Hyperbaric Medicine

Hyperbaric and diving physicians are doctors, often anaesthetists, who specialise in conditions that affect divers and those who have been in areas of high pressure. They also are the doctors who operate the hyperbaric chamber. This is used in the treatment of some diving related injuries, but also in the treatment of other conditions including carbon monoxide poisoning and wound treatment. They often also run clinics that assess people for fitness to dive – ie they run diving medicals for amateur and professional divers.

Medical Conditions

Decompression illness
The staggers, the bends, the chokes
Arterial gas embolism (AGE)

Specialty Areas of Interest

Associated Tests

Blood gases
Chest X-Ray
CT head

Procedures

Treatment of diving related decompression illness involves supportive measures as well as recompression (“diving”) the patient and gradually resurfacing.
Hyperbaric oxygen therapy also involves taking the patient into a hyperbaric chamber and “diving” or increasing the pressure within the chamber to increase the partial pressure of oxygen in the patient’s blood and wound.

What to expect

History

If the disease is diving related, history will focus on current symptoms, particularly neurological (brain and nerves), musculoskeletal (aches and pains), respiratory (coughing) as well as any other prominent symptoms. Details of the dive, depth, duration, ascent, other dives are paramount.
Past medical problems, medications, allergies, family and social history are also relevant.

Examination

A quick general examination again focusing on brain and nerves, eyes, chest and joints is carried out. If immediate treatment is required this is commenced prior to more detailed physical examination.

Training and Qualifications

Entry into hyperbaric and diving medicine training is often via another specialist route. Doctors may specialise in anaesthetics, intensive care, emergency medicine or general practice before developing a special area of expertise in hyperbaric and dive medicine. Hyperbaric medicine involves controlling dive / hyperbaric chambers to treat patients with diving related illness (like the bends). Hyperbaric oxygen therapy is also used for many other problems including carbon monoxide poisoning, chronic ulcer treatment and other wound healing. Doctors specialising in this area of medicine generally do a year or two fellowship working under the guidance of a hyperbaric specialist before independent practice.
Dive medicine has many overlaps with hyperbaric medicine, but many doctors involved with dive medicine do so from the occupational health point of view. They conduct medical examinations to determine whether people are fit to dive, either recreationally or professionally. They require special training in addition to their basic medical qualification and are specially certified to conduct dive medicals.