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Decompression sickness is a medical condition caused by dissolved gases emerging from solution as bubbles inside the body tissues during decompression. DCS most commonly occurs during or soon after a decompression ascent from underwater diving, but can also result from other causes of depressurisation, such as emerging from a caisson, decompression from saturation, flying in an unpressurised aircraft at high altitude, and extravehicular activity from spacecraft. DCS and arterial gas embolism are collectively referred to as decompression illness.
Saturation diving is diving for periods long enough to bring all tissues into equilibrium with the partial pressures of the inert components of the breathing gas used. It is a diving mode that reduces the number of decompressions divers working at great depths must undergo by only decompressing divers once at the end of the diving operation, which may last days to weeks, having them remain under pressure for the whole period. A diver breathing pressurized gas accumulates dissolved inert gas used in the breathing mixture to dilute the oxygen to a non-toxic level in his or her tissues, which can cause decompression sickness if permitted to come out of solution within the body tissues; hence, returning to the surface safely requires lengthy decompression so that the inert gases can be eliminated via the lungs. Once the dissolved gases in a diver's tissues reach the saturation point, however, decompression time does not increase with further exposure, as no more inert gas is accumulated.
Diving medicine, also called undersea and hyperbaric medicine (UHB), is the diagnosis, treatment and prevention of conditions caused by humans entering the undersea environment. It includes the effects on the body of pressure on gases, the diagnosis and treatment of conditions caused by marine hazards and how relationships of a diver's fitness to dive affect a diver's safety. Diving medical practitioners are also expected to be competent in the examination of divers and potential divers to determine fitness to dive.
Diving disorders, or diving related medical conditions, are conditions associated with underwater diving, and include both conditions unique to underwater diving, and those that also occur during other activities. This second group further divides into conditions caused by exposure to ambient pressures significantly different from surface atmospheric pressure, and a range of conditions caused by general environment and equipment associated with diving activities.
A diving chamber is a vessel for human occupation, which may have an entrance that can be sealed to hold an internal pressure significantly higher than ambient pressure, a pressurised gas system to control the internal pressure, and a supply of breathing gas for the occupants.
The Varying Permeability Model, Variable Permeability Model or VPM is an algorithm that is used to calculate the decompression stops needed for ambient pressure dive profiles using specified breathing gases. It was developed by D.E. Yount and others for use in professional diving and recreational diving. It was developed to model laboratory observations of bubble formation and growth in both inanimate and in vivo systems exposed to pressure. In 1986, this model was applied by researchers at the University of Hawaii to calculate diving decompression tables.
In diving and decompression, the oxygen window is the difference between the partial pressure of oxygen (PO2) in arterial blood and the PO2 in body tissues. It is caused by metabolic consumption of oxygen.
Captain Albert Richard Behnke Jr. USN (ret.) was an American physician, who was principally responsible for developing the U.S. Naval Medical Research Institute. Behnke separated the symptoms of Arterial Gas Embolism (AGE) from those of decompression sickness and suggested the use of oxygen in recompression therapy.
Professor Albert Alois Bühlmann was a Swiss physician who was principally responsible for a number of important contributions to decompression science at the Laboratory of Hyperbaric Physiology at the University Hospital in Zürich, Switzerland. His impact on diving ranged from complex commercial and military diving to the occasional recreational diver. He is held in high regard for his professional ethics and attention to his research subjects.
The decompression of a diver is the reduction in ambient pressure experienced during ascent from depth. It is also the process of elimination of dissolved inert gases from the diver's body, which occurs during the ascent, largely during pauses in the ascent known as decompression stops, and after surfacing, until the gas concentrations reach equilibrium. Divers breathing gas at ambient pressure need to ascend at a rate determined by their exposure to pressure and the breathing gas in use. A diver who only breathes gas at atmospheric pressure when free-diving or snorkelling will not usually need to decompress, Divers using an atmospheric diving suit do not need to decompress as they are never exposed to high ambient pressure.
The practice of decompression by divers comprises the planning and monitoring of the profile indicated by the algorithms or tables of the chosen decompression model, to allow asymptomatic and harmless release of excess inert gases dissolved in the tissues as a result of breathing at ambient pressures greater than surface atmospheric pressure, the equipment available and appropriate to the circumstances of the dive, and the procedures authorized for the equipment and profile to be used. There is a large range of options in all of these aspects.
Decompression in the context of diving derives from the reduction in ambient pressure experienced by the diver during the ascent at the end of a dive or hyperbaric exposure and refers to both the reduction in pressure and the process of allowing dissolved inert gases to be eliminated from the tissues during this reduction in pressure.
Decompression theory is the study and modelling of the transfer of the inert gas component of breathing gases from the gas in the lungs to the tissues and back during exposure to variations in ambient pressure. In the case of underwater diving and compressed air work, this mostly involves ambient pressures greater than the local surface pressure, but astronauts, high altitude mountaineers, and travellers in aircraft which are not pressurised to sea level pressure, are generally exposed to ambient pressures less than standard sea level atmospheric pressure. In all cases, the symptoms caused by decompression occur during or within a relatively short period of hours, or occasionally days, after a significant pressure reduction.
There are several categories of decompression equipment used to help divers decompress, which is the process required to allow divers to return to the surface safely after spending time underwater at higher ambient pressures.
Brian Andrew Hills, born 19 March 1934 in Cardiff, Wales, died 13 January 2006 in Brisbane, Queensland, was a physiologist who worked on decompression theory.
The thermodynamic model was one of the first decompression models in which decompression is controlled by the volume of gas bubbles coming out of solution. In this model, pain only DCS is modelled by a single tissue which is diffusion-limited for gas uptake and bubble-formation during decompression causes "phase equilibration" of partial pressures between dissolved and free gases. The driving mechanism for gas elimination in this tissue is inherent unsaturation, also called partial pressure vacancy or the oxygen window, where oxygen metabolised is replaced by more soluble carbon dioxide. This model was used to explain the effectiveness of the Torres Straits Island pearl divers empirically developed decompression schedules, which used deeper decompression stops and less overall decompression time than the current naval decompression schedules. This trend to deeper decompression stops has become a feature of more recent decompression models.
The physiology of decompression is the aspect of physiology which is affected by exposure to large changes in ambient pressure, and involves a complex interaction of gas solubility, partial pressures and concentration gradients, diffusion, bulk transport and bubble mechanics in living tissues. Gas is breathed at ambient pressure, and some of this gas dissolves into the blood and other fluids. Inert gas continues to be taken up until the gas dissolved in the tissues is in a state of equilibrium with the gas in the lungs,, or the ambient pressure is reduced until the inert gases dissolved in the tissues are at a higher concentration than the equilibrium state, and start diffusing out again.
The following index is provided as an overview of and topical guide to underwater diving:
References
- 1 2 3 4 5 Bevan, John; Towse, John (September–October 2006). "Remembering a legend in the field of decompression (Obituary)". Underwater Contractor International. Teddington, Middlesex, UK: Underwater World Publications Ltd.: 27, 28. ISSN 1362-0487.
- 1 2 3 4 "Val Hempleman". www.worldnavalships.com. Retrieved 4 November 2021.Originally published in the "Daily Telegraph" 30 Oct 2006
- ↑ Huggins, Karl E. (1992). "4". Dynamics of decompression workshop (Course Taught at the University of Michigan). p. 3. Archived from the original on April 15, 2013. Retrieved 10 January 2012.
{{cite book}}: CS1 maint: unfit URL (link) - ↑ Imbert, Jean Pierre (February 2006). Lang; Smith (eds.). "Commercial Diving: 90m Operational Aspects" (PDF). Advanced Scientific Diving Workshop. Retrieved 30 June 2012.
