Badalveda Diving Medicine Network - Thailand

07/02/2016

We are happy to introduce our new evacuation plan for diving accident. It is free for download to be kept in your dive shops, dive boat, or personal use.

02/12/2015

We like to share an excellent table describing possible effects of different classes of medications to scuba diving. Understand the side effects of your medication may save your life.

The table is captured from www.scuba-doc.com/drugsdiv.htm

27/11/2015

One of the hardest things about diving (no, really) is squirming into your wetsuit. A nice, snug fit underwater can mean an impossible time trying to don the suit on dry land. Here are a few tips to help you keep from breaking a sweat, or a nail, while getting ready to hit the water.

17/11/2015

AM I TOO OLD TO DIVE?

There is no formal age limitation for recreational scuba diving and according to the Diver’s Alert Network (DAN), older divers are defined as those over the age of 50. The recommendations are depended on general health of an individual’s, especially the limitation to sustain physical activities. Unfortunately, physical conditioning tends to decline with age and chronic illness such as coronary artery disease, which is a major contributor to diving-related deaths. Individuals aged 40 or older should undergo exercise stress testing to rule out coronary artery disease. Other physiological change with age may includes high blood pressure, reduced lung area for gas exchange (resulting in shortness of breath), diabetes, difficulty maintaining body temperature, reduce in range and slower movements, and altered neurological functions.


All of these factors must be considered before an elderly go scuba diving. A significant or multiple small physical defects may contribute to an increased risk of danger or injuries. Therefore elderly individuals should consider safe recreational diving with a good understanding of physical demand as well as safe guards during the dive. We also recommend a diving program that is less vigorous than for the younger individuals. Hiring a dive guide or a young, fit dive partner is recommended.


Potential of injuries in elderly divers

1. Myocardial Infarct (heart attack)
2. Pulmonary edema (fluids accumulation in lung) – due to heart failure or inability of the heart to keep up with increasing physical demand
3. Risk of fractures
4. Increased risk of DCI
5. Inability to self secure


We recommend things that should be considered before an elderly go on a dive

1. Condition related – this depends on the ability to sustain workload and physical demand as previously mentioned.
2. Treatment related – will there be trained personnel and facilities available when an emergency and specific treatment to your chronic disease is needed?
3. Divers related – your own physical capabilities, fitness, ability to comprehend and act in emergent situation. Are you on special medications and will there be side effects that is dangerous for diving?


Photo by Norman Lancefield: http://www.scubadiving.com/training/advanced-skills/what-its-be-worlds-oldest-diver

Norman Lancefield is 91 and still an active diver. Read his story, as well as that of Lucas Barroso, Canada's youngest rebreather diver.

07/11/2015

CAN I DIVE IF I HAVE ASTHMA?

What is Asthma?

Asthma is a disease of the airway that is characterized by recurring symptoms of wheezing, coughing, chest tightness, and shortness of breath. These symptoms are due to reversible narrowing of the small airways (breathing tube).

How does Asthma cause injury?

It causes air to be trapped within the lung resulting in increased pressure in the lung and risk of barotraumas (lung damage due to air trapping). If any of the air passages become closed (as can happen in asthma), the air cannot escape and will expand within the lungs, eventually causing the lung to burst. It is a big threat to life if not promptly treated.

Is there risk of Asthma attack while diving and outcome?

The risk of asthma attack while diving increases because cold, exercise, dry air or emotions can serve as triggers for many asthmatics and there are several reasons to why asthma attack while diving is at greater risk of misadventure:

1. Air trapping during ascent increases risk of barotraumas as already mentioned, but as well as gas embolism

2. Asthma exacerbation underwater is difficult to treat and restrict the divers’ ability to safely complete the dive

3. Added resistance in regulator and increased gas density at depth increases the work of breathing and further exhausts an individual

4. Bronchodilators and allow passage of bubbles across the lung and leads to decompression sickness

What are our recommendations?

1. Candidates should see a doctor prior to take up diving to complete a lung function test (test that look at your lung and airway functioning) and peak expiratory flow

a. Those with history of asthma should undergo bronchial provocation testing (including exercise, hyperpnoea of dry air and hypertonic saline), which exposes patients to those stimuli experienced in diving. A positive test is contraindicate for diving

2. Lung function test should be normal for an asthmatic can dive, and the test should also be normal after a dive

3. Candidates with poorly controlled asthma are advised against diving despite passing the lung function test. People who fit one of the below is considered to be a poorly controlled asthmatic:

a. Experiences symptoms more than 2 days a week
b. Asthma symptoms limiting physical activity
c. Symptoms recurring at night
d. Use a reliever more than twice a week

4. Candidates are advised to have annual review of their diving fitness

5. Asthmatics that are cleared to dive should be aware of their triggers and avoid diving if those triggers are presence eg. cold, dives that demand heavy exercises etc.

24/09/2015

Badalveda Phuket provides a 1st Hyperbaric Oxygen Therapy after relocating to the New Brain Centre at Bangkok Phuket Hospital.

12/09/2015

MY DOCTOR SAID I HAVE A HOLE IN MY HEART (ATRIUM). CAN I STILL ENJOY SCUBA DIVING?

Patent Foramen Ovale (PFO) is described as a hole between right and left chambers (two small chambers of the heart). This hole is usually closed after birth, but in some circumstances it remains open through to adulthood. The hole may cause ‘shunting’ of blood from right atrium to left atrium, bypassing the respiratory system. This usually occurs when there is an increased of pressure in the lung, which is likely to occur during diving. The gas bubbles that are formed in the venous system may escape your lung and not filtered out. These bubbles will enter the arterial system and cause Decompression Sickness (DCS) or Gas emboli (blockade of the arteries in the brain, heart, or limbs).

Risk of DCS in recreational divers is 0.005-0.08%, and divers with PFO have 4.5 times the risk (0.02-0.36%). This means the risk of PFO divers are still significantly low.

Current evidences support that people with PFO is not contraindicated for diving, and general population do not need to be screened for PFO for picking up diving. These are precautions that should be taken in a PFO diver:
1. Avoid exposure that do not allow direct ascent
2. Ascend at the rate of 10 m/min maximum
3. Always include short safety stop at 5-6 m
4. Should avoid breath hold diving, hard physical work or forceful Valsalva maneuvers 2-3 hours after dive
5. Use diving tables conservatively

A diver with PFO who has had a history of DCS after a low risk dive should avoid diving in the future.

06/09/2015

CAN I SCUBA DIVE IF I HAVE CORONARY HEART DISEASE? (Angina, Heart attack, Myocardial Ischemia, Myocardial Infarct)

16 million Americans have Coronary heart disease and it is second to drowning as a cause of death related to diving.

Decision whether you should or should not dive depends on your overall heart risk factors (Obesity, high blood pressure, family history, smoking, previously treated for heart disease, diabetes, etc.) as well as likely stress that might be put to the heart in a particular dive.

If you are over the age of 40 you should undergo risk assessment of coronary disease. An exercise stress test, a test which a doctor asks you to walk on a treadmill and monitor how well your heart is keeping up with increasing exercise, may be performed.

If you are known to have had the disease or have had a procedure (stent, revascularization, taking medications) to prevent the disease you should undergo a heart and lung evaluation to confirm that you are currently fit enough for diving.

You should wait at least 6-12 months if you have recently had a procedure for treating a heart attack (stent, revascularization) and undergo a thorough heart and lung assessment before going back to or start diving.

Young low risk divers do not need routine screening unless you have already developed the disease or have strong risk factors.

For more enquiries, please call DIVING MEDICAL HOTLINE +66(0)81 989 9482

02/09/2015

Pregnant Aussie

04/06/2015

Understanding Nitrogen Narcosis (Rapture of the deep)

What is Nitrogen Narcosis?

Nitrogen narcosis is not to be confused with Decompression Sickness; it is consequences of breathing gases under high pressure causing gases to dissolve in blood at a high concentration impairing brain and neurons functioning.

The condition is commonly confused with Decompression sickness; while Decompression sickness is related to expansion of gases in tissues from rapid decline of pressure- Nitrogen narcosis is related to amount of gases dissolve in the tissues.

What causes Nitrogen Narcosis?

Henry’s law indicates that gases solubility in tissues increases with pressure. The term Nitrogen indicates nitrogen as the causal gas. Nitrogen narcosis commonly occurs in divers who dive with mixed gases to a great depth or at a long period of time under water. This result in higher numbers of nitrogen dissolves into the blood stream and crosses into the brain, impairing brain functions and other neurons functioning.

What are the risks of developing Nitrogen Narcosis?

Significant risks develop on dives below 30 meters (100 feet), but a diver’s cognition may be affected at the depth as shallow as 10 meters (33 feet). Other factors that increase risks of Nitrogen narcosis include thermal cold, stress, heavy work, fatigue, and initial gas retention. Alcohol intoxication, op**te, narcotics and recreational drugs such as ma*****na also increase risk of narcosis and increase its severity.

What are the symptoms of Nitrogen Narcosis?

Nitrogen Narcosis produces symptoms and signs similar to alcohol intoxication, which may include;
- Impaired reasoning
- Sensory impairment, balance or gait impairment
- Euphoria, nausea
- Visual or auditory impairment
- Memory impairment
- Anxiety, laughter, over confidence
- Dizziness
- Hysteria, terror, hallucinations
- Manic, depressive, blackout
- Unconsciousness, death
Alleviation of symptoms once ascend to shallower depths confirm the diagnosis

Nitrogen narcosis is reversible. If symptoms fail to resolve after ascent, narcosis is not the cause and should seek medical treatment.

How can we treat Nitrogen Narcosis?

Initial management is to access to shallower depths, but should also be aware of development of decompression sickness and not ascend to rapidly. The diver should abort the dive and commence decompression schedule.

How can we prevent Nitrogen Narcosis?

1) Limit depth of dives because risks of narcosis increases with depths (recreational depth should be 18 meters, examples are mixes gas containing helium in place of nitrogen
3) Avoid using alcohol, recreational drugs, or medications before dives – consult your physician to the safety of each prescribed medications prior to diving
4) Maintain fitness, avoid heavy workload or overwork during dives
5) Maintain body temperature via appropriate dive suites
6) Use of buddy system so one can look out for the other for any strange behaviours during diving

25/05/2015

Understanding The Bends (Decompression Sickness)

Decompression Sickness (also known as Caison disease, the bends) is a common illness that may occur in divers when too much nitrogen or gas are dissolves in your blood and the body experiences rapid reduction in pressure causing the gas bubbles to expand.

What cause decompression sickness?

Henry’s Law states that at a constant temperature, the amount of gas that is dissolved in a liquid is directly proportional to the partial pressure of the gas (more gasses dissolves in tissue when there is an increased in pressure).

Boyle’s Law states what at a constant temperature; the volume of gas is inversely proportional to pressure (the greater the pressure, the lesser the volume).

When divers breathe air under pressure (undersea), the tissues become loaded with increase amount of oxygen and nitrogen. When divers return to the surface and pressure is decreased, these gases are released from tissues in the form of bubbles. These bubbles may be in blood vessels, joints, or any tissues in the body. They may compress on tissues, cause inflammatory cascade or lead to organ dysfunctions.

What predispose someone to decompression sickness?

1. Heart condition –there is an increased risk of decompression sickness and diving may be contraindicated in a person with a heart condition. Please seek medical advice prior to diving if you have a known heart problem, or receive a health check before diving for the first time.
2. Air Travel – Patients what travel by air soon after diving are at increased risk of decompression sickness in flight. It is suggested that you should wait at least 12 hours (if you only one dive) or at least 48 hours (if you had multiple dive) since before travel by air.
3. Inexperienced diver – An inexperienced diver is at a greater risk of decompression sickness, this may relate to incorrect decompression stops, non-adherence to dive schedules, etc. Please follow advice from your dive instructor adhesively.
4. Fatigue
5. Older age
6. Rapid ascent – please follow safety stop as instructed by your instructor or as recommended by the guideline.
7. Depth and length of the dive – the deeper and the longer the dive increases the risk
8. Intoxication – predispose to lack of awareness and leadership failure

What are the symptoms of decompression sickness?

Symptoms of decompression sickness often occur within one to twelve hours of surfacing. Symptoms may be:
- Malaise
- Fatigue
- Sense of foreboding or fearful apprehension
- Anorexia
- Headache, confusion
- Joint pain
- Itchiness
- Pins and needles, tingling sensations, or numbness
- Weakness
- Impaired vision
- Impaired balance
- Loss of bowel, urinary control
- Chest pain
- Wheeze
- Short of breath
- Choking sensation

How is decompression sickness treated?

When you suspect of someone of developing a decompression sickness, the best initial treatment include:
- Hydration
- Breathing with 100% Oxygen
- Position the person on left side with bed angled downward toward head

Contact a healthcare practitioner as soon as possible, the definitive treatment for decompression sickness is hyperbaric oxygen therapy in a recompression chamber and should be initiated as soon as possible. Hyperbaric treatment may be undertaken for at least four hours to ensure that all the gas bubbles are completely removed from the system.

How to prevent decompression sickness?

- Restrict depth and duration of dive to a range that does not requite decompression (safety) stop
- Ascending with decompression stops as specified in authoritative guidelines (for example the United States Navy Diving Manual)
- Slow ascent (recommend maximum speed 18m/minute)
- Avoid air travel at least 12 hours since last dive for one dive and 48 hours for multiple dive
- If you have completely recovered from decompression sickness, please refrain from diving for at least two weeks
- Get necessary health check prior to diving
- Avoid excessive drinking (alcohol) prior to diving
- Adequate hydration
- Good aerobic conditioning
Understanding The Bends (Decompression Sickness)

Decompression Sickness (also known as Caison disease, the bends) is a common illness that may occur in divers when too much nitrogen or gas are dissolves in your blood and the body experiences rapid reduction in pressure causing the gas bubbles to expand.

What cause decompression sickness?

Henry’s Law states that at a constant temperature, the amount of gas that is dissolved in a liquid is directly proportional to the partial pressure of the gas (more gasses dissolves in tissue when there is an increased in pressure).

Boyle’s Law states what at a constant temperature; the volume of gas is inversely proportional to pressure (the greater the pressure, the lesser the volume).

When divers breathe air under pressure (undersea), the tissues become loaded with increase amount of oxygen and nitrogen. When divers return to the surface and pressure is decreased, these gases are released from tissues in the form of bubbles. These bubbles may be in blood vessels, joints, or any tissues in the body. They may compress on tissues, cause inflammatory cascade or lead to organ dysfunctions.

What predispose someone to decompression sickness?

1. Heart condition –there is an increased risk of decompression sickness and diving may be contraindicated in a person with a heart condition. Please seek medical advice prior to diving if you have a known heart problem, or receive a health check before diving for the first time.
2. Air Travel – Patients what travel by air soon after diving are at increased risk of decompression sickness in flight. It is suggested that you should wait at least 12 hours (if you only one dive) or at least 48 hours (if you had multiple dive) since before travel by air.
3. Inexperienced diver – An inexperienced diver is at a greater risk of decompression sickness, this may relate to incorrect decompression stops, non-adherence to dive schedules, etc. Please follow advice from your dive instructor adhesively.
4. Fatigue
5. Older age
6. Rapid ascent – please follow safety stop as instructed by your instructor or as recommended by the guideline.
7. Depth and length of the dive – the deeper and the longer the dive increases the risk
8. Intoxication – predispose to lack of awareness and leadership failure

What are the symptoms of decompression sickness?

Symptoms of decompression sickness often occur within one to twelve hours of surfacing. Symptoms may be:
- Malaise
- Fatigue
- Sense of foreboding or fearful apprehension
- Anorexia
- Headache, confusion
- Joint pain
- Itchiness
- Pins and needles, tingling sensations, or numbness
- Weakness
- Impaired vision
- Impaired balance
- Loss of bowel, urinary control
- Chest pain
- Wheeze
- Short of breath
- Choking sensation

How is decompression sickness treated?

When you suspect of someone of developing a decompression sickness, the best initial treatment include:
- Hydration
- Breathing with 100% Oxygen
- Position the person on left side with bed angled downward toward head

Contact a healthcare practitioner as soon as possible, the definitive treatment for decompression sickness is hyperbaric oxygen therapy in a recompression chamber and should be initiated as soon as possible. Hyperbaric treatment may be undertaken for at least four hours to ensure that all the gas bubbles are completely removed from the system.

How to prevent decompression sickness?

- Restrict depth and duration of dive to a range that does not requite decompression (safety) stop
- Ascending with decompression stops as specified in authoritative guidelines (for example the United States Navy Diving Manual)
- Slow ascent (recommend maximum speed 18m/minute)
- Avoid air travel at least 12 hours since last dive for one dive and 48 hours for multiple dive
- If you have completely recovered from decompression sickness, please refrain from diving for at least two weeks
- Get necessary health check prior to diving
- Avoid excessive drinking (alcohol) prior to diving
- Adequate hydration
- Good aerobic conditioning

25/05/2015

FOR DIVING MEDICAL HOTLINE - +66(0)81 989 9482

Welcome to Badalveda's page. We are the Thailand's largest diving and hyperbaric medicine network, formed by a group of certified clinician and nurses specialized in diving medicine.

Our goal is to make Thailand a safe destination for divers by providing professional medical care, education program, and promoting dive safety. Through our network, we provide emergency evacuation services and recompression facilities available 24/7 throughout Thailand.

FOR DIVING MEDICAL HOTLINE - +66(0)81 989 9482
or Email us - vedainfo@badalveda.com

We strongly hope that you'll never need us, but if there's an emergency- we are here to help you.

http://www.badalveda.com/ #

Introduction: Badalveda Diving Medicine Network is Thailand’s largest diving and hyperbaric medicine network. In 2002, Badalveda was formed by a group of physicians and nurses specialized in a diving medicine. We provide a comprehensive health service to divers through our network at major dive dest…