Kesehatan Penyelaman

Kesehatan Penyelaman
Studi kesehatan manusia yang mempelajari tentang faktor determinan dalam aktivitas dan proses adaptasinya di lingkungan penyelaman (underwater), yang dapat menyebabkan ganguan kesehatan serta mencegah dan merehabilitasikannya melalui upaya yang terorganisasi agar tetap dalam kondisi sehat fisik dan mental.

Diving Stressors
1. TEKANAN AMBIENT

2.
3. GAS 4.

DENSITAS GAS MEDIA NAFAS

TEKANAN PARSIAL GAS MEDIA

KELARUTAN GAS

Diving Strains
1. ORGAN PARU 2. ORGAN KARDIOVASKULER 3. ORGAN SUSUNAN SARAF PUSAT 4. ORGAN LAIN [THT,MATA,GIT,KULIT]

Pulmonary Strains
1. HIPOVENTILASI (STATIS,DINAMIS) 2. PENURUNAN RESPON VENTILASI TERHADAP PENINGKATAN CO2

Cardiovascular Strains
1. HEART RATE (BRADYCARDIA)

2. ELECTROCARDIOGRAM (ARHYTMIA)
3. CARDIAC OUTPUT, ARTERIAL PRESSURE, SYSTEMIC VASCULAR RESISTANCE WORK CAPACITY

4.

CNS Strains
1. GRADUAL LOSS

,INTELECTUAL,PSYCHOMOTOR AND PSYCHOSENSORIAL FUNCTION 2. ELECTROPHYISIOLOGIC

3. NEUROTRANSMISSION [MONOAMIN,AMINO ACID)]

Pathobiologi
KLASIFIKASI I
1. BIOMEKANIK, BAROTRAUMA 2. BIOKIMIA, KERACUNAN GAS (O2.CO2,CO, INERT) 3. BIOFISIK, DECOMPRESSION SICKNESS

Pathobiologi
KLASIFIKASI II
1. PERIODE TURUN, DESCENT 2. PERIODE DI DASAR, DEPHT 3. PERIODE NAIK, ASCENT

BAROTRAUMA
BAROTRAUMA TELINGA BAROTRAUMA SINUS BAROTRAUMA GIGI BAROTRAUMA PARU BAROTRAUMA DIGESTIVE BAROTRAUMA MATA BAROTRAUMA KULIT

BAROTRAUMA
Barotrauma is The clinical or Biomechanical name for the mechanical impact of pressure changing

Barotrauma during descent is called a squeese. Barotrauma of ascent is called reverse squeese.

BAROTRAUMA
There are 5 conditions that must be met for barotrauma to occur 1. there must be a gas-filled space, 2. the space must have rigid walls, 3. the space must be enclosed. the space must be vascularized, and have a membrane lining at least one wall of the space, 4. there must be a change in ambient pressure (Boyles Law)

BAROTRAUMA[SQUEESE] TELINGA TENGAH MIDDLE EAR SQUEESE

SINONIM
AEROSALPINGOTYMPANI OTITIC OTIC BAROTRAUMA AEROTITIC MEDIA AERO-OTITIS MEDIA

MIDDLE EAR SQUEESE

Middle ear squeese is caused by the failure or inability of a diver to equalized pressure in the middle ear space during descent. Rupture of the membrane will occur if the pressure differential is greater than 100 mmHg.

MIDDLE EAR SQUEESE

PATHOGENESIS
1. KEGAGALAN, MENYAMAKAN TEKANAN DI RUANG TELINGA TENGAH SELAMA TURUN/KOMPRESI 2. AKIBAT TEKANAN NEGATIF DI RUANG TELINGA TENGAH, M.TYMPHANI TERDORONG,OEDEMA & PERDARAHAN MUKOSA SAMPAI PERFORASI 3. RUPTUR M.TYMPHANI BILA GRADIENT TEKANAN >100mmHg

MIDDLE EAR SQUEESE

SYMPTOMS & SIGNS
DEPTH OF ONSET [BAYLISS,1968]
DEPTH OF ONSET

[FSW]

PERCENT OF 524 SUBJECTS WITH SYMPTOM

1-5 6-10 11-20 21-33 34-66 >66

0,2 5,3 6,9 3,6 2,9 0,6

MIDDLE EAR SQUEESE

Degree
Teed 0 Teed 1 Teed 2 Teed 3 Teed 4 Teed 5

Sign
No visible damage Congestion of umbo and pars flaccida, occurs with a pressure differential of 2 psi Congestion of entire drum, occurs with a pressure differential of 2-3 psi Hemmorrhage into drum Extensive middle ear hemorrage, with blood bubbles visible behind the tymoanic membrane, the membrane may be ruptured. Entire middle ear filled with deoxygenated blood

MIDDLE EAR SQUEESE

Degree Sign

MacFie 1 MacFie 2 MacFie 3 MacFie 4 MacFie 5

Injection of tympanic membrane Slight hemorrage into tympanic membrane Gross hemmorage into tympanic membrane From blood in middle ear space Rupture of tympanic membrane

MIDDLE EAR SQUEESE

TREATMENT
Oral dencongestants, occasionaly, an antihistamine, decongestant combination, systemic antibiotic such as ampicillin [If perforation of the membrane has occurred]

SQUEESE PARU BAROTRAUMA PARU

BAROTRAUMA PARU TURUN,DESCENT [SQUEESE PARU]
PADA PENYELAM TAHAN NAFAS (BREATHOLD DIVE)

SQUEESE PARU
1. PENYEBAB, KENAIKAN TEKANAN TIDAK DIIKUTI KESTABILAN VOLUM PARU

2. TERJADI PADA PENYELAM TAHAN NAFAS

3. VOLUME PARU DIKEDALAMAN MENDEKATI VOLUME RESIDU PARU

4. SERING TERJADI PADA PENYELAM DENGAN KAPASITAS VOLUME PARU YANG KECIL
5. BERLANJUT SEBAGAI ATELEKTASIS PARU

BAROTRAUMA PARU NAIK

PULMONARY OVERINFLATION BAROTRAUMA PARU

1. PENYEBAB, PENURUNAN TEKANAN TIDAK DIIKUTI PENGURANGAN VOLUM PARU

2. TERJADI PADA PENYELAM DENGAN ALAT

3. VOLUME PARU EKSPANSI SEWAKTU MENUJU KE PERMUKAAN/DIPERMUKAAN 4. SERING TERJADI PADA KEDARURATAN PENYELAM ATAU LATIHAN ASCAPE 5. BERLANJUT SEBAGAI EMBOLI UDARA

PULMONARY OVERINFLATION
RUPTUR OF ALVIOLI

PULMONARY INTERSTETIAL EMPHYSEMA

ARTERIAL GAS EMBOLISM

MEDIASTENAL PNEUMOTHORAX EMPHYSEMA

CEREBRAL GAS EMBOLISM

CORONARY GAS EMBOLISM

SUBCUTANEOUS EMPHYSEMA

PNEUMOPERICARDIUM

BAROTRAUMA PARU NAIK

PULMONARY OVERINFLATION
INITIAL TREATMENT
1. MAINTAIN AN ADEQUATE AIRWAY,VENTILATION 2. CORRECTION HYPOTENSION 3. ADMINISTER 100 % O2 4. ADMINISTER A BOLUS OF DEXAMETHASONE

DEFINITIVE TREATMENT
RECOMPRESSION THERAPY

ADJUVANT THERAPY
1. STEROIDS 2. FLUIDS 3. HEMODYNAMIC SUPPORT 4. VENTILATION

NARKOSE GAS INERT

SINONIM INTOKSIKASI GAS INERT PENYEBAB [STRESSOR] PENINGKATAN TEKANAN PARSIAL GAS INERT INCIDENCE,SYMPTOMS, SIGNS 1. PENYELAMAN DENGAN UDARA KOMPRESI [AIR COMPRESSED], CAMPURAN GAS [MIXED GAS] 2. BERGANTUNG DENGAN KEDALAMAN. KECEPATAN KOMPRESI [DESCENT RATE] VARIASI DAN TOLERANSI PENYELAM 3. RIVERSIBEL GEJALA TERGANTUNG PADA DESCENT RATE 4. KEMUNDURAN INTELLECTUAL PERFORMANCE DAN NEUROPHYSIOLOGIC 5. PATHOGENESIS, BIOPHYSIC THEORY DAN BIOCHEMICAL THEORY

PULMONARY OXYGEN TOXICITY

1. SEVERAL EXPOSURE TO OXYGEN [ABOVE 0,6 BAR] 2. PENURUNAN VOLUME PARU STATIS 3. PENYELAMAN DALAM [EXTENDED BOTTOM TIME]

NARKOSE GAS INERT

CONTRIBUTING FACTOR
1. TEKANAN PARSIAL O2 2. TEKANAN PARSIAL CO2 3. ACCLIMATIZATION

PREVENTION
1. HINDARI BEKERJA MENYELAM LEBIH DARI 30 METER DENGAN UDARA KOMPRESI 2. SEGERA NAIK BILA TERASA GEJALA NARKOSE GAS INERT

OXYGEN TOXICITY
KATAGORI
1. CENTRAL NERVOUS SYSTEM TOXICITY [OXYGEN EPILEPSY,PAUL BERT EFFECT] 2. LUNG TOXICITY [LORAIN SMITH EFFECT]

ETIOLOGI [STRESSOR]
PENINGKATAN TEKANAN PARSIAL O2

INCIDENCE
1. SURFACE SUPPLIED SYSTEM DIVING 2. CLOSED CIRCUIT DIVING 3. HYPERBARIC OXYGEN THERAPY

CNS OXYGEN TOXICITY

1. UNDER HIGH OXYGEN EXPOSURE
2. SYMPTOMS AND SIGNS
a. NAUSEA, VOMITING b. GENERAL SENSATIONS c. TUNNEL VISION d. VERTIGO e. TINNITUS f. TWITCHING, CONVULSION [TONIC CLONIC, LOSS OF CONSCIOUSNESS]

CNS OXYGEN TOXICITY

[DONALD, 1947]
V E N T I D = = = = = = VISUAL DISTURBANCES EAR DISTURBANCES NAUSEA TWITCHING IRRITABILITY DIZZINESS

CNS OXYGEN TOXICITY

FACTORS WHICH AFFECT OXYGEN TOLERANCE
1. EXERCISE 2. INCREASEED FICO2 OR HYPOVENTILATION 3. HYPERVENTILATION

4. IMMERSION IN WATER
5. INERT GAS 6. REPEATED EXPOSURE 7. FEVER 8. COLD

DECOMPRESSION SICKNESS

SYNONIMS
CAISSON DISEASE BENDS STAGGERS CHOKES AND AEROEMBOLISM

DECOMPRESSION SICKNESS
CLINICAL MANIFESTATIONS

A. TYPE I (PAIN ONLY) LIMB PAIN LYMPHATIC MANIFESTATIONS CUTANEOUS MANIFESTATIONS B. TYPE II (SERIOUS) CARDIOPULMONARY CEREBRAL SPINAL VESTIBULAR

DECOMPRESSION SICKNESS
PREDISPOSING FACTORS

EXERCISE
LOCAL INJURY

COLD WATER AGE DEHYDRATION CARBON DIOXIDE

DECOMPRESSION SICKNESS
TREATMENT

RECOMPRESSION
5,6 US NAVY TABLES COMEX TABLES GERS MER TABLES HYDRATION STEROID HEPARINE ASPIRIN

O2 TREATMENT TABLE 5

O2 TREATMENT TABLE 6