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

UNDERWATER AND HYPERBARIC NAVAL MEDICINE (Historic Perspective and Actual Situation). Underwater and Hyperbaric Naval Medicine. Hyperbaric oxygen therapy: HOW? Hyperbaric chamber Cylinder shape Resistant to high pressures.

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

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

  2. Underwater and Hyperbaric Naval Medicine Hyperbaric oxygen therapy: HOW? Hyperbaric chamber Cylinder shape Resistant to high pressures • Medical device type IIb ( CCE’s directive 93 / 42 from June the 14th 1993)

  3. Underwater and Hyperbaric Naval Medicine Hyperbaric oygen therapy: HOW? One-place chamber: Pressurized with pure oxygen Multi-place chamber: Pressurized with air

  4. Hyperbaric oxygen therapy: HOW?Pure oxygen inhalation inside the chamber Underwater and Hyperbaric Naval Medicine oro-nasal Cephalic tent Tracheal tube

  5. Underwater and Hyperbaric Naval Medicine Hyperbaric therapy: For what? To reduce the gas bubbles size (Boyle’s law: PV = C)

  6. Underwater and Hyperbaric Naval Medicine Hyperbaric therapy: For what? Increases the blood’s oxygen and reverts the tissues hypoxia (Dalton’s Law: Pp = Pt . Fi:%) (Henry’s Law: Q = SPp) (FicK’s Law: dQ = P x  c dt x A)

  7. Underwater and Hyperbaric Naval Medicine Portuguese Navy UHM Evolution 1992: Urgency Service ECHM and UHMS list 1994: professional divers certification1995: commun service of the military force 3 branchesNATO ADIV-P2 list 1953 (S.S. - D.S.) 1967 (S.S. - D.S.) 1989 (CHM-LNH.) 2001(CHM-LNH)

  8. Underwater and Hyperbaric Naval Medicine Portuguese Navy UHM Evolution Nitrox / heliox “Critical” patients 26 patients simultaneously C.H.M. – L.N.H. (2001)

  9. Underwater and Hyperbaric Naval Medicine CHM – Global Activity - 1989 – 2008 10.812 Consultations - Total Individual hyperbaric sessions - global 99.390 Individual hyperbaric sessions - routine 97.627 Individual hyperbaric sessions - urgency 1.763

  10. CHM – Global Activity - 1989 – 2008 Underwater and Hyperbaric Naval Medicine 4.973 Patients observed - total 3.703 Patients observed - Routine 1.273 Patients observed - Urgency 4.090 Treated patients - Total Treated patients - Routine 2.836 Treated patients - Urgency 1.254

  11. Underwater and Hyperbaric Naval Medicine CHM – Global Activity - 1989 – 2008 (origin of the patients) Observed patients Treated patients Origin(31.12.2008) % % Hospitals ( 64 ) 3.932 79 3.480 85 Assistent Doctors 885 19 576 14 Own iniciative 159 3 34 1 TOTAL 4.976 4.090

  12. Underwater and Hyperbaric Naval Medicine CHM ROUTINE TREATED DISEASES (1989 – 2008) MALIGNANT EXTERNAL EAR INFECTION NECROTIZING SOFT TISSUE INFECTIONS DIABETIC RETINOPATHY / ISCHEMIC NEURITIS/PIGMENTED RETINOPATHY RADIO-INDUCED BONE NECROSIS CRITICAL ISCHEMIA OSTEOMIELYTIS RADIO-INDUCED CISTYTIS/PROCTYTIS/RECTYTIS DIABETIC FOOT LEG ULCERS SUDDEN DEAFNESS

  13. Underwater and Hyperbaric Naval Medicine CHM URGENCE TREATED DISEASES (1989 – 2008) Sudden deafness Radio-induced cistytis Necrotizing soft tissues infections Fournier’s gangrene Gas gangrene Gas embolism Decompression sickness Hydrogen sulphide poisoning Carbon monoxide poisoning

  14. Underwater and Hyperbaric Naval Medicine CHM – Instruction Activity • 17 Dive and Hyperbaric Medicine Basic Courses (ISU04/ISU05) – 121 health military professionals • 3 Underwater and Hyperbaric Medicine Post Graduation Course – 36 doctors • UHM Optional Chair – LUMF and Naval School– 92 4rth yearstudents • National Underwater and Hyperbaric Medicine Meetings– 1997, 1999, 2001 • European Consensus Conference on the Role of HBO in Radio-induced Soft tissues Lesions - 2001

  15. Underwater and Hyperbaric Naval Medicine 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)

  16. Underwater and Hyperbaric Naval Medicine 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

  17. Underwater and Hyperbaric Naval Medicine CHM Structural and Functional Evolution – 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

  18. Underwater and Hyperbaric Naval Medicine CHM Structural and Functional Evolution – How? CUHM Director Medical Dep. Techn. Dep. Admin. Dep. System Drive System Superv. • Int Med; Y N & T; Cardiolgy • Pneumol; Ophtalmology • Gen & Vasc Surg • O R; Anesth & Rean • Neurosciencies; Motility Unit Clinical Unit Operational Unit Invest Unit

  19. Underwater and Hyperbaric Naval Medicine CHM Structural and Functional Evolution – 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

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