What are the main causes of decompression sickness. How can divers recognize the symptoms of “the bends”. What is the recommended treatment for decompression illness. Why is proper decompression so critical for scuba divers.

Understanding Decompression Sickness: A Diver’s Nemesis

Decompression sickness (DCS), commonly known as “the bends,” is a potentially life-threatening condition that can affect scuba divers, workers in pressurized environments, and even astronauts. But what exactly causes this condition, and why is it so dangerous?

At its core, decompression sickness occurs when dissolved gases, typically nitrogen, form bubbles inside the body as a result of rapid depressurization. This process can happen during ascent from a dive, leaving a pressurized work environment, or even flying at high altitudes in an unpressurized aircraft.

What causes decompression sickness?

The primary cause of decompression sickness is the rapid formation of gas bubbles in the body’s tissues and bloodstream. When a diver descends, the increased pressure causes their body to absorb more nitrogen. As they ascend, this dissolved nitrogen can form bubbles if the ascent is too rapid, leading to various symptoms and potentially severe health consequences.

Who is at risk for decompression sickness?

• Scuba divers
• Commercial divers
• Caisson workers
• Pilots and passengers in unpressurized aircraft
• Astronauts during spacewalks

While the incidence of decompression sickness is relatively low, with estimates suggesting about three cases per 10,000 dives for recreational scuba divers, the potential consequences make it a serious concern for anyone engaging in activities involving pressure changes.

Recognizing the Symptoms: When Bubbles Become Troublesome

Identifying the symptoms of decompression sickness is crucial for prompt treatment and prevention of serious complications. But what should divers and others at risk look out for?

What are the main symptoms of decompression sickness?

Decompression sickness symptoms can vary widely and may appear immediately after surfacing or up to 24 hours later. Common signs include:

• Joint pain, often called “the bends”
• Skin rashes or itching
• Fatigue and weakness
• Dizziness and vertigo
• Numbness or tingling sensations
• Confusion or memory problems
• Shortness of breath
• Paralysis or muscle weakness (in severe cases)

It’s important to note that symptoms can range from mild to severe and may worsen over time if left untreated.

How quickly do decompression sickness symptoms appear?

While many cases of decompression sickness present symptoms within the first hour after surfacing, it’s crucial to remain vigilant for up to 24 hours post-dive. Some divers may experience delayed onset of symptoms, which can be just as serious as those that appear immediately.

Types of Decompression Sickness: Understanding the Classifications

Decompression sickness is typically classified into two main types, each with its own set of symptoms and potential complications. But what distinguishes these types, and why is the classification important?

What are the two main types of decompression sickness?

Decompression sickness is categorized into Type I and Type II:

1. Type I DCS: This milder form primarily affects the skin, muscles, and joints. Symptoms may include joint pain (the classic “bends”), skin rashes, and lymphatic swelling.
2. Type II DCS: This more serious form involves the central nervous system, respiratory system, or circulatory system. Symptoms can include paralysis, sensory disturbances, dizziness, breathing difficulties, and shock.

Understanding these classifications helps medical professionals determine the appropriate treatment approach and assess the potential severity of the condition.

Risk Factors: Who’s More Susceptible to the Bends?

While anyone engaging in activities involving pressure changes can potentially develop decompression sickness, certain factors can increase an individual’s risk. But what are these risk factors, and how can divers mitigate them?

What factors increase the risk of decompression sickness?

Several factors can contribute to an increased risk of developing decompression sickness:

• Dehydration
• Presence of a patent foramen ovale (a heart defect)
• Previous injuries
• Cold ambient temperatures
• High body fat content
• Alcohol consumption
• Fatigue
• Age (older divers may be at higher risk)
• Multiple dives within a short period

By understanding these risk factors, divers and other at-risk individuals can take steps to minimize their chances of developing decompression sickness.

How can divers reduce their risk of decompression sickness?

While it’s impossible to completely eliminate the risk of decompression sickness, divers can take several precautions to reduce their chances of developing this condition:

1. Follow proper ascent rates and decompression stops
2. Use dive computers or tables to plan dives
3. Stay well-hydrated before and after diving
4. Avoid alcohol before and immediately after diving
5. Maintain good physical fitness
6. Allow adequate surface intervals between dives
7. Avoid flying or traveling to high altitudes for at least 24 hours after diving

By adhering to these guidelines, divers can significantly reduce their risk of experiencing decompression sickness.

Treatment Approaches: Addressing the Bubbles

When decompression sickness occurs, prompt and appropriate treatment is crucial to prevent long-term complications and potentially save lives. But what does treatment for decompression sickness involve, and why is time of the essence?

What is the primary treatment for decompression sickness?

The gold standard treatment for decompression sickness is recompression therapy using a hyperbaric chamber. This treatment involves:

1. Placing the patient in a pressurized chamber
2. Increasing the pressure to simulate the dive depth
3. Administering 100% oxygen
4. Gradually decreasing pressure to allow safe elimination of gas bubbles

Recompression therapy works by shrinking existing bubbles and allowing them to be reabsorbed into the bloodstream, alleviating symptoms and preventing further damage.

Why is immediate treatment crucial for decompression sickness?

Immediate treatment is essential because:

• It can prevent bubbles from causing permanent tissue damage
• It reduces the risk of long-term neurological complications
• Early intervention often leads to better outcomes and faster recovery
• Delayed treatment may result in more severe symptoms and longer recovery times

In cases where immediate access to a hyperbaric chamber is not possible, providing 100% oxygen and arranging rapid transport to a facility with recompression capabilities is crucial.

Prevention Strategies: Diving Safely and Smartly

While treatment options for decompression sickness have improved over the years, prevention remains the best approach. But what strategies can divers and others at risk employ to minimize their chances of developing this condition?

What are the key prevention strategies for decompression sickness?

Preventing decompression sickness involves a combination of proper planning, adherence to safety guidelines, and awareness of personal risk factors. Key prevention strategies include:

1. Proper dive planning and execution
2. Use of dive computers or tables to calculate safe ascent rates and decompression stops
3. Adherence to no-decompression limits
4. Gradual ascent rates (typically 30 feet per minute or slower)
5. Performance of safety stops, even on no-decompression dives
6. Adequate surface intervals between dives
7. Avoidance of factors that increase risk (e.g., dehydration, alcohol consumption)
8. Regular maintenance and proper use of diving equipment
9. Continuous education and training in dive safety

By implementing these strategies, divers can significantly reduce their risk of developing decompression sickness and enjoy safer underwater experiences.

How important is proper training in preventing decompression sickness?

Proper training plays a crucial role in preventing decompression sickness. Well-trained divers are:

• More likely to plan dives safely and adhere to decompression limits
• Better equipped to recognize and respond to potential problems underwater
• More aware of their personal limits and risk factors
• Capable of using dive computers and tables effectively
• Knowledgeable about emergency procedures and first aid for diving-related injuries

Investing in comprehensive dive training and staying up-to-date with the latest safety practices can significantly reduce the risk of decompression sickness and other diving-related injuries.

Emerging Research and Future Directions

As our understanding of decompression sickness continues to evolve, researchers are exploring new ways to prevent, detect, and treat this condition. But what are some of the most promising areas of research, and how might they impact divers in the future?

What new technologies are being developed to prevent decompression sickness?

Several innovative technologies and approaches are being explored to enhance diver safety and reduce the risk of decompression sickness:

• Advanced dive computers with more sophisticated decompression algorithms
• Wearable sensors to monitor physiological changes during dives
• Improved breathing gas mixtures to reduce inert gas loading
• Virtual reality simulations for enhanced dive planning and training
• Genetic testing to identify individuals with higher susceptibility to DCS

These advancements hold the potential to revolutionize dive safety and provide divers with more personalized tools to manage their risk of decompression sickness.

How might our understanding of decompression sickness change in the future?

Ongoing research is likely to enhance our understanding of decompression sickness in several ways:

1. Improved models of bubble formation and tissue interactions
2. Better understanding of individual susceptibility factors
3. Development of more effective treatment protocols
4. Insights into long-term effects of repeated decompressions
5. Advanced imaging techniques to visualize bubble formation in real-time

As our knowledge grows, we can expect more tailored approaches to dive planning, risk assessment, and treatment of decompression sickness, ultimately making diving safer for enthusiasts and professionals alike.

In conclusion, while decompression sickness remains a significant concern in diving and other pressure-changing activities, ongoing research and improved safety practices continue to reduce its incidence and severity. By staying informed about the latest developments and adhering to established safety guidelines, divers can minimize their risk and enjoy the wonders of the underwater world with greater peace of mind.

Decompression Syndromes: The Bends Treatment: First Aid Information for Decompression Syndromes: The Bends

Call 911 if the person has any of the following symptoms within an hour of surfacing from a dive:

• Confusion
• Severe dizziness
• Tingling or numbness of hands or feet
• Visual or speech disturbances
• Difficulty walking
• Signs of altered consciousness
• Trouble breathing
• Chest pain
• Unconsciousness

After calling 911 for immediate symptoms, take the following steps.

1. Administer CPR, if Necessary

• For a child, start CPR for children.
• For an adult, start adult CPR.
• Use supplemental oxygen while administering breathing, if available.
• Position the person on their left side in case the person vomits.
• Keep the person on 100% oxygen until help arrives.

2. Contact Divers Alert Network (DAN]

• Call 1-919-684-9111 or 1-919-684-4DAN (4326).  Experts can advise you and the medical facility on further treatment.

3. Watch for Symptoms if They Didn’t Appear Immediately

• Symptoms usually appear within 6 hours, but may appear later.

• Increasing joint or torso pain or other symptoms can cause severe long-term disability.

• If you have questions, call DAN at 1-919-684-9111 or 1-919-684-4326.

• Avoid flying, traveling to higher altitude, or diving for 12 to 24 hours.

4. If Symptoms Appear in the Next Few Hours

If the person has severe pain but no obvious neurological symptoms or other distress:

• Call 911 or go to a hospital emergency room.

• Put the person on 100% oxygen, if available, until you get medical help.

• Be prepared to provide information on dive(s), symptoms, and treatment already received.

5. If Symptoms Appear Later

If symptoms progress slowly or aren’t obvious for days:

• Call DAN or a medical facility for advice, or go to the nearest hospital for evaluation.

6. Follow Up

Hospital follow-up will depend on the severity of symptoms.

• The person will receive oxygen.

• The person may be placed in a recompression or hyperbaric chamber.

Decompression Sickness – StatPearls – NCBI Bookshelf

Continuing Education Activity

Decompression sickness (DCS) occurs when dissolved gasses (usually nitrogen or helium, used in mixed gas diving) exit solution and form bubbles inside the body on depressurization. DCS occurs from underwater diving decompression (ascent), working in a caisson, flying in an unpressurized aircraft, and extra-vehicular activity from spacecraft. Proper decompression procedures during diving can help decrease DCS. Experts have classified DCS as Type I with symptoms involving only the skin, musculoskeletal system, or lymphatic systems; and Type II with symptoms that involve the central nervous system. This activity reviews the presentation of decompression sickness and highlights the role of the interprofessional team in its management.

Objectives:

• Review the etiology of decompression sickness.

• Describe the presentation of decompression sickness.

• Summarize the treatment of decompression sickness.

• Outline the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by decompression sickness.

Access free multiple choice questions on this topic.

Introduction

Decompression sickness (DCS) occurs when dissolved gasses (usually nitrogen or helium, used in mixed gas diving) exit solution and form bubbles inside the body on depressurization. DCS occurs from underwater diving decompression (ascent), working in a caisson, flying in an unpressurized aircraft, and extra-vehicular activity from spacecraft. Proper decompression procedures during diving can help decrease DCS. Experts have classified DCS as Type I with symptoms involving only the skin, musculoskeletal system, or lymphatic systems; and Type II with symptoms that involve the central nervous system.

Etiology

DCS is bubble formation, growth, and elimination caused by a reduction in ambient pressure that results in inert gasses, usually nitrogen, that are dissolved in solution within tissues of the body. Individuals that breathe air in a pressurized environment reach a state of equilibrium/saturation of gas. This dissolved gas will be driven out of solution when leaving a higher-pressure environment to a lower pressure environment, such as ascending from depth during self-contained underwater breathing apparatus (SCUBA) diving, leaving a caisson worksite, or ascending to altitude in an unpressured aircraft. There are individual factors identified as possibly contributing to an increased risk of DCS. These include dehydration, patent foramen ovale,[1] previous injury, cold ambient temperature, high body fat content, and alcohol consumption. Type II decompression sickness (neurological symptoms) is thought to occur from right-to-left shunting of venous bubbles.[2]

Epidemiology

The incidence of decompression sickness, fortunately, is rare. Estimates for sports diving are three cases per 10,000 dives. The incidence among commercial divers can be higher ranging from 1.5-10 per 10,000 dives. As expected, the incidence depends on the length and depth of the dive.[3] The risk for DCS is 2.5 times greater for males than females.

Pathophysiology

The pathophysiology of DCS is due directly to the formations of bubbles coming out of solution. Tissue damage results from multiple mechanisms including blockage of blood flow and vascular spasm.[4] Gas bubbles also cause endothelial damage resulting in activation of the intrinsic clotting cascade with platelet activation. Inflammatory mediators are released and with increased endothelial permeability development of edema, which leads to tissue ischemia.[5]

History and Physical

The initial evaluation of a patient suspected of DCS should include a detailed history and physical exam. For a conscious patient, get the details of exposure, including onset, duration, and progression of symptoms. For a diver with DCS, it is vital to determine the patient’s dive profile and gas mix.[3] An ear exam should look for signs of barotrauma. The patient should have a detailed neurological exam. 

DCS occurs most frequently in the shoulders, elbows, knees, and ankles. Joint pain (“the bends”) accounts for most cases, with the shoulder being the most prevalent site. Neurological symptoms present in 10% to 15% of DCS cases with a headache and visual disturbances being the most common symptoms. Skin manifestations are a feature in about 10% to 15% of DCS cases. Pulmonary DCS (“the chokes”) is quite rare in divers and much less frequently seen in aviators because of oxygen pre-breathing protocols. Bubbles in the skin or joints result in mild symptoms, larger numbers of bubbles in the venous blood may cause lung damage, and bubbles involving spinal cord function may lead to paralysis, sensory dysfunction, or death. If there is a cardiac right-to-left shunt, (e.g., a patent foramen ovale), venous bubbles could potentially enter the arterial circulation, resulting in an arterial gas embolism.

DCS should be suspected if related symptoms occur following a drop in pressure within 24 hours of diving. The diagnostic confirmation is if the symptoms are relieved by recompression. Magnetic resonance imaging (MRI) or computed tomography (CT) can occasionally identify bubbles in DCS, but they are not good at determining the diagnosis and certainly cannot be used to rule out DCS.

Evaluation

DCS is a clinical diagnosis. As the goal for treating all patients with symptomatic DCS is hyperbaric oxygen (HBO), with emphasis placed on recompression, there should be no delay in treatment for further diagnostic workup. The one exception is a chest x-ray, as untreated pneumothoraces are an absolute contraindication for HBO.[3]

Treatment / Management

All decompression sickness cases should have initial treatment with 100% oxygen until HBO therapy is available. Neurological, pulmonary, and mottled skin lesions should be treated with HBO therapy even if seen several days after development. Fluid administration is indicated, as this helps minimize dehydration. The recommendation to administer aspirin is no longer valid, as analgesics may mask symptoms. Patient placement is in the supine position or the recovery position if vomiting occurs. The Trendelenburg position and the left lateral decubitus position (Durant’s maneuver) may be potentially beneficial if air emboli are suspected, but these positions are no longer recommended for extended periods, owing to concerns regarding cerebral edema. If the patient experiences an altered mental status or is unconscious, initial management should focus on the treatment and stabilization of ABCs, (airway, breathing, and circulation). Patients should receive HBO treatment as soon as possible.

Patients that need evacuation to a definitive treatment center by aeromedical transport should fly on pressurized aircraft. If unpressurized aircraft, such as helicopters, are the only means of transport then flight altitude should be limited to 300 m or 1000 ft if possible. [3]

Differential Diagnosis

Vertigo can indicate inner ear or vestibular decompression sickness wherein bubbles form in the perilymph fluid of the cochlea.[6] However, other diving-related causes merit consideration, as recompression and hyperbaric oxygen can cause worsening of some of these conditions. Inner ear barotrauma, in particular, would be a contraindication to compression as high-pressure gas may be forced into the cochlea causing further trauma on decompression. Alternobaric and caloric vertigo should be differentiated from decompression sickness by history. Cerebral arterial gas embolism affecting the midbrain or cerebellum can also present as inner ear decompression sickness but receives similar treatment.[1]

The differential diagnosis for divers should also consider that the stress of diving can exacerbate chronic medical problems. Consider cardiac disease for patients with chest pain and exacerbation of intrinsic lung disease for shortness of breath. Other considerations include pain from previous musculoskeletal injury and stroke and hypoglycemia for altered mental status.  Further concerns include drowning or near-drowning and thermal stress.[3]

Treatment Planning

There are a variety of hyperbaric chamber treatment protocols for decompression sickness. These differences are based on such things as the severity of the insult and the availability of oxygen. There are also in water recompression protocols. The usual US treatment protocol is a US Navy Treatment Table 6 done with oxygen pressurized to 2.8 atmospheres absolute (ATA). In water, recompression is a relatively high risk but is a consideration if there would otherwise be significant delays to treatment, logistical difficulties, or other problems. It requires appropriate training, equipment, and pre-planning. Immediate treatment at the surface with oxygen is beneficial for improving outcomes and decreasing recompression treatments.   

Treatment of DCS employing the US Navy Treatment Table 6 with oxygen at 18m is the standard of care. Significant delay to treatment, transportation difficulties, and facilities with limited experience may lead one to consider on-site treatment.  Surface oxygen for first aid is shown to improve the efficacy of recompression and decreased the number of recompression treatments required when administered less than four hours post-dive. In-water recompression (IWR) to 9m, breathing oxygen is one option that has shown success over the years. IWR is not without risk and requires certain precautions. IWR would only be suitable for an organized and disciplined group of divers with suitable equipment and practical training in the procedure.

Prognosis

Having had decompression sickness may place patients at increased risk for future similar events. Prognosis is severity dependent and also dependent on such factors as the time to recompression, availability and time to surface oxygen, and supportive care.

Complications

Decompression sickness can cause long-term damage. Central nervous system lesions in the spine and brain may occur.

Deterrence and Patient Education

The risk of decompression sickness is reducible in several ways. Divers should avoid flying within 24 hours after their last dive and longer no-fly periods may be required based on dive profiles and guided by decompression tables or computers. The use of oxygen-enriched gas can also ameliorate risk if used on “air tables.” Using a more conservative dive table or dive computer setting will likewise reduce risk. Isobaric decompression, breathing oxygen at depth, likewise can lessen the inert gas burden and reduce decompression sickness risk. 

Cold exposure, heavy exercise, recent alcohol use, and dehydration all increase risk and should be avoided. Preliminary research also shows that exercise several hours before diving may be protective while exercise after diving may increase the risk of DCS.[7]

Pearls and Other Issues

The treatment of DCS is with 100% oxygen, followed by recompression in a hyperbaric chamber.[8] In most cases, this will prevent long-term effects. However, permanent injury from DCS is possible. To prevent the excess formation of bubbles leading to decompression sickness, divers limit their ascent rate. The recommended ascent rate used by popular decompression models is about 10 meters (33 ft) per minute.

Enhancing Healthcare Team Outcomes

The management of patients with decompression sickness best done with an interprofessional team. Early identification and referral to a hyperbaric center are important for good outcomes from serious decompression sickness. In water, treatments need a well-trained and organized team approach.[9][10] Divers should have oxygen for immediate administration in the case of DCS. The Divers’ Alert Network provides referrals to hyperbaric facilities and 24/7 consultation with hyperbaric trained physicians and other providers.

References

1.

Livingstone DM, Smith KA, Lange B. Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care. Diving Hyperb Med. 2017 Jun;47(2):97-109. [PMC free article: PMC6147252] [PubMed: 28641322]

2.

Clarke JR, Moon RE, Chimiak JM, Stinton R, Van Hoesen KB, Lang MA. Don’t dive cold when you don’t have to. Diving Hyperb Med. 2015 Mar;45(1):62. [PubMed: 25964043]

3.

Pollock NW, Buteau D. Updates in Decompression Illness. Emerg Med Clin North Am. 2017 May;35(2):301-319. [PubMed: 28411929]

4.

Geng M, Zhou L, Liu X, Li P. Hyperbaric oxygen treatment reduced the lung injury of type II decompression sickness. Int J Clin Exp Pathol. 2015;8(2):1797-803. [PMC free article: PMC4396314] [PubMed: 25973070]

5.

Hall J. The risks of scuba diving: a focus on Decompression Illness. Hawaii J Med Public Health. 2014 Nov;73(11 Suppl 2):13-6. [PMC free article: PMC4244896] [PubMed: 25478296]

6.

Mitchell SJ, Doolette DJ. Pathophysiology of inner ear decompression sickness: potential role of the persistent foramen ovale. Diving Hyperb Med. 2015 Jun;45(2):105-10. [PubMed: 26165533]

7.

Madden D, Thom SR, Dujic Z. Exercise before and after SCUBA diving and the role of cellular microparticles in decompression stress. Med Hypotheses. 2016 Jan;86:80-4. [PubMed: 26804603]

8.

Chin W, Joo E, Ninokawa S, Popa DA, Covington DB. Efficacy of the U.S. Navy Treatment Tables in treating DCS in 103 recreational scuba divers. Undersea Hyperb Med. 2017 Sept-Oct;44(5):399-405. [PubMed: 29116694]

9.

Mitchell SJ, Bennett MH, Bryson P, Butler FK, Doolette DJ, Holm JR, Kot J, Lafère P. Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies. Undersea Hyperb Med. 2018 May-Jun;45(3):273-286. [PubMed: 30028914]

10.

Walker, III JR, Murphy-Lavoie HM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 15, 2021. Diving In Water Recompression. [PubMed: 29630272]

Bends | Encyclopedia.com

How is the Body Affected?

How Do Doctors Treat the Bends?

What Do Scuba Divers Need to Know?

Resource

The bends is a painful condition that occurs in scuba divers who ascend too quickly or in aviators flying at high altitudes. Also called decompression sickness, the bends results when bubbles from dissolved gases form in the blood or in tissues because of rapidly decreasing pressure.

KEYWORDS

for searching the Internet and other reference sources

Decompression sickness

Hyperbaric chamber

Scuba diving

The bends is also called decompression sickness or caisson* sickness. When a person is scuba diving, the water pressure increases with depth. As depth increases, the pressure of the air breathed also must increase. This causes more of the air to dissolve in the bloodstream.

* caisson

(KAY-son) means a watertight container that divers or construction workers use under water.

The main components of air are oxygen and nitrogen gases. Oxygen is continuously used by the body, but nitrogen is not used. When a diver ascends, the pressure decreases and the blood can no longer hold all the nitrogen dissolved in it.

If a diver ascends slowly, the nitrogen escapes into the lungs and is breathed out harmlessly. But if the diver ascends rapidly, the nitrogen forms bubbles in the blood that can lodge at joints such as the elbow or knee and cause pain. In severe cases, extreme pain causes the sufferer to double over, hence the common name “the bends.”

Symptoms of the bends usually show up within 90 minutes of diving but may take as long as two days. Minor cases cause itching, rash, joint pain, or skin discoloration. Severe cases cause symptoms such as extreme pain at the joints, headache, seizures, hearing problems, nausea and vomiting, back or abdominal pain, vision disturbances, or chest pain.

Minor cases of the bends usually require no treatment, although a doctor should be consulted. Treatment of severe cases, however, requires a hyperbaric (hy-per-BARE-ik) chamber, a device that creates pressure to redissolve the gas bubbles. The patient is placed under high-pressure conditions, and then the pressure is slowly decreased. Prompt treatment increases the chances for a complete recovery.

There are about 5 million people who scuba dive. Scuba divers must be certified and must take training classes, where they learn how to dive safely to avoid decompression sickness. The bends is a preventable condition when safety rules are followed strictly.

See also

Altitude Sickness

Marine Medical Systems, 84 North Main Street, South Norwalk, CT 06854. Marine Medical Systems posts a fact sheet about diving injuries and decompression sickness at its website. Telephone 800-272-3008 http://www.marinemedical.com/diving.htm

What Is Decompression Sickness or the Bends?

Understanding DCS

Decompression sickness — aka the bends — is one form of decompression illness. Simply put, it is an injury caused by gas bubbles occurring after a rapid ascent (though not always; read “An Unexplained Hit”).

Decompression illness affects scuba divers, aviators, astronauts and compressed-air workers. “The exact number of divers affected by DCS is not known,” says Petar Denoble, director of mission for the Divers Alert Network (DAN). “DAN data indicates that there may be about 1,000 cases of DCS per year among recreational divers in the USA and Canada.” DCS can strike randomly — often one diver will get bent while his or her buddy completes the dive injury-free, even though their profiles were identical.

That’s because there are other risk factors that may increase the chance of DCS occurring. The injured diver may have had a deep or long dive earlier, for example.

And even seasoned dive professionals can get bent. Just ask Jill Heinerth about her DCS experience while diving Dos Ojos in Mexico.

Here’s your body on a dive when you ascend too rapidly, according to DAN: The body’s tissues absorb nitrogen from the breathing gas in proportion to the surrounding pressure. As long as the diver remains at pressure, the gas presents no problem. If the pressure is reduced too quickly, however, the nitrogen comes out of solution and forms bubbles in the tissues and bloodstream. This commonly occurs as a result of violating or approaching too closely the diving table limits, but it can also occur even when accepted guidelines have been followed.

Bubbles forming in or near joints are the presumed cause of the joint pain of a classic DCS “hit.” When there are a lot of bubbles, complex reactions can take place in the body, usually in the spinal cord or brain. Numbness, paralysis and impaired cerebral brain may result. If great amounts of decompression are missed and large numbers of bubbles enter the venous bloodstream, congestive symptoms in the lung and circulatory shock can then occur.

In some cases, the injury is mild and not an immediate threat. In other instances, serious injury does occur; when this happens, the sooner treatment begins, the better the chance for a full recovery.

The good news is that even when treatment is delayed, the outcome can be positive. “In cases where recompression is done at the dive site within minutes, like in military and commercial diving, the rate of total symptom resolution appears higher,” says Denoble. “However, the data for cases treated hours after symptom onset is not so clear-cut. Most cases of DCS respond well to treatment despite delay of 24 or more hours.”

On the other hand, says Denoble, “some data indicates that in very severe cases the initial injury cannot be completely reverted and permanent injury remains despite early treatment.”

There is no guaranteed diagnosis for decompression sickness — a doctor can’t give a 100-percent diagnosis — because the symptoms aren’t always obvious. They can be confused with other injuries or medical conditions and easily written off as unrelated to diving. You may have to speak up and insist on being treated for DCS. Contact DAN or the nearest medical facility for advice.

What is Decompression Sickness and How Can You Treat it?

decompression sicknes should be treated with oxygen 2

Decompression sickness (DCS) also known as “the bends” is one of the few bad things that can happen to us as divers.

It might occur when you surface from a dive too fast, and the excess nitrogen in your body that has built up during the dive as a side effect of breathing air at a higher ambient pressure does not have time to be released from your body, but instead forms bubbles that will travel through your system, until they find a nice spot to nestle.

While definitely something to take into consideration, decompression sickness is not as common as you might think. It is also very easily avoided, as you might remember from your Open Water Diving course, in case you already are a certified diver.

Decompression sicknes should always be treated with oxygen

What causes Decompression Sickness?

During your open water course, you have looked at the primary cause for getting bent, which would be a rapid ascent, but there are many contributing factors that will make decompression sickness more likely.
Some of these you have to take into consideration during the dive.

Prevent seesaw diving patterns, also called yoyo diving, strenuous activity or stress during the dive, reaching your physical limits (think fighting a current, working, object recovery for when you finally found that treasure chest) or very deep dives and staying at depth for an extended period.

But also on land and before and after the dive, you can contribute to not getting decompression sickness by following the rules below.

• Dive well rested (especially if you are planning on doing one of those BIG dives on your bucket list!).
• Give yourself plenty of surface time in between dives to get rid of extra nitrogen.
• Maintain a reasonable level of fitness for the sort of diving you want to do, get a medical check-up regularly and stay hydrated.

Here are the main contributing factors to decompression sickness in a nutshell:

• Diving in cold water
• Taking part in a strenuous exercise at depth
• Deep diving for an extended amount of time

Although decompression sickness is dangerous, it is very rare, with around 1,000 divers a year in the US experiencing it in one form or another.

I have been working as a scuba instructor for many years and experienced very few cases of decompression sickness (I recall three in total. These three all occurred after multiple dives on multiple days and linked to inadequate hydration and a “bad” diving profile with a rapid ascent and/or no safety stop).

Since off-gassing is not an “exact science”, there is no way of telling if and when a diver will be affected. One day you come up a bit quick after a 30 m dive and you are fine, the next day, maybe not so, and you might experience one or more of the symptoms of decompression sickness.

The Symptoms of Decompression Sickness

If you or a fellow diver believes they are suffering from DCS, there are a few signs and symptoms that you should look out for.

These include:

• Pain in the joints
• Tingling, numbness or paralysis
• Fatigue
• Itchy skin or a blotchy skin rash
• Vertigo or dizziness
• Confusion and personality changes
• Amnesia
• Unconsciousness

These symptoms can appear within 15 minutes of surfacing from the dive, however, in some cases, they can take up to 24 hours to appear. In very rare situations symptoms can show after 24 hours although this almost always happens after a period of air travel. You should also remember and respect the rules regarding diving and flying at all times.

How to Prevent Decompression Sickness?

As serious as decompression sickness is, it can be prevented if you dive conservatively, avoid a seesaw dive pattern, dive well within your physical limits and make sure to take a safety stop at 5 meters for the required amount of time (usually three minutes).

If you are deep diving, you will need to take safety stops at various depths to ensure the nitrogen is removed from your body in the safest manner. You should also limit the amount of time that you spend at depth, especially in cold water and avoid strenuous activity.

To prevent a rapid ascent, you should make sure that you do not inflate your BCD, lose your weight belt or do anything else to increase the rate at which you travel up to the surface.

Also read: Why You Should Never Miss A Safety Stop?

How Should You Treat Decompression Sickness?

All forms of decompression sickness, no matter how severe should be treated in a decompression chamber (hyperbaric chamber) not by re-descending and ascending again!

In-water recompression can make things worse and is never a good idea! Early oxygen first aid should also be administered and in some situations, this can reduce the symptoms of DCS substantially. If symptoms are reduced after oxygen administration, continue giving oxygen since this confirms a decompression sickness!

After coming out of the water, the severity of the DCS should be determined where possible as this will determine the amount of oxygen needed and the urgency of getting them to a decompression chamber.

The closest decompression chamber should be notified as soon as possible. Depending on the severity of decompression sickness, divers will receive treatment and then be advised as to how long they have to stay out of the water – this will be at least two weeks.

There should be an oxygen kit with various masks and a trained oxygen provider on all dive boats, who will be able to help you in the unlikely event you might get decompression sickness. But nevertheless, you should check when speaking to the dive center for the first time.

Do you have any experience with decompression sickness? Let us know in the comments below

This article is written by RUSHKULT, the online booking platform for Scuba Diving. Visit the RUSHKULT platform to book your next Scuba Dive training, guided trip, and accommodation.

Air or gas embolism – NHS

Air or gas embolism in scuba divers

It can happen if a scuba diver:

• spends too long underwater
• surfaces too quickly
• holds their breath as they come up

Air can escape from the lungs into the blood vessels (arterial gas embolism) or nitrogen bubbles can form in the blood vessels (decompression sickness or “the bends”).

Air or gas embolisms can cause serious and potentially fatal conditions, such as a stroke or heart attack.

Call 999 and ask for an ambulance if you or someone you’re with feels unwell after scuba diving and you suspect an air or gas embolism.

Symptoms of an air or gas embolism after diving

Symptoms of an air or gas embolism after diving include:

You may not have these symptoms immediately. They can develop within 10 to 20 minutes or sometimes even longer after surfacing. Do not ignore these symptoms – get medical help immediately.

Getting medical help

Call 999 and ask for an ambulance if you or someone you’re with feels unwell after scuba diving.

A diver with a suspected air or gas embolism should be transferred to an A&E department as soon as possible.

They should be laid down flat and given 100% oxygen until they reach hospital. Once stabilised, they’ll be taken to a pressurised room called a hyperbaric chamber, either at the hospital or at another location.

Why diving can lead to an air or gas embolism

If a diver surfaces too quickly, nitrogen bubbles can form in their tissues and bloodstream. This is often referred to as decompression sickness or “the bends”.

Surfacing too quickly or holding your breath while you swim to the surface can cause the air in your lungs to expand. This may rupture lung tissue (pulmonary barotrauma), which can lead to gas bubbles being released into the arterial circulation (arterial gas embolism).

In some divers, underlying conditions can increase the chance of decompression sickness. These should be discussed with a doctor who specialises in diving medicine.

If the gas bubble blocks an artery, it can cut off the blood supply to a particular area of the body.

The seriousness of the blockage depends on which part of the body is affected, the size of the gas bubble and the amount of inert gases (unreactive gases) within the diver’s tissues.

An air or gas embolism can cause different problems depending on where the blockage is:

These conditions are very serious and can be fatal, particularly if the air embolism is not treated quickly.

Treating an air or gas embolism caused by diving

After a diver with an air or gas embolism has received emergency medical attention and their condition has stabilised, they’ll be transferred to a hyperbaric chamber.

A person being treated in a hyperbaric chamber

Credit:

They’ll need to lie in the hyperbaric chamber for several hours, breathing a mixture of gases and oxygen in a pressurised environment. The high pressure restores normal blood flow and oxygen to the body’s tissues, and reduces the size of the air bubbles in the body.

In cases of decompression sickness, the pressure forces the bubbles of nitrogen to dissolve into the bloodstream.

The pressure in the chamber is then gradually reduced to allow the gases to leave the body, mimicking slowly surfacing from a dive.

Depending on the severity of symptoms, treatment may need to be continued for several days.

Preventing an air or gas embolism while diving

To reduce your risk of getting an air or gas embolism when diving you should:

• limit the depth and duration of your dives
• always surface slowly and perform safety stops to allow any air in your tissues and blood vessels to escape safely; use a dive computer or dive tables to maintain a safe rate of ascent, and do not dive again until you’ve spent a suitable amount of time at the surface
• relax and breathe normally as you ascend
• do not dive with a cold, cough or chest infection
• avoid vigorous exercise before, during and after a dive
• make sure you’re well hydrated before diving
• leave adequate surface intervals between dives (if planning several dives) to allow the nitrogen to leave your body
• wait 24 hours after diving before flying or going to a higher altitude

The British Sub-Aqua Club (BSAC) has more information about diving safety

Other causes of air or gas embolisms

Although uncommon, it’s possible to get an air or gas embolism during surgery, some medical procedures, and when ascending to a high altitude.

In hospitals and health centres, care should be taken to prevent air embolisms by:

• removing air from syringes before injections and from intravenous lines before connecting them
• using techniques when inserting and removing catheters and other tubes that minimise the risk of air getting into blood vessels
• closely monitoring patients during surgery to help ensure air bubbles do not form in their blood vessels

Air embolisms caused by surgery, anaesthesia or other medical procedures can be difficult to treat. Treatment is usually needed to support the heart, blood vessels and lungs.

For example, fluids may be used to treat a fall in blood pressure, and oxygen may be given to correct reduced oxygen levels. Treatment in a hyperbaric chamber is occasionally needed in these cases.

Molecular changes in white blood cells can he

For over a century, researchers have known about “the bends”, a serious condition affecting scuba divers. However, we still know relatively little about its physiological basis. Doctors do not yet have a definitive test for the bends, instead relying on symptoms to diagnose it. A new study in Frontiers in Physiology is the first to investigate genetic changes in divers with this condition, finding that genes involved in inflammation and white blood cell activity are upregulated. The findings cast light on the processes underlying the bends, and may lead to biomarkers that will help doctors to diagnose the condition more precisely.

The bends, more formally known as decompression sickness, is a potentially lethal condition that can affect divers. Symptoms include joint pain, a skin rash, and visual disturbances. In some patients, the condition can be severe, potentially leading to paralysis and death.

Researchers have known about the condition for a long time. A paper published in 1908 correctly hypothesized that it involves bubbles of gas forming in the blood and tissue because of a decrease in pressure. However, despite this, researchers do not yet fully understand the precise mechanisms underlying the condition. Animal studies have suggested that inflammatory processes may have a role in decompression sickness, but no-one had studied this in humans.

Divers have developed methods to reduce the risk of the bends, including controlled ascents from the depths, and it is now relatively rare. However, for suspected cases, doctors have no way to test for the condition, and instead rely on observing symptoms and seeing whether patients respond to hyperbaric oxygen therapy, which involves breathing oxygen at high pressures.

To investigate the basis of decompression sickness, the researchers behind this new study took blood samples from divers who had been diagnosed with decompression sickness and divers who had completed a dive without developing the condition. The researchers took blood samples at two distinct times: within 8 hours of the divers emerging from the water, and 48 hours afterwards, when the divers with decompression sickness had undergone hyperbaric oxygen treatment. They performed RNA sequencing analysis to measure gene expression changes in white blood cells.

“We showed that decompression sickness activates genes involved in white blood cell activity, inflammation and the generation of inflammatory proteins called cytokines,” explained Dr Nikolai Pace of the University of Malta, a researcher involved in the study. “Basically, decompression sickness activates some of the most primitive body defense mechanisms that are carried out by certain white blood cells.”

Interestingly, these genetic changes had diminished in samples taken at 48 hours after the dive, after the patients had been treated with hyperbaric oxygen therapy. The findings provide a first step towards potentially developing a diagnostic test for decompression sickness, and may also reveal new treatment targets.

“We hope that our findings can aid the development of a blood-based biomarker test for human decompression sickness that can facilitate diagnosis or monitoring of treatment response,” said Prof Ingrid Eftedal of the Norwegian University of Science and Technology, who was also involved in the project. “This will require further evaluation and replication in larger groups of patients.”

###

Journal

Frontiers in Physiology

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Road Clinical Hospital

Stroke (infarction) of the brain – a sudden closure of the lumen of the arteries of the brain, leading to the death of its individual sections, is the third most frequent cause of death in the developed countries of the world. Strokes are ischemic – against the background of spasm or sudden closure of the lumen of the artery by a thrombus, and hemorrhagic – due to hemorrhage in the brain tissue, for example, when an artery bursts against the background of a hypertensive crisis.About 80% of ischemic strokes occur due to damage to the carotid or vertebral arteries. The most common narrowing of the carotid arteries by atherosclerotic plaques. The second place is occupied by kinking of the carotid and vertebral arteries.
Narrowing (stenosis) of the carotid artery – occurs due to the formation of an atherosclerotic plaque in the lumen of the artery. As a result, the blood flow through the artery decreases, its turbulence occurs, which contributes to thrombosis of the artery and the development of cerebral stroke in the blood supply of this artery.In addition, under stressful loads, a stroke can occur due to blood redistribution and, as a result, a lack of blood flow through the affected artery without its thrombosis. The third cause of stroke in atherosclerosis is the transfer of pieces of disintegrating atherosclerotic plaque (embolism) and blockage of small vessels of the brain with their thrombosis.
Pathological tortuosity (kinking) of the artery leads to a sharp disruption of blood flow. With hypertension, the carotid or vertebral arteries are lengthened, bends are formed at an acute angle.Blood has difficulty passing through the kinked artery, and symptoms of chronic cerebrovascular insufficiency develop. During a hypertensive crisis, the lumen of the artery can bend completely, which leads to an acute violation of cerebral circulation. The most common cause of vertebrobasilar insufficiency is pathological tortuosity of the vertebral arteries.
With stenosis and occlusion (complete closure of the lumen) of the subclavian artery with atherosclerotic plaques, the patient develops pain in the arm during exercise and persistent dizziness, since the blood supply to the arm begins to occur by stealing the arterial blood flow in the brain.This condition is called Steel Syndrome. It is dangerous by the development of ischemic stroke in the posterior parts of the brain.

Consequences.

Circulatory disorders in the brain often end in the development of ischemic stroke and lead to the development of irreversible paralysis of the extremities and disability of the patient, and sometimes to death.
Any disorders of cerebral circulation, including transient or transient ischemic attacks, should be the reason for a detailed examination of the main arteries supplying the brain.In the countries of Western Europe, in the last 20 years, there has been a persistent trend towards a decrease in the incidence of ischemic stroke, which indicates the success of diagnosis and the correct approach to prevention. Every year in Western Europe and the United States, hundreds of thousands of operations are performed to remove plaque from the carotid arteries, which has led to a significant decrease in the disability of the population from strokes. Unfortunately, this cannot be said about Russia. Very often, a vascular surgeon is called to an already paralyzed patient, when complete thrombosis of the carotid artery occurs, part of the brain tissue has died and the situation cannot be corrected.

Treatment.

Indications for performing reconstructive operations on the main arteries of the head are:
• Atherosclerotic plaque, narrowing the carotid artery by 70% or more in the presence of signs of cerebral circulation insufficiency or stroke in the area of ​​blood supply to this artery;
• Pathological tortuosity of the carotid arteries, in the presence of signs of cerebral circulation insufficiency or stroke;
• Atherosclerotic plaque or kinking in the vertebral artery in the presence of symptoms of vertebrobasilar insufficiency and the absence of other causes of neurological disorders;
• Atherosclerotic plaque, narrowing the carotid artery by 70% and without signs of cerebral circulatory insufficiency, but if surgery is necessary on the heart or abdominal aorta.There are 2 types of operations for stenosis of the carotid arteries – open (carotid endarterectomy) and endvascular (balloon angioplasty and stenting of the carotid artery). Both operations are performed in our department.
With pathological tortuosity of the carotid artery, an open operation is performed – under general anesthesia, a tortuous vessel is isolated, after the imposition of vascular clamps, its modified part is removed, so that after stitching the ends of the artery, a straight vessel without bends is obtained.
In case of stenosis and occlusion (complete closure of the lumen) of the subclavian artery, the patient is offered surgical treatment – open or endovascular surgery.These are carotid-subclavian shunting or balloon angioplasty and stenting of the subclavian artery. These operations allow to restore blood circulation in the hand, eliminate dizziness and eliminate the risk of developing a stroke.

Treatment provided by: Department of Vascular Surgery

Pathological tortuosity of the carotid arteries – glossary of terms

Pathological tortuosity is a deformation of the carotid artery, while the artery can take the shape of the letter “C” (C-shaped tortuosity), the shape of the letter “S” (S-shaped tortuosity) and even form loop (see.on the picture). Most often, pathological tortuosity of the internal carotid artery is observed (Figure 2), less often the common carotid artery is deformed (Figure 1).

• Figure 1. Pathological tortuosity of the common carotid artery.
• Figure 2. Pathological tortuosity of the internal carotid artery.

How is it manifested?

There are no specific symptoms for this pathology. Such patients usually turn to a neurologist with complaints of headaches, dizziness, memory loss, etc.But often this disease can proceed without any symptoms and is a diagnostic finding when performing screening ultrasound of the carotid arteries.

What is the danger of pathological tortuosity of the carotid arteries?

The carotid artery supplies the brain with blood. With tortuosity of the carotid arteries, it can bend, which ultimately can lead to disruption of the blood supply to the brain. In the area of ​​inflection, microthrombus formation is possible, which can come off and clog the lumen of the cerebral arteries.Violation of cerebral blood supply provoke the above complaints. In the worst case, through this artery, blood will not flow to the brain and a stroke will occur.

Why is it developing?

This pathology is associated with a congenital feature of the structure of the arterial wall. In the presence of risk factors, deformation of the arterial wall occurs. The main risk factor is high blood pressure. Pathological tortuosity of the carotid arteries often develops in women, less often in men, over the age of 40, suffering from hypertension.Therefore, it is important to monitor your health and control your blood pressure.

What treatment?

When the tortuosity is significant (artery bending or looping occurs), in the presence of complaints, an operation is performed: the artery is cut off, straightened, its excess is excised, then it is sutured again. This operation helps to avoid a rather serious complication – a stroke.

Carotid artery surgery has helped millions of patients to avoid strokes. Do not risk your health, see your doctor on time.Remember, your health depends on you.

Posture disorder – center of Dr. Bubnovsky

Health is happiness, it is worth and should be fought for.

In determining human health, an important place is occupied by posture, which is determined by the state of the skeleton, muscles, ligaments, the state of the nervous and psychoemotional systems. Posture formation begins in early childhood and continues until the completion of bone growth (16-18 years).

POSTURE DISORDER OR SCOLIOSIS?

Differential diagnosis of symptoms of postural disorder with manifestations of scoliosis is not an easy task.But already at the stage of the initial examination, an experienced doctor is able to solve it.

Poor posture is an asymmetric posture, that is, a functional unstable deviation of the spine in the frontal plane, which is easily corrected by straining certain muscle groups.

The term “scoliosis” is from the Greek. skoliosis (curvature) was introduced by the classic of ancient medicine K. Galen (2nd century AD) – this is a relatively persistent lateral curvature of the spinal column followed by rotation (twisting) of the vertebrae around the vertical axis.

Changes in the spine during the development of scoliosis entail deformation of the ribs and the chest as a whole, its shape changes, and the interposition of internal organs is disrupted. Further, this leads to the development of scoliotic disease, which is accompanied by a disruption in the activity of the cardiovascular and respiratory systems, and neurological complications are not uncommon.

Children with developing scoliosis experience serious discomfort associated with back pain, with age the child becomes apathetic, shy, negative emotions arise in relations with peers and parents, an inferiority complex is formed.

The key point in the correction and prevention of the development of scoliosis is early detection and complex conservative treatment, which should be prescribed immediately after diagnosis and carried out systematically for a long time until the end of the child’s growth (16-18 years).

The criteria for early diagnosis of postural disorders and the development of scoliosis, which the doctor fixes during the examination and which parents can pay attention to, are:

• When examining a child, front view: asymmetry of the contours of the chest, waist triangles, determine if there is a difference in the length of the legs.
• On examination, side view: the state of the physiological curves of the spine is determined (thoracic kyphosis – posterior bending, cervical and lumbar lordosis – anterior bending).
• When viewed from the back: allows you to identify the asymmetry of the shoulder girdle, the position of the shoulder blades, waist triangles, gluteal folds, there are other landmarks.
• Palpation during examination allows the doctor to determine the presence of stability and severity of asymmetry phenomena, muscle tone and the position of the spinal column in the frontal plane.

The Adams test (forward tilt of the trunk) is important during examination, which allows to determine the functional state of the physiological curves of the spine and gives an idea of ​​the degree of the rotational component (twisting), which is one of the signs of the development of scoliosis.

“FLAT BACK” (smoothness of the physiological curves of the spine) already in the early stages of a child’s development, allows one to suspect the initial manifestations of typical scoliosis.

“ROUND BACK”, as a rule, increased thoracic kyphosis, allows you to pay attention to the possibility of atypical development of scoliosis.

All of the above allows us to define scoliosis as a persistent three-plane deformity of the spine, and a doctor diagnosing scoliosis in a child who has come with parents and their complaints of poor posture can promptly prescribe an adequate treatment regimen.

Similar correctional and prophylactic programs have been developed and are successfully applied at the “Center for Rehabilitation and Kinesitherapy of Dr. S.M. Bubnovsky “. The basis of these programs is the development of an individual optimal static-dynamic stereotype for a person. In addition, physical exercises have a general stimulating effect on the child’s body, improve metabolic processes, blood supply to the muscles of the back and spinal column. Thus, they create physiological conditions for stabilizing the spine and correcting the pathological process.

Specially selected equipment, a set of exercises, taking into account individual characteristics under the supervision of a doctor and an instructor, allow you to work out deep muscles without axial load on the spine, create your own corset, for the normal physiological development of the spine, or keep the spinal column in the position of maximum correction.

Neurologist, kinesitherapist Andrey Ivanovich Basenko

Correction of kyphoscoliotic deformity of the spine

Over a long period of the existence of the disease, many methods of scoliosis correction, both conservative and operative, have been tested. In recent years, there has been a significant leap forward in the treatment of this disease.

Complex conservative treatment is effective only in the initial stages of scoliosis of 1-2 degrees.Conservative therapy includes unloading the spine, therapeutic corrective gymnastics, massage, physiotherapy procedures, corset therapy.

Surgical treatment is carried out in patients with progressive scoliosis of the 2nd degree and in all patients with 3-4 degree of deformity. Currently, a significant number of surgical techniques have been proposed aimed at eliminating curvature and stabilizing the spine. During the operation, the spine is fixed with metal rods.

Indications for surgical treatment:

• deformations of 40º and more (according to Cobb),
• documented progression,
• torso imbalance,
• cosmetic defect,
• pain syndrome,
• cardiopulmonary dysfunction,
• the patient’s desire.

The goals of surgical treatment of scoliosis: feasible correction of deformity in three planes, cessation of the progression of curvature, normalization of appearance, achievement of balance of the trunk in the frontal and sagittal planes.

A common tactic for adolescent mobile deformities up to 75 ° is a one-stage dorsal intervention; for severe and rigid scoliosis – two-stage corrections. With a two-stage correction, the first stage involves discectomy at the apex of the deformity; at the second stage, dorsal correction.The technique with simultaneous implementation of multilevel discectomy and dorsal correction is also used.

Multilevel discectomy and dorsal correction (one- or two-stage) is accompanied by extensive tissue trauma, profuse blood loss, pronounced cosmetic defect of the chest.

At the Center, the kyphoscoliotic deformity of the spine is corrected using endoscopic techniques. This technique was developed in the mid-90s, which led to a decrease in the invasiveness of interventions, made it possible to more thoroughly perform surgical correction.With standard thoracotomy, the apex of the curvature of the spine is well visualized, but access to the underlying and overlying intervertebral spaces is difficult, which affects the results of operations. The introduction of endoscopic techniques avoids this disadvantage.

In thoracoscopic spine surgeries, thoracoscopic release of the anterior spine and thoracoscopic ventral correction are performed using specialized instrumentation.

The operation is performed under endobronchial intubation anesthesia, in a lateral position opposite to the curvature, by access through 3-4 thoracoports along the middle and posterior axillary lines at the apex of the deformity after labeling the skin under image intensifier control.Discectomy is performed at the apex of the deformity (2-4 intervertebral discs) under direct thoracoscopic assessment using instrumentation. In order to achieve anterior fusion, the interdiscal space is filled with a funnel and an impactor with a synthetic granular graft, the defined and constant size of the cells of which ensures a quick and reliable achievement of anterior fusion, and the plasticity of the material prevents it from entering the pleural cavity during dorsal correction.

At the second stage of the operation, in the prone position of the patient, skeletonization of the spine, segmental installation of the system elements, derata tion maneuver and correction with fixation of the spine using specialized instrumentation are performed. The installation of the systems is complemented by postero-lateral fusion, in which grafts are used.

Bed rest after surgery – 3-5 days, which is significantly less than when using thoracotomy. Patient verticalization is carried out on the 4th-5th day.External fixation is not used in the corset. Discharge home – on the 14th day after the operation.

Examples:

1) Patient C. Born in 1998. Was undergoing treatment in the children’s department of the FGBU “FTsTOE” of the Ministry of Health and Social Development of Russia (Cheboksary) with a diagnosis of Idiopathic right-sided thoracic lordoscoliosis of severe (IV) degree with lumbar antiarrice. 3c Lenke type.

Treatment performed: Operation 10/12/2011: Thoracoscopic mobilizing discectomy at the apex of the deformity, anterior fusion.Correction of scoliotic deformity with a double-rod dorsal multi-support CD system. Posterior fusion.

Verticalized on the 4th day. After surgical treatment, a normal sagittal profile was formed, a satisfactory correction was achieved (radiographically – correction of the thoracic arch from 68 ° to 10 °, correction of the lumbar arch from 62 ° to 0 °), the body balance was normalized, there were no sensory and motor disorders.

DO:

AFTER:

2) Patient L.Born in 1993. Was undergoing treatment in the children’s department of the Federal State Budgetary Institution “FTsTOE” of the Ministry of Health and Social Development of Russia (Cheboksary) with a diagnosis of Idiopathic right-sided thoracic lordoscoliosis 3 tbsp. 1a-type Lenke.

Treatment performed: Operation 09/27/2011: Correction of scoliotic deformity with a double-rod dorsal multi-support CD system using the technique of true derotation. Posterior fusion.

Verticalized on the 4th day. After surgical treatment, a normal sagittal profile was formed, a satisfactory correction was achieved (X-ray – correction of the thoracic arch from 55 ° to 10 ° with complete elimination of rotation), the body balance was normalized, there were no sensory and motor disorders.

DO:

AFTER:

3) Patient M. born in 1993. Was undergoing treatment in the children’s department of the FGBU “FTsTOE” of the Ministry of Health and Social Development of Russia (Cheboksary) with a diagnosis of Pathological thoracic kyphosis due to Scheuerman-Mau disease.

Treatment performed: Operation 10/17/2011: Thoracoscopic mobilizing discectomy at the apex of the deformity anterior fusion. Smith-Petersen osteotomy, correction of kyphotic deformity with a double-rod dorsal multi-support CD system.Posterior fusion.

Verticalized on the 4th day. After surgical treatment, radiographically, the magnitude of the thoracic kyphosis decreased from 85 ° to 38 °, which is a physiological norm, clinically – the correction is satisfactory, the sagittal balance is achieved, there are no sensory and motor disorders.

DO:

AFTER:

4) Patient O. born in 1998. Was undergoing treatment in the children’s department of the Federal State Budgetary Institution “FTsTOE” of the Ministry of Health and Social Development of Russia (St.Cheboksary) with a diagnosis of Idiopathic juvenile right-sided thoracic lordoscoliosis 4 tbsp. 1c-type Lenke.

Treatment performed: Operation 05/11/2011. Thoracotomy. Mobilizing discectomy at the apex of the deformity, anterior fusion. Correction of scoliotic deformity with a double-rod dorsal multi-support CD system. Posterior fusion.

Verticalized on the 4th day. After surgical treatment, a normal sagittal profile was formed, a satisfactory correction was achieved (radiographically – correction of the thoracic arch from 75 ° to 15 °), the body balance was normalized, there were no sensory and motor disorders.

DO:

AFTER:

Posture disorders in children – Rod

Poor posture is a very common problem in today’s children.

Depending on the causes and symptoms, several diseases are distinguished, which, fortunately, can be cured by regular exercise therapy!

Kyphotic posture

This posture presents a deformed spine in the thoracic region with a posterior bulge in the sagittal plane.It is also called round back syndrome.

Signs and Symptoms:

• Narrowing of the chest

• Head tilt forward

• Reflex protrusion of the abdomen

• Shoulders brought forward and down

• Bent knees

• Pain in the lower extremities

• Feeling of creeping creeps

• Frequent urination

• Difficulty breathing

• Problems with the reproductive system

Over time, the mobility of the ribs decreases, the movements of the intercostal muscles are disrupted, the respiratory function of the lungs is limited.

Deformities of the chest (from chest to back) visible to the naked eye make it possible to diagnose kyphosis. It is confirmed by X-ray.

Kyphoscoliotic posture

A combination of scoliosis (curvature of the spine) and stoop (kyphosis) occurs in kyphoscoliotic posture. The disorder develops in adolescence (13 – 15 years) for no apparent reason. At the beginning, scoliosis appears, and then kyphosis. In boys, pathology is more common than in girls.

Symptoms:

• Rapid fatigability.

• Stoop.

• Dyspnea on exertion.

• In the later stages – disorders of the cardiovascular system.

• Disorders of sensitivity in the legs.

• Urinary incontinence.

Types of posture disorders are diagnosed by a neurologist and an orthopedist, checking tendon reflexes, spinal deformity, muscle strength of the arms, neck, back.

The deformation angle is determined using X-ray. To clarify the diagnosis, tomography is prescribed: computer and magnetic resonance imaging.

Main causes of occurrence:

Congenital kyphoscoliosis makes itself felt after the age of six months. At first subtle, the deformity of the spine increases over time. The disease can progress rapidly.

In 20% of cases of kyphoscoliosis, there are abnormalities in the development of the genitourinary system.

Slouch

Deformity of the back, which occurs due to muscle weakness.It is usually observed during the period of increased skeletal growth and, if there is no treatment, it can acquire a stable form with the formation of scoliosis.

The main symptom of slouching is a feeling of heaviness and fatigue in the back. With the progression of the disease, pain is added.

External signs of pathology are as follows:

• Bent knees.

• Uncontrolled protrusion of the abdomen.

• Rounding of the back due to forward-facing shoulders.

• Head tilt forward.

• Narrowed chest.

Disturbances of posture are visible on x-rays, which are done in a standing or lying position, in several projections of the spine.

Round back

With a round back, thoracic kyphosis is significantly pronounced and lumbar lordosis is absent. The center of gravity of the body is shifted. To maintain balance, a person is forced to move on bent legs.

The following symptoms are also present:

• The arms hang slightly in front of the body.

• Shoulders are raised.

• The abdomen protrudes.

• Buttocks are flat.

• Sunken chest.

The round back is combined with pterygoid shoulder blades. The diagnosis is made during an examination by an orthopedist and is confirmed by x-rays.

Circular back

Types of posture disorders include such deformities as a circular back.With it, all the bends of the spine increase, and the center of gravity of the body shifts. As a result, the knee joints are deformed and the gait stereotype changes.

Symptoms

• The abdomen protrudes.

• Head, neck, shoulders are tilted forward.

• Shoulders are raised and brought forward.

• The angle of inclination of the pelvis is increased.

• Sunken chest.

• The buttocks sag.

• Pterygoid scapula.

Poor posture is determined by a physician on a physical examination and confirmed by X-ray.

Flat back

Deformity in which the physiological curves of the spine are reduced, and in shape it approaches a straight line is called a flat back. The defect is often found in weakened and developmentally lagging children.

It can also occur in fast-growing children, when the muscles do not have time to develop following the joints of the skeleton.With this posture, the amortization function of the spine is reduced, which causes constant microtrauma of the spinal cord and brain, which causes headaches and constant fatigue.

Signs and Symptoms:

• The shoulder blades are pterygoid (the lower angles are behind the back).

• The lumbar lordosis displaced upward is barely outlined.

• The inclination of the pelvis is reduced.

• The thoracic kyphosis is poorly expressed, the chest is also displaced anteriorly.

• The abdomen protrudes forward.

• Different waist triangles on both sides (between the elbow joint of the lowered arm and the waist).

The progression of scoliosis with a flat back can be intense, so you need to start treatment without delay.

An important diagnostic criterion is X-ray, especially a side scan. Information about the vertebrae and the spinal canal can be obtained from myelogram, MRI, CT.

Flatback

The vertebral column is curved according to the following principle: lumbar lordosis (forward concavity) is weakened and physiological kyphosis (backward bulge) in the thoracic spine decreases.This leads to nerve root entrapment and pain.

Signs and Symptoms:

This type of posture is a variant of a flat back and is rare: with a relatively flat back, the buttocks protrude sharply back. The pelvis is strongly tilted forward. The thoracic kyphosis and cervical lordosis are flat, the lumbar region of the spine is retracted, and the line of the general center of gravity of the trunk runs in front of the hip joints.

When this type of posture occurs in children, the functions of the respiratory, digestive and cardiovascular systems decrease, the spring function of the spine is impaired.

Treatment requires regularity and diligence. On average, the spinal axis can be returned to its normal position within 60 to 90 days. In our center for exercise therapy, the correction takes place according to individually compiled programs, the training programs are made by exercise therapy doctors, specialists with many years of experience. Classes are held under the strict guidance of instructors in exercise therapy and adaptive physical culture.

90,000 Posture disorders: causes, varieties, prevention.

Ideal posture is not just the external aesthetics of the human body, but also the guarantee of spine health. This means, and many other organs and systems of the body. However, not everyone has perfect posture. Someone is born with pathologies, and many acquire posture disorders for various reasons.

Read more about the causes, types of posture disorders and the prevention of these pathologies in the article below.

Causes of poor posture

Posture disorders are any deviation of the trunk from the natural position due to a violation of the physiological curves of the spine (smoothing or vice versa strengthening).

Posture disorders are not considered a disease. However, they are a direct prerequisite for the development of serious diseases. For example, scoliosis, pathological kyphosis and pathological lordosis. Many other diseases of the musculoskeletal system can also be triggered by “banal” posture disorders. So it is impossible to ignore violations of posture either in childhood or in adulthood.

The causes of poor posture can be congenital (various anomalies in the development of the vertebrae) and acquired.Acquired posture disorders are much more common.

Most common causes of acquired posture disorders:

• Incorrect position of the body at the table for a long time. Therefore, posture disorders are a scourge of schoolchildren, students and representatives of sedentary professions.
• Incorrect ratio of the height of the table and chair in the workplace in relation to the height of the person.
  Prolonged tension of the back in one position, combined with insufficient physical activity.
• Neck and back injuries.
• Certain infectious diseases.
• Ankylosing spondylitis (chronic inflammation of the joints of the spine).
• Rickets.
• Flat feet.
• Dysplasia of the hip joints.

The first signs of impaired posture in an adult or a child are not difficult to notice if you are careful. This is a slouch, too strong a lumbar bend, a forward neck, an unnaturally round back. Or vice versa – the back is flat, like a board.

What are the types of posture disorders?

Varieties of posture disorders are distinguished depending on the curvature of different parts of the spine. Kyphosis is the increased curvature of the thoracic spine. And lordosis is an increased curvature of the lumbar spine.

For example, when stooping, kyphosis increases and lordosis decreases. If the kyphosis increases even more, and lordosis is almost completely absent, doctors talk about a round back. There is also a round concave back.At the same time, both kyphosis and lordosis increase (not only of the lower back, but also of the neck). By analogy with the previous examples, there is a flat (absolutely all natural curves are smoothed out) and flat-concave (reduced kyphosis and normal or increased lordosis) back.

The diagnosis “scoliosis” occurs most often among school-age children. And this is no longer just a type of posture disorder, but a disease of the spine. It is characterized by curvature of the spine to the right or left of its natural axis. In this case, the vertebrae move, which squeeze the nerve roots, causing pain, making it difficult to breathe properly.

Scoliosis is easy to distinguish: one shoulder is higher than the other, the waist triangles are asymmetric in the vertical position of the body, the axis of the spine is curved in the shape of the letter S, over time, a rib hump is formed.
A scoliosis begins with an asymmetric (scoliotic) posture. If you notice in time an arcuate curvature of the spine to the side, while the vertebrae have not yet begun to twist, it will be much easier and faster to return to a healthy posture.

Diagnostics and prevention of posture disorders

Usually, posture disorders are easy to diagnose with the help of external examination and instrumental diagnostics.Previously, it was X-ray, but nowadays it is much more effective, informative and safer to use MRI.

Magnetic resonance imaging is safe even for young children and pregnant women, as it does not have harmful radiation, unlike X-rays.

Prevention of posture disorders is not difficult, but it deserves special attention. Especially when it comes to schoolchildren, students or office workers.

Parents of schoolchildren need to carefully select a table and chair, taking into account the child’s height.Correctly organize an ergonomic learning space with lighting. In order for the child’s spine to not suffer from heavy weights, a high-quality orthopedic portfolio is needed. Good orthopedic shoes are also important to prevent flat feet. Make sure that the child does not sit at the table for hours – every 30-40 minutes you need to get up and warm up.

Many of these guidelines are great for adults as well. For example, proper organization of the workplace, work breaks for warm-ups and compensation for sedentary work with physical activity in their free time will become quite effective prevention of posture disorders.

90,000 Wisdom Teeth – Treat or Remove? | Megastom

Someone grows all 4 “eights”, two on the lower and two on the upper jaw, and some may not appear at all. These teeth do not contribute to the formation of the correct physiological occlusion and practically do not participate in the chewing process. The fact is that the need for wisdom teeth disappeared when a person stopped taking coarse and tough food.

Over time, the jaw of modern humans has become shorter.There is simply no room for third molars, so the eruption of such teeth is often difficult. This can be expressed in the wrong location, the direction of growth. Wisdom teeth can rest against the cheek or the roots of adjacent teeth. However, even if the “eights” grow correctly, it can be accompanied by discomfort and pain.

The fact is that there were no milk teeth in place of the “eights” before and they have to make their way for the first time. Therefore, the eruption of a wisdom tooth is accompanied by inflammation and swelling of the eruption area.

The structure of the wisdom tooth

Root canals can grow together or be twisted one on top of the other so that it may seem that there are two or three roots. Sometimes these teeth can have four or even five roots.

Partially and unerupted wisdom teeth are called impacted. They can be the same size as the rest of the molars even in the gum.

Since these teeth are considered difficult to access for hygiene, they become a place of accumulation of plaque with bacteria, which as a result leads to infection.

Treatment of wisdom teeth

The process of treating “eights” is very difficult, since the bends of the roots of the tooth significantly complicate their treatment in comparison with the rest of the molars. In addition to bends, the picture is distorted by the incorrect position, inaccessibility and unpredictability of the root canals.

It is safe to say that nothing is impossible for a true professional, including the virtuoso treatment of wisdom teeth.However, it should be understood that even a successfully treated third molar can become a source of problems again after a while. Why? The wisdom tooth is still difficult to access for oral hygiene. The inflammation can recur.

What conclusion can be drawn?

If the wisdom tooth is located correctly, there is no gingival hood, where bacteria accumulate and the third molar does not rest against the adjacent teeth, then it can be left.Of course, in this case, the tooth must be constantly supervised by an experienced dentist.

An incorrectly positioned figure eight that damages adjacent teeth must be removed. It should be understood that the extraction of such a difficult tooth can only be entrusted to a professional surgeon, since it is in this place of the oral cavity that there is a large accumulation of nerve endings and blood vessels.