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Health Matters
Fig 2. Fig 3. Fig 4. Fig. 6
Fig. 6 F
Fig 5.
ig 8.
Legend fi g 5.
Tympanogram with tubal dysfunction e.g.
in colds and associated dysfunction of the
Eustachian tube.
Left side: the left shift of the curve indicates
a negative pressure in both the middle ear.
Right side: after pressure equalization
maoeuvre the curve of the right ear shifted
rightwards back to the normal range, the
Fig 7.
left ear slightly topped over the median
Fig 9.
line, indicating a positive pressure.
Overall, the mobility of the curves shows
a successful equalization maoeuvre - the
tubes are still permeable and can be
ventilated.
essential for safety. However, a diver’s attitude often changes drastically A diving-specifi c medical history includes: the level of training; number of
when it comes to a medical check of their body. dives; date of the last dive; the type of diving (such as air, nitrox and trimix
gas diving, rebreather, ice diving and drift diving); the profi le of the diver
An oft quoted dictum by divers in my clinic is: if I was down there to die,
(recreational or professional divers such as research divers, rescue divers,
I could not imagine a more glorious death. But it is not that simple or
fi re brigade or police divers) and, of course, any preconditions of diving-
glorious! We endanger not only ourselves but our buddy by evoking a
related incidents, problems or even decompression sickness.
potentially harmful and dangerous emergency situation triggered by our
own health problems underwater. Very few dive accidents end in what Particularly for children, an important but often forgotten question is:
these people may see as a ‘pleasant death’ underwater. Even considering can you swim? For beginners and novices, it is interesting in terms of
a serious case of decompression sickness, a diver seldom dies, but is more psychological profi le to ask about the motivation to dive - particularly in
likely to travel home in a wheelchair. children and non-diving spouses.
Most divers think themselves safe after a ‘goodwill investigation’ by a non-
Physical Examination
diving medical specialist. Some may think that simply because they have
a doctor’s signature on their dive-medical,nothing can go wrong. Wrong! The physical examination gives a general impression of the diver’shealth
A lack of medical knowledge of the diving-related physiological aspects to the doctor. The patient should be undressed so conditions, the
can lead to problems. It should be pointed out here, however, that even a nutritional status and major skeletal abnormalities can be detected.
thorough examination is not a free ticket for foolish behavior in the water!
The further course of the examination may be done following the offi cial
In principle, any licensed doctor with the appropriate knowledge can do a examination sheet and includes the whole body – from the pupillary
dive-medical examination, if he or she is familiar with the physical realities refl ex (pupil response to light) down to a wobble of the big toe. In this
of diving and sports medicine. One can fi nd a trained specialist for diving way, one small lymph node in the neck area can be recorded as carefully
and hyperbaric medicine locally on the website of any diving medical as an attenuated refl ex of the Achilles tendon.One by one, the various
organisation (see table one). organ systems are examined; head, ENT (ear, nose, and throat) and neck
region of the respiratory - cardiovascular system, abdomen, as well as an
Screening of recreational divers orientating neurological examination and a check of the musculoskeletal
system. The investigation must be complete and accurate. An essential
In Germany, the guidelines of the Society for Diving and Hyperbaric
and indispensable part of the investigation is, of course, the inspection of
Medicine regulates the scope of services with a given examination form.
the ears, ear canals and eardrums, which includes inspecting the eardrum
It can be accessed on the portal of GTÜM. In the UK, one can refer to the
movement during equalization (see Figure 2). In case of functional or
guidelines of the HSE (Health and Safety Executive), EUBS (European
structural problems, a so-called tympanogram (ultrasound of the drum)
Underwater and Baromedical Society). For other websites see table one.
can give further information about the nature of the disorder. (see Figure
The nature and course of the investigation
3, 4 and 5 + Legend Fig 5)
Particular attention is directed toward the chest, heart and lungs.
Medical history: At the initial examination a detailed survey of the entire
Auscultation (listening with a stethoscope) of the heart and lungs in all
medical history is needed, or an interim history for repeat examinations.
the sections is compulsory. Blood pressure and pulse rate are taken (See
This provides the physician with the necessary background information,
Figure 6).
which may indicate the possible need for additional investigations. Also
signifi cant are chronic diseases, medication and previous operations, as If there are any pathological (abnormal) fi ndings, which could cause
well as nicotine, alcohol consumption and physical activity. problems in diving, the diver should be referred to consult a specialist
Issue 5 March - April ‘10 www.cdws.travel 51
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