What is the bens: The Bends: Prevention, Symptoms & Treatment
Treating Decompression Sickness (The Bends)
Decompression sickness (DCS) is one of the most common problems reported to Divers Alert Network® (DAN®). Although scuba diving accidents are rare, it’s important to know how to handle suspected cases of DCS. Your ability to take appropriate action can make a difference in the life of someone you care about.
What is Decompression Sickness?
DCS, also known as the bends, describes a variety of injuries that result from inadequate decompression following exposure to increased pressure. This can occur following uneventful dives within accepted no-decompression limits but is more likely after dives that involve a rapid underwater ascent. DCS can also be prompted by ascending in an airplane too soon after diving. When there is a rapid decrease in surrounding pressure, nitrogen absorbed by the body at depth comes out of solution, creating bubbles in the bloodstream and/or body tissues.
Symptoms of DCS can occur immediately after surfacing or up to 24 hours later.
On average a diver with DCS will experience symptoms between 15 minutes and 12 hours following a dive.
Symptoms of DCS
- Unusual fatigue
- Itchy skin
- Pain in the joints and/or muscles of the arms, legs or torso
- Dizziness, vertigo and ringing in the ears
- Numbness, tingling and paralysis
- Shortness of breath
Signs of DCS
- Blotchy rash
- Muscle weakness or paralysis
- Difficulty urinating
- Confusion, personality changes or bizarre behavior
- Staggering
- Coughing up bloody, frothy sputum
- Collapse or unconsciousness
How to Treat a Diver with Suspected DCS
If you suspect a diver has DCS, provide emergency oxygen right away. Next, determine the severity of their condition (emergency, urgent or timely) by following the guidelines below:
Emergency DCS
A diver who is profoundly dizzy, intermittently conscious, weak, walking with an abnormal gait or having trouble breathing is experiencing a serious medical emergency.
Administer 100 percent oxygen, and arrange emergency evacuation to the nearest medical facility.
Always contact emergency medical services first, then contact DAN. Although a diver with severe DCS requires recompression, it is essential that he or she be stabilized at the nearest medical facility before transportation to a chamber.
Urgent DCS
A diver experiencing severe pain that is either constant or increasing should be placed on 100 percent oxygen and given fluids. The next step is to contact DAN or the nearest medical facility. Emergency air transportation may not be necessary in all cases. Do not give the diver analgesics (pain relievers) unless advised to do so by medical personnel.
After obtaining professional medical advice, conduct a neurological exam and write down as much information as you can about the diver’s recent diving activity. A neurological exam can be done by anyone; no medical experience or training is required. Simply follow the on-site neuro exam directions found here.
Ask the diver about any diving activities within the past 48 hours, including depths, times, ascent rates, surface intervals, breathing gas used and any problems experienced during or after the dives.
Obtain as much info as you can without delaying transportation to a medical treatment facility. If time allows, the following additional information may aid medical professionals with diagnosis and treatment:
- Symptom onset times and progression after the diver surfaced from their last dive
- A list of all first aid measures taken (including times and method of oxygen delivery) and their effect on symptoms
- A description of any joint or other musculoskeletal pain including location, intensity and changes based on movement or weight-bearing maneuvers
- Photos of any rashes with a detailed description of their location
- Information about any traumatic injuries sustained before, during or after the dive
Timely Cases of DCS
Divers who do not have obvious symptoms or whose symptoms develop slowly over multiple days may have a “timely” case of the bends.
Common signs and symptoms may include vague complaints of pain or abnormal sensations.
Follow the steps described previously under “Urgent DCS” to conduct a neurological assessment and collect information about the diver’s recent activity. Next, contact DAN or a medical professional, or go to the nearest medical facility for advice and further evaluation.
Denial: The Worst Symptom of DCS
Denial is arguably the worst “symptom” of DCS. Delayed treatment can lead to permanent injury and prolong (or even prevent) the diver’s full recovery. Emergency oxygen can cause symptoms to temporarily improve only to reappear later — it is no substitute for a medical evaluation. Always contact DAN or a medical professional with training in dive medicine in cases of suspected DCS — even if the symptoms and signs appear to have resolved.
Be Prepared, Get Insured
Dive accidents can happen to anyone, not just newly certified divers. According to a recent DAN Annual Diving Report, nearly 600 divers contacted DAN with concerns about DCS, and divers with 21-60 logged dives were the most likely to report a diving incident.
Learn more about the Top 5 Factors That Increase a Diver’s Risk of Getting the Bends.
Many medical insurance plans cover only the cost of hyperbaric treatments and not the cost of getting you to the chamber (the average cost for an air ambulance is around US$20,000). Ensure you have protection against the unexpected by purchasing DAN Dive Accident Insurance.
Join DAN
Business Executives for National Security
We match the best talent in business together with senior national security leaders to apply best practices and cutting-edge ideas to solve some of the Nation’s most complex and pressing national security challenges.
Maintaining the U.S. Defense Sector’s Competitive Edge
by Kurt Scherer and Fatih Ozmen
Read More
Who We Are
We are a nationwide network of elite business leaders who are united in the belief that private-sector expertise can assist the national security enterprise to ensure that the United States remains secure.
We are a trusted nonpartisan nonprofit with 40 years of experience bringing pro-bono private-sector executive talent to partner with the government’s national security agencies.
Project Areas
BENS Summary of the FY23 National Defense Authorization Act (NDAA)
The FY23 NDAA authorizes $858B for national defense. The FY23 Omnibus Bill also appropriated $858B for defense spending. The BENS team has summarized some of the key legislative provisions of relevance to BENS.
READ MORE
Podcasts
In-depth series featuring business and national security experts providing an insider’s perspective on today’s most vexing challenges facing our nation’s security.
Building the Base Episode 32: Mike Brown
The podcast features Lauren Bedula, Hondo Geurts, and Michael Brown discussing national security and public/private partnerships.
Mike Brown, a former…
BENS President and CEO, General Votel (Ret.) interviews BENS members for insights on national security trends and highlights public-private cooperation to solve security challenges.
Episode 20: Adam Leslie
Tune in to Episode 20 as General Votel talks with BENS member Adam Leslie about being a UH-1 helicopter gunship…
BENS MEMBER NEWS & EVENT RECAPS
Member News
BENS Southeast
July 16, 2023
Member News
BENS member, General Tim Ray
July 9, 2023
Member News
BENS member, Sherif Wahby
July 2, 2023
Event Recaps
Event Recaps – July 02, 2023
July 2, 2023
Member News
BENS Member David McDonald
June 25, 2023
Member News
BENS member Dr.
Rachel Kleinfeld
June 18, 2023
Member News
BENS member Jennifer Pritzker
June 18, 2023
Member News
Former BENS Vice Chair Josh Weston
June 18, 2023
Event Recaps
Event Recaps – June 18, 2023
June 18, 2023
Member News
BENS Member, Sam Meek
June 11, 2023
Receive BENS news and insights in your inbox.
GLOBAL News OF INTEREST
News
The West Again Learns That War Needs Industry
July 16, 2023
News
Nearly 40% of US Attack Submarines in or Awaiting Repair as Shipyards Face Worker Shortages, Supply Chain Issues
July 16, 2023
News
Europe’s Defense Dilemma: To Buy, or Not to Buy American
July 16, 2023
News
Chip Wars: How ‘Chiplets’ are Emerging as a Core Part of China’s Tech Strategy
July 16, 2023
News
‘Tech Watchlist’ Reveals Pentagon Vision of Future Digital Battlefield
July 16, 2023
News
Charting the Military’s Path Across the Technology Valley of Death Using Bar Napkin Math
July 16, 2023
News
NATO Summit Takes Aim at China
July 16, 2023
News
Defense Innovation Unit Teams with Companies on Space-Based Internet
July 16, 2023
News
Chinese Hackers Breach Email of Commerce Secretary Raimondo and State Department Officials
July 16, 2023
News
Us Firms Eye Ties With PH in Health, Digital, Energy Sectors
July 14, 2023
Upcoming Events
10
Aug
Luncheon w/VADM Robert S.
Harward, Jr., USN (Ret.)
Dallas, TX
Please join BENS members and guests in the Salon Room at Hotel Crescent Court on Thursday, August 10th, for a…
16
Aug
Luncheon on Social Media (San Antonio)
San Antonio, TX
Please join us for a luncheon discussion on for a discussion on how extremists from all ideologies benefit from social…
17
Aug
Luncheon on Social Media (Austin)
Austin, TX
Please join us for a luncheon discussion on for a discussion on how extremists from all ideologies benefit from social…
Past Events
12
Jul
Discussion w/NY Cyber Task Force
NY
Please join BENS for a luncheon conversation with the New York Cyber Task Force on Wednesday, July 12th. The task…
12
Jul
Discussion on FY24 Defense Budget with Seamus P.
Daniels, CSIS
Washington, DC
Please join BENS for a conversation on Wednesday, July 12th as we host Seamus P. Daniels, Fellow, Defense Budget Analysis…
11
Jul
SE Visit to Joint Special Operations University
Atlanta, GA
We will visit JSOU on Tuesday, July 11th from 12:00 pm – 4:45 pm (7708 Tampa Point Blvd, Tampa, FL…
Bence-Jones protein in urine, quantitative (urine immunofixation)
Detection of free light chains of immunoglobulins (Bence-Jones protein) in urine, used to diagnose monoclonal gammopathies, including multiple myeloma.
Synonyms Russian
Free light chains of immunoglobulins in urine, M-gradient.
Synonyms English
Bence-Jones protein, Urine (immunofixation)
Free light chains, Urine
Urinary FLC
Research method
Immunofixation.
Which biomaterial can be used for research?
Daily urine, mid-morning urine.
General information about the study
Bence-Jones protein is a group of monoclonal free immunoglobulin light chains that can be detected in urine or blood. Their appearance is characteristic of lymphoproliferative diseases such as multiple myeloma. This feature was first described by the English physician Henry Bence-Jones while examining a urine sample, which gave it its name. Subsequently, it became known that the Bence-Jones protein is, in fact, a homogeneous group of free light chains of immunoglobulins synthesized by a single plasma cell (monoclonal). The Bence-Jones protein is the collective name for monomers, dimers, tetramers, and other polymeric structures made up of immunoglobulin light chains.
Free chains of immunoglobulins are polypeptides with a molecular weight of 22 kDa, which are synthesized by plasma cells and, when combined with heavy chains, form immunoglobulin molecules of various classes: IgG, IgM, IgA and others.
Depending on the structure of the constant domain, two classes of light chains are distinguished – lambda (λ) and kappa (κ) chains. Each immunoglobulin can have only one class of light chains – either lambda or kappa. Normally, plasma cells synthesize more light chains than heavy chains. Light chains that are not included in the composition of immunoglobulins are called free. Free kappa chains generally exist as a monomer, are small in size, and are therefore relatively easy to filter into primary urine. Lambda chains, in contrast, usually exist in dimeric form, making them difficult to filter in the glomerulus. In rare cases, both kappa and lambda chains can form tetramers, large complexes of proteins that do not pass into the urine. Normally, almost all of the light chains that enter the renal tubules are reabsorbed, and only a small part of them is excreted in the urine (no more than 0.75-1.8 mg / l). The appearance of an excess of free light chains of immunoglobulins in the urine (the appearance of Bence-Jones protein) may indicate their excessive production by plasma cells (gammapathies) or a violation of the process of renal reabsorption (kidney disease).
Bence-Jones protein detection can be used to diagnose and monitor the treatment of these diseases.
Bence-Jones protein is determined in 50-70% of patients with multiple myeloma, 30-40% of patients with Waldenström’s macroglobulinemia and in 90% of patients with primary amyloidosis. Other conditions in which Bence-Jones protein can be observed in the urine are lymphoma, leukemia (more often chronic lymphocytic leukemia or plasma cell leukemia), pancreatic cancer, medullary thyroid carcinoma, benign gammopathy of unknown origin. In the absence of any reason for the appearance of this protein in the urine, they speak of idiopathic Bence-Jones proteinuria.
Free immunoglobulin light chains cannot be detected by routine urinalysis – special tests are used for this. As a rule, laboratory diagnostics for suspected gammopathy begins with conventional electrophoresis of plasma and urine proteins. This step is necessary to determine the concentration of the M-protein (paraprotein) and the initial differential diagnosis of gammopathy.
Electrophoresis, however, is not sensitive enough. For this reason, at the second stage of the examination, a more sensitive test is recommended – urine protein immunofixation. This avoids diagnostic errors, given that gammopathy may have a normal protein electrophoresis result. The immunofixation method allows not only to detect even a small amount of free light chains, but also to determine their class (lambda or kappa chains).
As a rule, a parallel analysis of both blood and urine is performed. This is due to some features of the excretion of light chains in gammopathy. For example, most patients with clinical signs of myeloma have more than 3 g of M-protein per dl of blood on serum electrophoresis. However, approximately 20% of patients have only a slight increase in M-protein (less than 1 g per dl of blood) or even a normal level of blood immunoglobulins. Urinalysis of these patients can detect increased excretion of light chains in the urine (this myeloma is often called Bence-Jones myeloma).
Thus, parallel analysis helps prevent diagnostic errors.
It should be noted that there is a special, rare form of myeloma in which light chains are not detected either in the blood or in the urine, either by electrophoresis or immunofixation (the so-called non-secreting multiple myeloma). To diagnose this form of myeloma, it is recommended to determine the ratio of free light chains of immunoglobulins λ and κ in blood serum.
Bence-Jones protein may also not be detected in urine early in the disease when excess free light chains can still be reabsorbed in the renal tubules (up to 1 g per day with normal kidney function), and in rare cases when free lungs chains form tetramers that are not filtered in the renal glomerulus.
False-positive results may occur with certain drugs (eg, high-dose aspirin and penicillin), chronic renal failure, or certain systemic diseases (rheumatoid arthritis, SLE, polymyositis).
Given these limitations of the immunofixation method, the interpretation of the results should be carried out taking into account additional anamnestic, laboratory and instrumental data.
What is research used for?
- For the diagnosis and treatment of monoclonal gammopathy (multiple myeloma, light chain disease, Waldenström’s macroglobulinemia).
When is the test ordered?
- If you suspect multiple myeloma and other diseases from the group of monoclonal gammopathy (multiple myeloma, light chain disease, Waldenström’s macroglobulinemia).
What do the results mean?
Reference values
Result: not found.
No paraprotein represented by kappa/lambda light chains.
Positive result:
- primary amyloidosis;
- monoclonal gammopathy of unknown origin;
- cryoglobulinemia;
- Fanconi syndrome;
- hyperparathyroidism;
- multiple myeloma;
- osteomalacia;
- Waldenström’s macroglobulinemia;
- medullary thyroid cancer;
- adenocarcinoma of the pancreas;
- lymphoma;
- leukemia;
- Bence-Jones idiopathic proteinuria.
Negative:
- normal;
- effective treatment of the disease.
What can influence the result?
- Disease stage: Bence-Jones protein may not be detectable in urine early in the disease;
- high doses of aspirin and penicillin may result in false positives;
- the presence of systemic diseases (rheumatoid arthritis, systemic lupus erythematosus, polymyositis) and chronic renal failure may lead to a false positive result;
- The presence of lambda or kappa light chain tetramers (not excreted in urine) may result in a false negative result.
Important notes
- Immunofixation of both urine and blood proteins is recommended;
- interpretation of the results should be carried out taking into account additional anamnestic, laboratory and instrumental data.
Also recommended
[06-004] Serum albumin
[06-035] Serum total protein
[06-038] Urine total protein
[08 -010] Total immunoglobulins G (IgG ) in serum
[08-011] Total immunoglobulins M (IgM) in serum
[06-011] Protein fractions in serum
[13-056] Immunofixation of blood serum immunoglobulins with antisera IgG, A, M K, L with quantitative determination of paraprotein
Who orders the examination?
Hematologist, oncologist, internist, general practitioner.
Literature
- NauKC, LewisWD. Multiple myeloma: diagnosis and treatment. Am Fam Physician. 2008 Oct 1;78(7):853-9. review.
- Levinson SS, Keren DF. Free light chains of immunoglobulins: clinical laboratory analysis. Clinic Chem. 1994 Oct;40(10):1869-78.
- Whicher JT, Hawkins L, Higginson J. Clinical applications of immunofixation: a more sensitive technique for the detection of Bence Jones protein. J Clin Pathol. 1980 Aug;33(8):779-80.
- Chernecky C. C. Laboratory Tests and Diagnostic Procedures / C.C. Chernecky, V.J. Berger; 5th ed. – Saunder Elsevier, 2008.
Brand history: 130 years of Mercedes-Benz
Illustrations courtesy of the press service of Mercedes-Benz RUS directly associated with the very concept of “car”. And this is justified at least by the historical significance of the brand: exactly 130 years ago, the German engineer Karl Benz officially filed a patent for a “vehicle with a gasoline engine.
”
The event that marked the beginning of the history of not only the German brand, but the entire global automotive industry, occurred on January 29, 1886. It was on this day that a German engineer and innovator named Benz received patent No. 37435 for his creation – the world’s first car with a gasoline engine.
Of course, Benz’s invention was very different from the modern image of the car: in fact, he installed a four-stroke engine he developed from scratch on a tricycle.
In the same year, independently of Benz, design engineer Gottlieb Daimler created his own motorized carriage. Daimler assembled a single cylinder four-stroke internal combustion engine. It was supposed to be installed in carriages. Daimler was assisted in the development of the new technology by engineer Wilhelm Maybach. Karl Benz, Gottlieb Daimler and
Wilhelm Maybach
Both engineers founded private companies with the help of partners and investors.
Benz founded Benz & Cie in Mannheim in October 1883, and Daimler founded the Daimler-Motoren-Gesellschaft (DMG) brand in November 1890. From 1901, Daimler’s company began to produce cars under the Mercedes brand.
The legendary brand got its name from the nickname of the daughter of the Austrian businessman Emil Jellinek named Adriana (Mercedes is the girl’s nickname). Her father, Honorary Vice Consul in Monaco, was wealthy and interested in modern technology. At his request in 189In the year 7, Gottlieb Daimler installed a 6 horsepower two-cylinder engine on a vehicle. After the success of this project, he ordered 4 more copies and sold them at a profit.
The same Mercedes She had a four-cylinder engine with a volume of almost 6 liters. and a power of 35 hp. The car was characterized by a wide wheelbase, a low center of gravity and an inclined steering column.
The honeycomb-type cooler has also become a distinguishing feature of the brand.
The car weighed 900 kg and had a top speed of 80 km/h. The model was designed by Wilhelm Maybach himself.
The first cars and engines of the Mercedes brand
The merger of the two most famous German manufacturers at that time took place in 1926. Thanks to the deal, the industrialists not only managed to survive in the difficult post-war period, but also significantly expanded their business.
The united concern was named “Daimler-Benz AG”, and another outstanding German designer Ferdinand Porsche became the first head, and later – the creator of another legendary Porsche brand.
All cars produced after the merger are named Mercedes-Benz, in honor of the company’s most successful car and its creator, Karl Benz.
The Daimler-Benz AG logo becomes a three-pointed star, which is framed by a wreath – the legacy of the Benz logo.
In the future, this wreath will be turned into a regular circle, which is still used today. One of the simplest (and recognizable) logos in history has become a symbol of luxury and wealth.
Mercedes logo
The partnership between Benz and Daimler proved to be one of the longest in the history of the automotive industry, as both companies in this combination survived until 1998. Their first car together was the K.
At the same time, the Mercedes CCK and SSKL were born, designed by Hans Niebel. In addition to the typical sports versions, the manufacturer also offers convertibles and production models with rally-adapted bodywork.
Daimler-Benz AG produces one legendary series after another. So, under the leadership of Ferdinand Porsche, the “S” series, a new generation of sports cars, appeared. The most famous car and the progenitor of the S-series was the car that was popularly nicknamed the “Death Trap”.
Having received the name “Mercedes-Benz 24/100/140”, the car had a powerful six-cylinder engine and developed a high speed for those times – up to 140 km / h.
The 18/80 HP model, known as the Nürburg 460 (1928), also received fame, equipped with an eight-cylinder engine with a displacement of 4622 cc. cm and a maximum power of 80 liters. With. at 3400 rpm; the 500K and 540K roadsters (30s) and the 770 model called Grosser Mercedes, whose first generation was built from 1930 to 1938. The model had a luxurious salon in which Adolf Hitler moved.
Advertising 770
The first model and mass production of the diesel Mercedes 260D was launched from 1936 to 1940. The 2.5 liter diesel engine had a power of 45 hp. With. Some of the cars of this brand were subsequently used by the German army.
World War II almost destroyed the Daimler-Benz AG business. All production facilities of the company were practically destroyed. Factories in Stuttgart, Sindelfingen and Mannheim literally turned into a pile of rubble.
In 1945, after the final meeting of the board of directors, a report was even issued, the result of which was the idea that the Daimler-Benz concern no longer exists.
However, despite all the difficulties, Daimler-Benz AG recovered quickly enough and in 1947 launched the 170 model, which had an engine capacity of 1767 m³, 4 cylinders and a power of 52 hp. With. A car that was completely different from previous models was the Mercedes 300 – a limousine formed on a frame with crossed beams. It was equipped with a three-liter six-cylinder engine with 115 hp. s., and its special version was created for the first
Among the vehicles produced by Mercedes-Benz after the Second World War, the 300 SL Coupe stands out with its characteristic winged doors that opened with part of the roof. It was the first sports car built after the war. The road version of this unusual vehicle was released in 1954.
Mercedes-Benz 300 SL Coupe
In February 1954, the 300 SL appeared.
March 1957 years began to produce the model 300 SL Roadster, beloved by Elvis Presley.
Cars produced in the 70-90s became iconic for the brand.
In 1975-1986, the Mercedes W123, popularly known as the “barrel”, was formed. In the 80s, the 190 model debuted, which was produced in the years from 1982 to 1993 and replaced by the C class. At the same time, the popular Mercedes W124 appeared, which was produced until 1997. After that, the W210 appears on the market, since 2002 it has been replaced by the W211, W212 versions. It is these models that are called class E.
Mercedes-Benz W211
In 1998, Mercedes buys back shares of the American company Chrysler. As a result, Daimler-Benz has gained a chance to get wider access to the US market. This agreement changed the corporate name of the company to Daimler Chrysler, the cooperation continued for almost 10 years. The decision to break off cooperation was influenced by the results of the poor financial condition of Chrysler.
After the sale of the shares of the American concern, the company returns the name Daimler AG.
Today, the company manufactures Mercedes Class A, B, C and E models. The brand’s modern cars are renowned for their safety and are still considered the most prestigious in the world. Mercedes S Class even entered the Book of Records as “the most durable car that has ever been released.”
Andrey Rodionov, Head of Corporate Communication at Mercedes-Benz RUS JSC
– When 130 years ago Karl Benz applied for a patent for a “vehicle powered by a gasoline engine” it meant the birth of the automobile. In the same year, Gottlieb Daimler created his own car. Thus began the 130-year success story of Mercedes-Benz, we entered the age of speed and the global automotive industry was born.
The patent became part of the UNESCO Memory of the World program, among such well-known works as the Gutenberg Bible, Magna Carta and Symphony No. 9 in D minor by J.
S. Bach. And it is no accident: the inventions of Karl Benz and Gottlieb Daimler, thanks to their ingenuity and entrepreneurial flair, revolutionized the field of transportation, opening up new opportunities for people.
Today’s innovations are based on the same values as 130 years ago: safety, comfort, efficiency and faith in success. Thanks to them, the brand demonstrates a dynamic growth in global sales, and in Russia in 2015 it is a confident leader in the premium segment. Mercedes-Benz delights its fans with the premieres expected in Russia – this is the new intelligent E-Class, the chic GLS, the sporty SL and SLC. And, of course, new special offers.
Mercedes-Benz ads have also always stood out for their trademark execution and creativity – the brand has never spared money on marketing.
Advertisement for the BlueEFFICIENCY system (the system is a technical solution for optimizing fuel consumption and emissions).