DEPTH Blog

We had entered a dense fog bank! I had a rather helpless feeling, as a boy of 18, guiding 2,300 tons of steel into the unknown at ten knots, with no way of notifying anyone. Fortunately after a few minutes, which seemed like an eternity, the mate returned to the bridge. Flipping on the radar on the port side of the wheelhouse, he remarked, "Looks like we've got a bit of thick weather." He stepped out on the bridge wing and blew his police whistle to alert Kalle Holm, my watch partner. Kalle immediately stuck his head over the top of the bridge ladder and was ordered to the bow to stand lookout. 

When the radar had warmed up, the mate said, "Looks like we've got another ship out there. Give her five degrees starboard."

I heard the ship's bell strike three times . . . It was the other ship's bow lookout and we were directly in his path! I saw a huge bow as high as our wheelhouse loom out of the fog!"

The above is just one of the hair-raising experiences described by Dr. Kindwall as he writes of his time in the merchant marines, and via Yale and Harvard, running a safe-house for the CIA, submarine school, patrol on an early Polaris nuclear submarine, and work with "sandhogs" in compressed air tunnel construction. 

Find more details here about the book, "Unexpected Odyssey, From Merchant Sailor to Hyperbaric Physician" by Eric P. Kindwall, MD

Although the incidence of clostridial myonecrosis infections has dropped precipitously in recent decades, it always remins a threat in injuries where contamination and severe tissue disruption have occurred. The decreased incidence of clostridial myonecrosis is attributed to the increased diligence of clinicians in preventing clostridial organisms from proliferating. This has been realized through the immediate initiation of antibiotics in open injuries, the use of prophylactic antibiotics in surveries, and the appreciation of the value of meticulous debridements in injuries where amssive contamination (e.g., farm-related), severe trauma to tissues (e.g., combat-related), and tissue death from hypoxia have occurred. 

Carbon monoxide exposed patients commonly present with nonspecific symptoms that mimic influenza-like illnesses (Table 1). Symptoms typically include headache, dizziness, nausea, vomting, weakness, and fatigue. The most common symptom reports is headache.

Photo Caption: The decompression chamber aboard the USS Dixon where David Scalia suffered his third cardio-respiratory arrest. Dr. Greg Adkission successfully resuscitated David and remained with him in the chamber for 12 hours.

More than 100 years ago, Sorbonne Professor Paul Bert, the father of pressure physiology, explained, “All symptoms, from the slightest to those that bring on sudden death, are the consequences of the liberation of bubbles of nitrogen in the blood [on-gassing], and even in the tissues, when compression has lasted long enough. The great protection is slowness of decompression [off-gassing].”

In 1982, when David Scalia was evacuated to San Diego after suffering an air embolism to his brain, there was no hyperbaric chamber in the city.

A textbook may sometimes gain the unusual trait of longevity beyond all other books — it can be revised
and remain a primary source of information for generations of students.

Sinus and internal and external ear disorders are the most common side effects of hyperbaric oxygen therapy (HBO2).¹ These spaces are the cranium’s pneumatic sockets and, particularly those of the middle and inner ear, are most frequently involved in the pressure stress caused by compression and decompression maneuvers during exposure to altered pressures in the hyperbaric chamber. Barotrauma is the mechanical tissue damage produced by environmental pressure variation, and the middle ear is the most frequently involved structure in this kind of damage. According to Boyle’s law (the product of pressure and volume is a constant for a given mass of confined gas) it is easy to understand why all enclosed air cavities are more susceptible to this kind of lesion. Barotraumas can occur due to an increase or decrease of gas volume. To avoid gas volume decrease during the compression phase, the patient must perform some compensatory maneuvers aimed at inhaling and forcing gas (air or oxygen) into the nasal and sinus cavities. During decompression in the chamber or even underwater, the body’s gas expands and is expelled from cavities to the outside, usually without any active maneuver. It is essential to teach the patient about the functions of the hyperbaric chamber and the correct maneuvers of baro compensation. In this article, we will describe the main barotraumas that can occur during hyperbaric oxygen therapy.

February is Heart Month and to support the movement we have teamed up with our sister company, Wound Care Education Partners, to bring you valuable resources and discounts. We invite you to learn more about cardiac issues as related to hyperbaric and undersea medicine and take advantage of these free and discounted resources on the topic.