Piepho T, Ehrmann U, Werner C, Muth C M
Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstrasse 1, 55131, Mainz.
Anaesthesist. 2007 Jan;56(1):44-52. doi: 10.1007/s00101-006-1097-1.
Diving accidents represent a departure from the routine practice of emergency physicians. The incidence of non-fatal diving accidents is reported as 1-2 per 10,000 dives. Apart from adequate intravenous hydration, oxygen is the only medication with a proven effect in the treatment of diving accidents. After a typical diving accident, administration of oxygen at an inspired concentration (F(I)O(2) 1.0) as high as possible is recommended. Many divers bring along their own oxygen administration systems to the diving sites and these are often better suited for the treatment of diving accidents than the oxygen systems of many emergency responders. Pressure regulators supplying low constant flow oxygen, nasal prongs and inhalation masks are inappropriate. When using artificial ventilation bags with face masks, an oxygen flow of at least 15 l/min should be used. Demand regulators are simple to use and able to deliver a F(I)O2 of 1.0. Their ease of use has earned them high marks in the emergency management of diving accidents and their similarity to standard diving equipment has also aided relatively widespread acceptance. Circulation breathing systems are more technologically complex oxygen delivery systems which permit CO2 absorption and re-breathing at low oxygen flow. In contrast to the demand modules, the likelihood of mistakes during their usage is higher. In diving accidents, the administration of normobaric oxygen, already begun in the field, is the most important therapy and should not be interrupted. Presented with an inadequate supplemental oxygen supply, the inspired oxygen concentration should not be decreased, rather the duration of the oxygen administration should be reduced. Hyperbaric oxygen therapy should be the mainstay of further treatment.
潜水事故有别于急诊医生的常规诊疗工作。据报道，非致命性潜水事故的发生率为每10000次潜水1 - 2例。除了充分的静脉补液外，氧气是唯一被证实在治疗潜水事故中有效果的药物。在典型的潜水事故发生后，建议尽可能给予高吸入氧浓度（F(I)O(2) 1.0）的氧气。许多潜水者会自带供氧系统前往潜水地点，这些系统往往比许多急救人员的供氧系统更适合治疗潜水事故。提供低恒定流量氧气的压力调节器、鼻导管和吸入面罩并不适用。使用带面罩的人工通气袋时，应使用至少15升/分钟的氧流量。按需调节器使用简单，能够提供F(I)O2为1.0的氧气。其易用性使其在潜水事故的应急处理中获得高分，而且它与标准潜水设备相似，这也有助于其得到相对广泛的接受。循环呼吸系统是技术上更复杂的氧气输送系统，可在低氧流量下允许二氧化碳吸收和再呼吸。与按需调节器不同，其使用过程中出错的可能性更高。在潜水事故中，在现场就已开始的常压氧疗是最重要的治疗方法，不应中断。如果补充氧气供应不足，不应降低吸入氧浓度，而应缩短吸氧时间。高压氧治疗应作为后续治疗的主要手段。
