Mitchell S J, Bennett M H, Bird N, Doolette D J, Hobbs G W, Kay E, Moon R E, Neuman T S, Vann R D, Walker R, Wyatt H A
Department of Anesthesiology, University of Auckland, New Zealand.
Undersea Hyperb Med. 2012 Nov-Dec;39(6):1099-108.
The Diving Committee of the Undersea and Hyperbaric Medical Society has reviewed available evidence in relation to the medical aspects of rescuing a submerged unresponsive compressed-gas diver. The rescue process has been subdivided into three phases, and relevant questions have been addressed as follows. Phase 1, preparation for ascent: If the regulator is out of the mouth, should it be replaced? If the diver is in the tonic or clonic phase of a seizure, should the ascent be delayed until the clonic phase has subsided? Are there any special considerations for rescuing rebreather divers? Phase 2, retrieval to the surface: What is a "safe" ascent rate? If the rescuer has a decompression obligation, should they take the victim to the surface? If the regulator is in the mouth and the victim is breathing, does this change the ascent procedures? If the regulator is in the mouth, the victim is breathing, and the victim has a decompression obligation, does this change the ascent procedures? Is it necessary to hold the victim's head in a particular position? Is it necessary to press on the victim's chest to ensure exhalation? Are there any special considerations for rescuing rebreather divers? Phase 3, procedure at the surface: Is it possible to make an assessment of breathing in the water? Can effective rescue breaths be delivered in the water? What is the likelihood of persistent circulation after respiratory arrest? Does the recent advocacy for "compression-only resuscitation" suggest that rescue breaths should not be administered to a non-breathing diver? What rules should guide the relative priority of in-water rescue breaths over accessing surface support where definitive CPR can be started? A "best practice" decision tree for submerged diver rescue has been proposed.
水下与高压氧医学协会潜水委员会已审查了与营救水下无反应压缩气体潜水员医学方面相关的现有证据。营救过程已细分为三个阶段，相关问题如下所述。第一阶段，上升准备：如果调节器从口中脱出，是否应更换？如果潜水员处于癫痫的强直或阵挛期，上升是否应延迟至阵挛期消退？营救使用循环呼吸器的潜水员是否有特殊注意事项？第二阶段，打捞至水面：“安全”上升速率是多少？如果救援者有减压义务，是否应将受害者带到水面？如果调节器在口中且受害者正在呼吸，这是否会改变上升程序？如果调节器在口中，受害者正在呼吸，且受害者有减压义务，这是否会改变上升程序？是否有必要将受害者头部保持在特定位置？是否有必要按压受害者胸部以确保呼气？营救使用循环呼吸器的潜水员是否有特殊注意事项？第三阶段，水面操作：在水中能否评估呼吸情况？在水中能否进行有效的急救呼吸？呼吸骤停后持续循环的可能性有多大？最近对“仅胸外按压心肺复苏”的倡导是否意味着不应对无呼吸的潜水员进行急救呼吸？在水中进行急救呼吸相对于获得可开始确定性心肺复苏的水面支持的相对优先级应遵循哪些规则？已提出了一个用于水下潜水员营救的“最佳实践”决策树。
