Ideas about bends have changed from the concept that a bubble
formed in the nervous system or the joint by cavitation-negative
pressure. Rapid ascent or joint motion caused the culprit to appear
and pressure would make the bubble go away. Now we are treating
tissue damage with oxygen. But, we are still using pressure and
oxygen to increase the partial pressure of oxygen in the affected
tissue. The treatment of choice is the 5 hour long U.S. Navy
Treatment Table 6 which washes out the nitrogen in the tissue and
washes in the oxygen. Careful understanding of how my patients got
bent and how they responded should make any diver more cautious
regarding repetitive diving and a multi-day series of dives.
Pressure at the deepest part of the dive washes in the nitrogen
over time. Fatty tissue, that includes the central nervous system
and peripheral nerves, absorbs more nitrogen than watery tissues
such as muscle. Shaping-up to dive includes weight loss, abstinence
during the duration of the series of dives, and improving lung
function.
Physical conditioning such as walking 20 or more minutes a day
for several weeks before diving is as important as paying for the
trip.
Dive accidents sometimes do not have a treatable solution. Most
"accidents" resolve after one recompression breahing oxygen under
pressure. Many patients were treated multiple times, and some did
not get complete relief of thir symptoms and/or neurological
fndings. Immediate thrapy traditionally is in-water recompression
which has its drawbacks. It is difficult to administer and
hypothermia, fatige, and drwning are risks. Surface-On-Deck oxygen
breathing from a facemask or immediate recompression in a chamber
are always effective treatments. Transport to a facility has
logistical problems and the destination chamber may not be
functional when it i needed. The book is about the chamber that I
personally operated and staffed. I was continually available except
for a few meetings, shopping trips for supplies, and family
obligations. The volume of bent divers that I treated, not all are
included, speaks for itself.
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