Dive Med

Kesehatan PenyelamanKesehatan Penyelaman

SStudi kesehatan manusia yang tudi kesehatan manusia yang mempelajari tentangmempelajari tentang faktor determinanfaktor determinan dalamdalam aktivitasaktivitas dan prosesdan proses adaptasinyaadaptasinya di lingkungandi lingkungan penyelaman penyelaman ((underwater)underwater), ,

yang dapatyang dapat menyebabkanmenyebabkan ganguanganguan kesehatan sertakesehatan serta mencegahmencegah dandan

merehabilitasikannyamerehabilitasikannya melaluimelalui upaya upaya yang terorganisasi agar tetap dalam yang terorganisasi agar tetap dalam kondisikondisi sehat fisiksehat fisik dandan mentalmental. .

Kesehatan Penyelaman

1. TEKANAN AMBIENT

2. DENSITAS GAS MEDIA NAFAS

3. TEKANAN PARSIAL GAS MEDIA GAS

4. KELARUTAN GAS

Diving StressorsDiving Stressors

1. ORGAN PARU

2. ORGAN KARDIOVASKULER

3. ORGAN SUSUNAN SARAF PUSAT

4. ORGAN LAIN [THT,MATA,GIT,KULIT]

Diving StrainsDiving Strains

1. HIPOVENTILASI (STATIS,DINAMIS)

2. PENURUNAN RESPON VENTILASI TERHADAP PENINGKATAN CO2

Pulmonary StrainsPulmonary Strains

1. HEART RATE (BRADYCARDIA)HEART RATE (BRADYCARDIA)

2. ELECTROCARDIOGRAM (ARHYTMIA)2. ELECTROCARDIOGRAM (ARHYTMIA)

3. CARDIAC OUTPUT, ARTERIAL PRESSURE,3. CARDIAC OUTPUT, ARTERIAL PRESSURE, SYSTEMIC VASCULAR RESISTANCESYSTEMIC VASCULAR RESISTANCE

4. WORK CAPACITY4. WORK CAPACITY

Cardiovascular StrainsCardiovascular Strains

1. GRADUAL LOSS GRADUAL LOSS ,INTELECTUAL,PSYCHOMOTOR,INTELECTUAL,PSYCHOMOTOR AND PSYCHOSENSORIAL FUNCTIONAND PSYCHOSENSORIAL FUNCTION

2. ELECTROPHYISIOLOGIC2. ELECTROPHYISIOLOGIC

3. NEUROTRANSMISSION3. NEUROTRANSMISSION [MONOAMIN,AMINO ACID)][MONOAMIN,AMINO ACID)]

CNS Strains

KLASIFIKASI I KLASIFIKASI I

1. BIOMEKANIK, BAROTRAUMA1. BIOMEKANIK, BAROTRAUMA

2. BIOKIMIA, KERACUNAN GAS (O2.CO2,CO, INERT)2. BIOKIMIA, KERACUNAN GAS (O2.CO2,CO, INERT)

3. BIOFISIK, DECOMPRESSION SICKNESS3. BIOFISIK, DECOMPRESSION SICKNESS

Pathobiologi

KLASIFIKASI II KLASIFIKASI II

1. PERIODE TURUN, DESCENT1. PERIODE TURUN, DESCENT

2. PERIODE DI DASAR, DEPHT2. PERIODE DI DASAR, DEPHT

3. PERIODE NAIK, ASCENT3. PERIODE NAIK, ASCENT

Pathobiologi

BAROTRAUMA BAROTRAUMA TELINGATELINGABAROTRAUMA BAROTRAUMA SINUSSINUSBAROTRAUMA BAROTRAUMA GIGIGIGIBAROTRAUMA BAROTRAUMA PARUPARUBAROTRAUMA BAROTRAUMA DIGESTIVEDIGESTIVEBAROTRAUMA BAROTRAUMA MATAMATABAROTRAUMA BAROTRAUMA KULITKULIT

BAROTRAUMBAROTRAUMAA

BAROTRAUMABAROTRAUMA

Barotrauma is The clinical or Biomechanical name Barotrauma is The clinical or Biomechanical name for the mechanical impact of pressure changingfor the mechanical impact of pressure changing

Barotrauma during descent is called aBarotrauma during descent is called a squeesesqueese. Barotrauma of ascent is calledBarotrauma of ascent is called reverse squeesereverse squeese.

BAROTRAUMABAROTRAUMA

There are 5 conditions that must be met for barotrauma to occur :There are 5 conditions that must be met for barotrauma to occur :1.1.there must be a gas-filled space,there must be a gas-filled space,2.2.the space must have rigid walls,the space must have rigid walls,3.3.the space must be enclosed. the space must be vascularized, the space must be enclosed. the space must be vascularized, and have a membrane lining at least one wall of the space, and have a membrane lining at least one wall of the space, 4. 4. there must be a change in ambient pressure (there must be a change in ambient pressure (Boyle’s Law)Boyle’s Law)

SINONIM

AEROSALPINGOTYMPANIOTITICOTIC BAROTRAUMAAEROTITIC MEDIAAERO-OTITIS MEDIA

BAROTRAUMA[SQUEESE] BAROTRAUMA[SQUEESE] TELINGA TENGAHTELINGA TENGAH

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

Middle ear squeese is caused by Middle ear squeese is caused by the failure or inability of a diver the failure or inability of a diver to equalized pressure in the middle earto equalized pressure in the middle earspace during descent. space during descent.

Rupture of the membrane will occurRupture of the membrane will occurif the pressure differential is if the pressure differential is greater than 100 mmHg.greater than 100 mmHg.

PATHOGENESIS

1. KEGAGALAN, MENYAMAKAN TEKANAN DI RUANG TELINGA TENGAH SELAMA TURUN/KOMPRESI

2. AKIBAT TEKANAN “NEGATIF” DI RUANG TELINGA TENGAH, M.TYMPHANI TERDORONG,OEDEMA & PERDARAHAN MUKOSA SAMPAI PERFORASI

3. RUPTUR M.TYMPHANI BILA GRADIENT TEKANAN >100mmHg

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

SYMPTOMS & SIGNSSYMPTOMS & SIGNS

DEPTH OF ONSET [BAYLISS,1968]DEPTH OF ONSET [BAYLISS,1968]

DEPTH OF ONSETDEPTH OF ONSET[FSW][FSW]

PERCENT OF 524 SUBJECTSPERCENT OF 524 SUBJECTSWITH SYMPTOMWITH SYMPTOM

1-5 0,21-5 0,26-10 5,36-10 5,311-20 6,911-20 6,921-33 3,621-33 3,634-66 2,934-66 2,9>66 0,6>66 0,6

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

Degree Sign

Teed 0Teed 1Teed 2Teed 3Teed 4Teed 5

No visible damageCongestion of umbo and pars flaccida, occurs with a pressure differential of 2 psiCongestion of entire drum, occurs with a pressure differential of 2-3 psiHemmorrhage into drum Extensive middle ear hemorrage, with blood bubbles visible behind the tymoanic membrane, the membrane may be ruptured.Entire middle ear filled with deoxygenated blood

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

Degree Sign

MacFie 1MacFie 2MacFie 3MacFie 4MacFie 5

Injection of tympanic membrane Slight hemorrage into tympanic membraneGross hemmorage into tympanic membraneFrom blood in middle ear spaceRupture of tympanic membrane

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

TREATMENTTREATMENT

Oral dencongestants, Oral dencongestants, occasionaly, an antihistamine, decongestant combination,occasionaly, an antihistamine, decongestant combination,systemic antibiotic such as ampicillinsystemic antibiotic such as ampicillin[[If perforation of the membrane has occurredIf perforation of the membrane has occurred]]

MIDDLE EAR SQUEESEMIDDLE EAR SQUEESE

BAROTRAUMA PARU BAROTRAUMA PARU

BAROTRAUMA PARU TURUN,DESCENT [SQUEESE PARU]

PADA PENYELAM TAHAN NAFAS (BREATHOLD DIVE)

SQUEESE PARUSQUEESE PARU

1. PENYEBAB, KENAIKAN TEKANAN TIDAK DIIKUTI 1. PENYEBAB, KENAIKAN TEKANAN TIDAK DIIKUTI KESTABILAN VOLUM PARUKESTABILAN VOLUM PARU

2. TERJADI PADA PENYELAM TAHAN NAFAS2. TERJADI PADA PENYELAM TAHAN NAFAS

3. VOLUME PARU DIKEDALAMAN MENDEKATI3. VOLUME PARU DIKEDALAMAN MENDEKATI VOLUME RESIDU PARUVOLUME RESIDU PARU

4. SERING TERJADI PADA PENYELAM DENGAN4. SERING TERJADI PADA PENYELAM DENGAN KAPASITAS VOLUME PARU YANG KECILKAPASITAS VOLUME PARU YANG KECIL

5. BERLANJUT SEBAGAI ATELEKTASIS PARU5. BERLANJUT SEBAGAI ATELEKTASIS PARU

SQUEESE PARUSQUEESE PARU

BAROTRAUMA PARU BAROTRAUMA PARU BAROTRAUMA PARU NAIKBAROTRAUMA PARU NAIKPULMONARY OVERINFLATIONPULMONARY OVERINFLATION

1. PENYEBAB, PENURUNAN TEKANAN TIDAK DIIKUTI 1. PENYEBAB, PENURUNAN TEKANAN TIDAK DIIKUTI PENGURANGAN VOLUM PARUPENGURANGAN VOLUM PARU

2. TERJADI PADA PENYELAM DENGAN ALAT2. TERJADI PADA PENYELAM DENGAN ALAT

3. VOLUME PARU EKSPANSI SEWAKTU MENUJU 3. VOLUME PARU EKSPANSI SEWAKTU MENUJU KE PERMUKAAN/DIPERMUKAANKE PERMUKAAN/DIPERMUKAAN

4. SERING TERJADI PADA KEDARURATAN PENYELAM4. SERING TERJADI PADA KEDARURATAN PENYELAM ATAU LATIHAN ASCAPE ATAU LATIHAN ASCAPE

5. BERLANJUT SEBAGAI EMBOLI UDARA5. BERLANJUT SEBAGAI EMBOLI UDARA

PULMONARY OVERINFLATIONPULMONARY OVERINFLATION

RUPTUR OF ALVIOLIRUPTUR OF ALVIOLI

PULMONARY INTERSTETIAL EMPHYSEMAPULMONARY INTERSTETIAL EMPHYSEMA

ARTERIAL GASARTERIAL GASEMBOLISMEMBOLISM

PNEUMOTHORAXPNEUMOTHORAXMEDIASTENALMEDIASTENALEMPHYSEMAEMPHYSEMA

CEREBRAL GASCEREBRAL GASEMBOLISMEMBOLISM

CORONARY GASCORONARY GASEMBOLISMEMBOLISM

SUBCUTANEOUSSUBCUTANEOUSEMPHYSEMAEMPHYSEMA

PNEUMO-PNEUMO-PERICARDIUMPERICARDIUM

INITIAL TREATMENTINITIAL TREATMENT 1. MAINTAIN AN ADEQUATE AIRWAY,VENTILATION1. MAINTAIN AN ADEQUATE AIRWAY,VENTILATION 2. CORRECTION HYPOTENSION2. CORRECTION HYPOTENSION 3. ADMINISTER 100 % O23. ADMINISTER 100 % O2 4. ADMINISTER A BOLUS OF DEXAMETHASONE4. ADMINISTER A BOLUS OF DEXAMETHASONE

DEFINITIVE TREATMENTDEFINITIVE TREATMENT RECOMPRESSION THERAPYRECOMPRESSION THERAPY

ADJUVANT THERAPYADJUVANT THERAPY 1. STEROIDS1. STEROIDS 2. FLUIDS2. FLUIDS 3. HEMODYNAMIC SUPPORT3. HEMODYNAMIC SUPPORT 4. VENTILATION4. VENTILATION

BAROTRAUMA PARU NAIKBAROTRAUMA PARU NAIKPULMONARY OVERINFLATIONPULMONARY OVERINFLATION

SINONIM INTOKSIKASI GAS INERT

PENYEBAB [STRESSOR] PENINGKATAN TEKANAN PARSIAL GAS INERT

INCIDENCE,SYMPTOMS, SIGNS 1. PENYELAMAN DENGAN UDARA KOMPRESI [AIR COMPRESSED], CAMPURAN GAS [MIXED GAS] 2. BERGANTUNG DENGAN KEDALAMAN. KECEPATAN KOMPRESI [DESCENT RATE] VARIASI DAN TOLERANSI PENYELAM 3. RIVERSIBEL GEJALA TERGANTUNG PADA DESCENT RATE 4. KEMUNDURAN INTELLECTUAL PERFORMANCE DAN NEUROPHYSIOLOGIC 5. PATHOGENESIS, BIOPHYSIC THEORY DAN BIOCHEMICAL THEORY

SINONIM INTOKSIKASI GAS INERT

PENYEBAB [STRESSOR] PENINGKATAN TEKANAN PARSIAL GAS INERT

INCIDENCE,SYMPTOMS, SIGNS 1. PENYELAMAN DENGAN UDARA KOMPRESI [AIR COMPRESSED], CAMPURAN GAS [MIXED GAS] 2. BERGANTUNG DENGAN KEDALAMAN. KECEPATAN KOMPRESI [DESCENT RATE] VARIASI DAN TOLERANSI PENYELAM 3. RIVERSIBEL GEJALA TERGANTUNG PADA DESCENT RATE 4. KEMUNDURAN INTELLECTUAL PERFORMANCE DAN NEUROPHYSIOLOGIC 5. PATHOGENESIS, BIOPHYSIC THEORY DAN BIOCHEMICAL THEORY

NARKOSE GAS INERTNARKOSE GAS INERT

1. SEVERAL EXPOSURE TO OXYGEN [ABOVE 0,6 BAR]

2. PENURUNAN VOLUME PARU STATIS

3. PENYELAMAN DALAM [EXTENDED BOTTOM TIME]

1. SEVERAL EXPOSURE TO OXYGEN [ABOVE 0,6 BAR]

2. PENURUNAN VOLUME PARU STATIS

3. PENYELAMAN DALAM [EXTENDED BOTTOM TIME]

PULMONARY OXYGEN TOXICITYPULMONARY OXYGEN TOXICITY

CONTRIBUTING FACTOR 1. TEKANAN PARSIAL O2 2. TEKANAN PARSIAL CO2 3. ACCLIMATIZATION

PREVENTION 1. HINDARI BEKERJA MENYELAM LEBIH DARI 30 METER DENGAN UDARA KOMPRESI

2. SEGERA NAIK BILA TERASA GEJALA NARKOSE GAS INERT

NARKOSE GAS INERTNARKOSE GAS INERT

KATAGORI 1. CENTRAL NERVOUS SYSTEM TOXICITY [OXYGEN EPILEPSY,PAUL BERT EFFECT] 2. LUNG TOXICITY [LORAIN SMITH EFFECT]

ETIOLOGI [STRESSOR] PENINGKATAN TEKANAN PARSIAL O2

INCIDENCE 1. SURFACE SUPPLIED SYSTEM DIVING 2. CLOSED CIRCUIT DIVING 3. HYPERBARIC OXYGEN THERAPY

KATAGORI 1. CENTRAL NERVOUS SYSTEM TOXICITY [OXYGEN EPILEPSY,PAUL BERT EFFECT] 2. LUNG TOXICITY [LORAIN SMITH EFFECT]

ETIOLOGI [STRESSOR] PENINGKATAN TEKANAN PARSIAL O2

INCIDENCE 1. SURFACE SUPPLIED SYSTEM DIVING 2. CLOSED CIRCUIT DIVING 3. HYPERBARIC OXYGEN THERAPY

OXYGEN TOXICITYOXYGEN TOXICITY

1. UNDER HIGH OXYGEN EXPOSURE

2. SYMPTOMS AND SIGNS a. NAUSEA, VOMITING b. GENERAL SENSATIONS c. TUNNEL VISION d. VERTIGO e. TINNITUS f. TWITCHING, CONVULSION [TONIC CLONIC, LOSS OF CONSCIOUSNESS]

CNS OXYGEN TOXICITYCNS OXYGEN TOXICITY

V V = VISUAL DISTURBANCES= VISUAL DISTURBANCESE E = EAR DISTURBANCES= EAR DISTURBANCESN N = NAUSEA= NAUSEAT T = TWITCHING= TWITCHING I I = IRRITABILITY= IRRITABILITYD D = DIZZINESS= DIZZINESS

[DONALD, 1947DONALD, 1947]

CNS OXYGEN TOXICITYCNS OXYGEN TOXICITY

FACTORS WHICH AFFECT OXYGEN TOLERANCEFACTORS WHICH AFFECT OXYGEN TOLERANCE 1. EXERCISE 1. EXERCISE 2. INCREASEED FICO2 OR HYPOVENTILATION2. INCREASEED FICO2 OR HYPOVENTILATION

3. HYPERVENTILATION3. HYPERVENTILATION

4. IMMERSION IN WATER4. IMMERSION IN WATER 5. INERT GAS5. INERT GAS

6. REPEATED EXPOSURE6. REPEATED EXPOSURE

7. FEVER7. FEVER

8. COLD8. COLD

CNS OXYGEN TOXICITYCNS OXYGEN TOXICITY

SYNONIMSSYNONIMS CAISSON DISEASECAISSON DISEASE BENDSBENDS STAGGERSSTAGGERS CHOKES AND CHOKES AND AEROEMBOLISMAEROEMBOLISM

DECOMPRESSION SICKNESSDECOMPRESSION SICKNESS

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS

A. TYPE I (PAIN ONLY)A. TYPE I (PAIN ONLY) LIMB PAINLIMB PAIN LYMPHATIC MANIFESTATIONSLYMPHATIC MANIFESTATIONS CUTANEOUS MANIFESTATIONSCUTANEOUS MANIFESTATIONS

B. TYPE II (SERIOUS)B. TYPE II (SERIOUS) CARDIOPULMONARYCARDIOPULMONARY CEREBRALCEREBRAL SPINALSPINAL VESTIBULARVESTIBULAR

DECOMPRESSION SICKNESSDECOMPRESSION SICKNESS

PREDISPOSING FACTORSPREDISPOSING FACTORS

EXERCISE LOCAL INJURY

COLD WATERAGEDEHYDRATION

CARBON DIOXIDE

DECOMPRESSION SICKNESSDECOMPRESSION SICKNESS

TREATMENTTREATMENT

RECOMPRESSIONRECOMPRESSION 5,6 US NAVY TABLESCOMEX TABLESGERS MER TABLES

HYDRATIONSTEROIDHEPARINEASPIRIN

DECOMPRESSION SICKNESSDECOMPRESSION SICKNESS

O2 TREATMENT TABLEO2 TREATMENT TABLE 55

O2 TREATMENT TABLEO2 TREATMENT TABLE 66