Cardiovascular risk assessment in divers: Toward safer diving.

Similar to aviation, diving is performed in an environment in which acute incapacitation may lead to a fatal outcome. In aeromedicine, a pilot is considered "unfit to fly" when the cardiovascular event risk exceeds one percent per annum, the so-called 1% rule. In diving no formal limits to cardiovascular risk have been established.

Children and diving, a guideline.

Scuba diving is an increasingly popular recreational activity in children and adolescents. During the dive medical examination aspects of human physiology, anatomy, and psychology, that differ between adults and children, deserve our special attention. For example, lack of mental maturity, diminished Eustachian tube function and heat loss can pose problems during diving.

[Sir Geoffrey Marshall, anaesthetist before the term existed].

At the start of World War I, relatively inexperienced physicians were responsible for administering anaesthesia to severely injured soldiers in shock. Lack of knowledge, experience and proper equipment led to high mortality rates. Based on his pre-war experience in the department of respiratory physiology at Guy's Hospital in London, the British physician Geoffrey Marshall was ordered to investigate the high mortality rates.

[Lidocaine: local anaesthetic with systemic toxicity].

In 4 patients, 3 women aged 63, 17 and 43 years, and a man aged 67 years, lidocain was used as a local anaesthetic for a transthoracic esophageal fundoplication (first patient), severe painful gonarthrosis (fourth patient) and legal abortion (second and third patients). All patients suffered from systemic toxicity as a result, a rare complication. They all had an uneventful recovery, except for the second patient who died from adult respiratory distress syndrome after two weeks in the intensive care unit.

Opening the microcirculation: can vasodilators be useful in sepsis?

Objective: A prominent feature of sepsis is dysfunction of the microcirculation, with impaired perfusion and regional tissue oxygenation causing a deficit in oxygen extraction. If shunting of oxygen transport past closed hypoxic microcirculatory beds is responsible for this, vasodilator therapy, which raises the driving pressure of the microcirculation and thereby promotes flow, could recruit such shunted microcirculatory units and improve tissue oxygenation.

Design: A literature search was conducted in Medline for evidence of this expected benefit of vasodilators in sepsis.