[abstract] GUIDELINES NEEDED FOR MANAGEMENT OF MILD DCI IN REMOTE LOCATIONS.

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[abstract] GUIDELINES NEEDED FOR MANAGEMENT OF MILD DCI IN REMOTE LOCATIONS.

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Title: [abstract] GUIDELINES NEEDED FOR MANAGEMENT OF MILD DCI IN REMOTE LOCATIONS.
Author: Wacholtz, CJ; Uguccioni, DM; Dear, GdeL; Vann, RD; Bennett, PB
Abstract: BACKGROUND: Remote DCI typically requires Air Evacuation (AEV) and usually results in significant delay to hyperbaric treatment. Approximately 5 percent (370) of DCI cases reported to DAN between 1989 and 1997 required an AEV. The average cost of an AEV in 1998 was US$9,392 and range up to US$35,680. Current standards of care guidelines (Vann, 1990; Sheffield, 1996) do not differentiate between whether cases are remote or relatively near to a chamber or whether severe or mild. METHODS: In order to consider only the more lengthy and expensive AEV''s, the folowing exclusion criteria were applied: (1) Severe cases where transport was clearly needed [199]. (DAN Dive Injury Database definitions for severe, mild neurological and pain/non-specific were used. A mild case means symptoms were pain, were non-specific or were mild neurological such as peripheal parathesias.); (2) AEV's within the US [110]; (3) AEV's within a country or region of islands [31]; (4) Any cerebral symptom case or one with a torso location symptom [6]. All 61 non-US, mild DCI, AEV cases were reviewed. RESULTS: The average delay to recompression for the 61 non-US mild AEV cases was 21 hours and 26 caes (43percent) had sequelae. In 19 of 61 (31percent) non-US DCI cases alternatives to evacuation might have been considered. The average delay for the 19 non-US, non-torso symptom, country to country, mild DCI AEV cases was 30 hours and 10 cases (53percent) had sequelae. CONCLUSIONS: Management and triage of remote, mild DCI in concious, alert, hemodynamically stable patients could be more effective with new guidelines. Questions for future consideration might include the use of Telemedicine (for diagnosis and training), portable chambers, in-water recompression and non-hyperbaric therapies such as surface oxygen and fluids. Guidelines that allow for alternatives to long distance evacuation would need to address the problem of differentiating the "mild" from the "more severe, but subtle" DCI case. Further study of AEV cases is needed to achieve these goals.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/775
Date: 1999

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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