UNDERWATER AND HYPERBARIC NAVAL MEDICINE (Historic Perspective and Actual Situation)

UNDERWATER AND HYPERBARIC NAVAL UNDERWATER AND HYPERBARIC NAVAL MEDICINEMEDICINE

(Historic Perspective and Actual Situation)(Historic Perspective and Actual Situation)

Hyperbaric oxygen therapy: HOW?HOW?

Hyperbaric chamber

Cylinder shape

Resistant to high pressures

Medical device type IIb ( CCE’s directive 93 / 42 from June the 14th 1993)

Underwater and Hyperbaric Naval MedicineUnderwater and Hyperbaric Naval Medicine

One-place chamber: Pressurized with pure oxygen

Hyperbaric oygen therapy: HOW?HOW?

Multi-place chamber:

Pressurized with air


oro-nasaloro-nasal

Cephalic tentCephalic tent

Tracheal tubeTracheal tube

Hyperbaric oxygen therapy: HOW?HOW?

Pure oxygen inhalation inside the

chamber


Hyperbaric therapy: For For what?what?

To reduce the gas bubbles size

(Boyle’s law: PV = C)


ATA 1 3

Fi O2 0.21

1

Lung’s P O2 100 mmHg 2193

Hb(O2) 4 19.7 vol.% 20.1

Plasm O2 0.285vol.% 6

Arterial PO2 95-100 mmHg 2052-2193

Tissue PO2 40 mmHg 402.8

Hyperbaric therapy: For what?For what?

Increases the blood’s oxygen and Increases the blood’s oxygen and reverts the tissues hypoxiareverts the tissues hypoxia

(Dalton’s Law: Pp = Pt . Fi:%)

(Henry’s Law: (Henry’s Law: Q = SPp)

(FicK’s Law: dQ = P x c

dt x A)


1953 (S.S. - D.S.) 1967 (S.S. - D.S.) 1989 (CHM-LNH.) 2001(CHM-LNH)

1992: Urgency Service

ECHM and UHMS list

1994: professional divers certification

1995: commun service of the military force 3 branches

NATO ADIV-P2 list


Portuguese Navy UHM EvolutionPortuguese Navy UHM Evolution

C.H.M. – L.N.H. (2001)

Nitrox / heliox

“Critical” patients

26 patients simultaneously


Portuguese Navy UHM EvolutionPortuguese Navy UHM Evolution

Individual hyperbaric sessions - urgency

97.627

Individual hyperbaric sessions - global

Individual hyperbaric sessions - routine

99.390

1.763

CHM – Global Activity - 1989 – 2008

Consultations - Total 10.812


CHM – Global Activity - 1989 – 2008

Treated patients - Routine

1.254

2.836

Patients observed - Urgency

4.973

1.273

Patients observed - Routine

Patients observed - total

3.703

Treated patients - Urgency

Treated patients - Total 4.090


Origin (31.12.2008) %

Hospitals ( 64 )

4.976TOTAL

% Observed

patients

Assistent Doctors

Own iniciative

4.090

159

885

3.932 3.480

576

3

19

79 85

14

134

Treatedpatients

CHM – Global Activity - 1989 – 2008 (origin of the patients)


947

448

381

314

190

157

174

74

28

5

0 100 200 300 400 500 600 700 800 900 1.000

SUDDEN DEAFNESS

LEG ULCERS

DIABETIC FOOT

RADIO-INDUCED CISTYTIS/PROCTYTIS/RECTYTIS

MALIGNANT EXTERNAL EAR INFECTION

CRITICAL ISCHEMIA

NECROTIZING SOFT TISSUE INFECTIONS

RADIO-INDUCED BONE NECROSIS

DIABETIC RETINOPATHY / ISCHEMIC NEURITIS/PIGMENTED RETINOPATHY

OSTEOMIELYTIS

CHM ROUTINE TREATED DISEASES (1989 – 2008)


1.034

4

76

4

11

13

19

2

88

0 100 200 300 400 500 600 700 800 900 1.000 1.100

Carbon monoxide poisoning

Hydrogen sulphide poisoning

Decompression sickness

Gas embolism

Gas gangrene

Fournier’s gangrene

Necrotizing soft tissues infections

Radio-induced cistytis

Sudden deafness

CHM URGENCE TREATED DISEASES (1989 – 2008)


17 Dive and Hyperbaric Medicine Basic Courses (ISU04/ISU05) – 121 health military professionals

3 Underwater and Hyperbaric Medicine Post Graduation Course – 36 doctors

National Underwater and Hyperbaric Medicine Meetings– 1997, 1999, 2001

UHM Optional Chair – LUMF and Naval School– 92 4rth year students

European Consensus Conference on the Role of HBO in Radio-induced Soft tissues Lesions - 2001

CHM – Instruction Activity


CHM - Science Cooperation Activity

ECHM - European Committee for Hyperbaric Medicine

EUBS - European Underwater Baromedical Society

Action COST B14 – Oxygen Hyperbaric Therapy

(European Science and Technological Cooperation in the HBO Research)


CHM - Operational Activity

Permanent Therapy Support

Instruction and Training Courses for military divers and other personnel

Tolerance tests to oxygen and nitrogen under pressure

Chamber training to deep divers

Chamber functional and stress tests for the deep dive equipment


CHM Structural and Functional Evolution – Why?Why?

1. Dive and hyperbaric Medicine – specific of Naval Medicine

2. Technological improvement of the military dive (deep dive)

3. Increased needs of medical support for the military dive practice

4. Maximal operational capacity of the CHM already attained


CHM Structural and Functional Evolution – How?How?

Int Med; Y N & T; CardiolgyInt Med; Y N & T; Cardiolgy

Pneumol; OphtalmologyPneumol; Ophtalmology

Gen & Vasc SurgGen & Vasc Surg O R; Anesth & ReanO R; Anesth & Rean

Neurosciencies; Motility UnitNeurosciencies; Motility Unit

System DriveSystem Drive System Superv.System Superv.

Clinical UnitClinical Unit

Operational UnitOperational Unit

Invest UnitInvest Unit

Medical Dep.Medical Dep. Techn. Dep.Techn. Dep. Admin. Dep.Admin. Dep.

CUHM DirectorCUHM Director


CHM Structural and Functional Evolution – for what?for what?

Maximize its functional capcity in order to:

1. Satisfy the naval operational dive increased needs of hyperbaric medical support

2. Initiate true investigational activity related to the dive and hyperbaric medicine

3. Develop the teaching , instruction and formation activities in the underwater and hyperbaric medicine field

4. Satisfy the civilian patients increased needs of hyperbaric medical support

5. Contribute for the maintaining of the Navy’s leadership in the UHM field and for the better individualization of the Naval Medicine


UNDERWATER AND HYPERBARIC NAVAL MEDICINE (Historic Perspective and Actual Situation)

Documents

hyperbaric therapy

hyperbaric oxygen therapy

hyperbaric oygen therapy

chamber underwater

c underwater

routine patients

patients total

air underwater