada, lapan
Our primary audience is the diving clinician, the and mainland Europe. This has not prevented us
physician responsible for scuba divers, the diving from being judgemental and selective when we
paramedic and the exceptional diving instructor deemed it fit. The inclusion of anecdotes and occa-
who needs a factual reference text. We have not sional humour may lessen the load on the reader - as
encompassed the needs of specialized deep or satu- it does on the authors.
ration diving units, submarine and military opera- This Third edition was to be the last of this text,
tions. But because good clinicians have a renaissance at least in its current format. One of the physicians
quality, refusing to accept the limitations of any spe- is more interested in diving the remote areas, than in
ciality, we have included some information on these writing about them. Another has moved into a spe-
subjects. cialist anaesthetic practice, and the scientist author
The recent extension of diving as a recreational is the sole survivor at the Royal Australian Navy Sub-
and as a commercial activity has led to the bewil- marine and Underwater Medicine Unit.
dered medical practitioner being confronted with To the speciality of diving medicine, to its coura-
diving problems about which he or she has received geous pioneers (many of whom are still bubbling
little or no formal training. Doctors experienced in and finning), and for the comradeship that diving
diving had previously found themselves in a similar has engendered, we shall be forever grateful.
situation — without a comprehensive clinical text.
This book encompasses the range of diving disor- Carl Edmonds
ders experienced by both the amateur scuba diver Christopher Lowry
and the professional deep-sea diver. It presents all John Pennefather