Diapositivo 1

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 ( CCEs directive 93 /
  42 from June the 14th 1993)

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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
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Underwater and Hyperbaric Naval Medicine

• Hyperbaric therapy For what?
• To reduce the gas bubbles size
• (Boyles law PV C)

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Underwater and Hyperbaric Naval Medicine
ATA 1 3
Fi O2 0.21 1
Lungs 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?
• Increases the bloods oxygen and reverts the
  tissues hypoxia
• (Daltons Law Pp Pt . Fi)
• (Henrys Law Q SPp)
• (FicKs Law dQ P x ? c
• dt x A)

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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)
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Underwater and Hyperbaric Naval Medicine
Portuguese Navy UHM Evolution

Nitrox / heliox Critical patients 26
patients simultaneously
C.H.M. L.N.H. (2001)
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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
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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
1.254
Treated patients - Urgency
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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
3.480
79
85
Assistent Doctors
885
576
19
14
Own iniciative
159
3
1
34
4.976
TOTAL
4.090
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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
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Underwater and Hyperbaric Naval Medicine
CHM URGENCE TREATED DISEASES (1989 2008)
Sudden deafness
Radio-induced cistytis
Necrotizing soft tissues infections
Fourniers gangrene
Gas gangrene
Gas embolism
Decompression sickness
Hydrogen sulphide poisoning
Carbon monoxide poisoning
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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 year students

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

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

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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)

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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

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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
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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
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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 Navys
leadership in the UHM field and for the better
individualization of the Naval Medicine