Sweet Dreams: When Can I Resume Diving Post Anaesthesia?
By Dr Cecilia Roberts
There is no definite data on how soon patients recover from the blunted sensorium that occurs with general anaesthesia. This is highly variable and influenced by numerous factors, including the type of premedication, the inhalation anaesthetic agent used, the length of the operation, the intra-operative medications administered and any post-operative recovery problems. In the elderly, long-term effects of general anaesthesia have been reported to decrease cognition for up to three months post-operatively.
The ability to dive depends on the diagnosis for which the anaesthetic was given and the disability from the surgical procedure will determine when you can resume diving. If one was put to sleep for some non-debilitating diagnosis (e.g. dental procedures) one should be able to resume diving after 24-48 hours. Longer periods of diving cessation may be recommended, depending on the procedure performed and the presence of complications.
The drugs used to induce general anaesthesia do not take long for your body to metabolise. It is recommended that at least 24 hours elapse after general anaesthesia before resuming daily activities. Diving should be safe after 48 hours, provided that the patient is not taking any sedatives. Entonox, often used in sedation for minor procedures, has a very short half-life and diving may be resumed after 12-24 hours. After local, spinal or epidural anaesthesia, recovery of full strength and normal sensation in the affected areas are vital.
The purpose of the assessment of fitness to return to diving after illness, surgery or injury is primarily to determine any factors which may affect in water safety.
Post-Operative Recovery
The most important hazard is the reduced exercise capacity dependent on the extent of the intervention and any post-operative conditions which could impair diving. Reduced physical fitness after surgery from inactivity and bedrest, pain, restricted function of organs, impairment of the motor system, and anaemia are several factors which play a role.
A diver may also put him/herself and his/her dive buddies at risk due to the impairment of his/her physical and psychological performance, owing to the medication being taken post-operatively. Medications which cause central nervous system depression can alter consciousness or hamper the diver’s decision-making ability.
Some systemic analgesics and narcotic pain relievers are contraindicated in diving. Their side effects include dizziness, drowsiness, impairment of mental performance and alterations in mood. These are dose-related and the lower the amount, the less frequent and severe the adverse reactions. Opiates can impair psychomotor performance and in high doses are known to cause respiratory depression which will be further potentiated by the narcotic effect of nitrogen as well as the increased work of breathing at depth due to increased gas density. Resultant carbon dioxide retention enhances the risk of oxygen toxicity. Nausea, a common side effect of medication, may further complicate matters. Paracetemol is considered a safe and non-steroidal anti-inflammatory drug and is relatively safe, as no medical contraindication for its use exists.
However, the major determinant is not the anaesthetic, but rather the reason for the anaesthetic. Diving is not a good idea immediately after surgery,irrespective of the anaesthetic.
When approaching the time to resume diving, one first has to consider the illness or condition being operated on and any relation of it to the diving environment. Any physical limitations as a result of the surgery, either short-term (like the rate that the wound heals and complications such as infection, wound disruption or temporary loss of function) or long-term disability (reducing the diver’s functional ability), should then be considered.
Thirdly, implants of any nature should be evaluated. Any air- or gas-filled implant poses a risk of exploding or rupturing, due to the effect of Boyle’s law. Metallic, silicone, composite and fluid-filled sacs do not contain any gas and are therefore not compressible and shouldn’t be a contraindication to diving. The following guidelines are used to advise on the return to diving for selected surgical interventions:
Ear, nose and throat surgeries
When undergoing septal deviation corrective surgery you should be able to return to diving three months after the successful surgery, provided there is no restricted nasal breathing and normal Eustachian tube function exists.
After surgical closure of a tympanic perforation (tympanoplasty), you may resume diving three months following the surgery, if the transplant has healed well and the Eustachian tube function is normal. Any extensive surgery on the middle ear and mastoid present a definite contraindication for diving due to the danger of tympanic rupture and prosthesis dislocation which will likely result in deafness. This includes hearing improving surgery.
Surgery of the lips, oral cavity, palate, or upper and lower jaw may cause insufficient hold and/or sealing of the regulator mouthpiece, which may predispose the diver to aspiration and panic. Therefore, candidates should perform a test dive and be able to hold and seal off the mouthpiece.
Respiratory surgeries
Pulmonary resection leads to differences in flow resistance and lung distensibility with the risk of lung barotrauma. After segmental resection or lobectomy, diving may be permitted three months post-operatively. Vital capacity should be 70-80% of the normal value with normal lung function testing results (FEV1/FEV; FVC at least 0.7). This decision must be made in consultation with a pulmonologist, preferably with diving medicine
experience. A pneumonectomy (excision of the lung or one or more lobes)
resection with a vital capacity less than 70% of the nominal value is an absolute contraindication to diving.
Special considerations on an individualised basis are taken in cases where barotrauma of the lungs (“burst lung”) has been surgically treated through pleurectomy (surgical excision of the lung pleura), but, in general, an incident of pulmonary barotrauma is a contraindication for further scuba diving and in most cases it is advised not to continue diving.
Pleurodesis (obliteration of the pleural cavity) ensures protection from a pneumothorax, but at the expense of an increasing risk of a cerebral arterial gas embolism (CAGE) and mediastinal emphysema.
Patients who have had a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. A post-operative wait of 12 weeks is advised, including studies to rule out air trapping.
Cardiovascular surgeries
Following any cardiac surgery with entry into the chest cavity, with no symptoms and a normal exercise test with normal haemodynamics and no rhythm disturbances, you may be cleared for diving three to six months postoperatively in consultation with the relevant specialist.
After surgery without entering the chest cavity, a six to eight week waiting period is advised or whenever the diver has physically rehabilitated to reach 13 metabolic equivalents (METs) on the treadmill. With peripheral revascularisation surgery, one can resume diving as soon as the wounds have healed and no symptoms are experienced.
Long-term anti-coagulation therapy does not represent any specific danger to diving and is not a contraindication to diving, but can lead to dangerous haemorrhages and therefore poses an increased bleeding risk and possibly worse outcomes in cases of trauma, barotrauma of the ear, sinuses or lungs, and spinal decompression sickness (DCS).
Nervous system surgeries
After successful treatment of aneurysms of the cerebral vessels and clearance from the neurosurgeon, one may be permitted to dive.
Any craniotomy (surgical opening of the skull) that is not definitely closed is an
absolute contraindication to diving. Burr hole cases or any complete reconstruction of the cranial vault and ventriculo-peritoneal (VP)- or ventriculo-atrial (VA)-shunts should allow a period of six months and be free of any residual symptoms or epileptic fits.
Internal organ surgeries
People with stomas or indwelling urethral catheters are able to dive, provided they have received thorough counselling regarding hygiene problems and personal care.
After surgical correction of a hernia, six weeks (in simple cases) to three months should be allowed before returning to diving. The patient should also be warned about lifting heavy dive gear and the risk of recurrence of the hernia.
The post-operative wait after laparotomy depends greatly upon the cause for the surgery and the extent of the surgery involved. A post-operative period of six to 12 weeks is recommended, with approval by the surgeon.
With gynaecological procedures, as a rule, six weeks is needed followed by a follow-up and clearance by the specialist. Otherwise, diving can resume when the vaginal stump has healed.
In all cases, the diver should be self-sufficient with adequate exercise capacity and fitness following complete healing, complete rehabilitation, have normal swimming ability and be able to assist his/her buddy, if necessary.
Musculoskeletal surgeries
After conservative or surgical treatment of joint dislocations or instabilities and fractures, diving may be resumed following the complete healing with normal swimming ability and no restrictions of function. This usually suggests a period of six weeks to three months with clearance from the relevant surgeon.
Weight-bearing, exits and entries should be carefully considered before certifying the return to diving.
Eye surgeries
Particular caution should be exercised in cases following intraocular surgery, because negative pressure could lead to a dehiscence of the operation scar with grave consequences.
After cataract surgery, dehiscence of the corneoscleral scar may be a risk and therefore a post-operative period of three months should be allowed before returning to diving. A six-to-12-month period is suggested following penetrating keratoplasty and radial keratoplasty and three months are suggested for lamellar keratoplasty.
It is recommended that divers wait a minimum of one month before resuming diving after laser-assisted in situ keratomileusis (LASIK) refractive surgery.
Plastic surgery
A three-to-six-month waiting period is advised after breast augmentation surgery. Botulinum toxin injections, used for cosmetic purposes, can in some cases prevent adequate sealing of the mouthpiece.
In Summary
Whether or not a person who has had surgery should be certified as “fit to dive” should be decided on the merits of each case.
Returning to diving depends mainly on the type of surgery performed, whether the diver is symptomatic, the medication requirements, the restrictions placed on the patient by the surgical procedure and the length of time the diver is post-operatively free of problems. Most candidates can probably return to diving. Of greatest importance is the impact on safety. Apart from the general condition and physical fitness, the following should be taken into consideration: decision-making ability, the ability to self-rescue and rescue other divers as well as residual disabilities that would limit the diver’s ability to gear up and move in the water. Prospective divers should in all cases provide full disclosure to the dive instructor and certifying agency, bearing in mind the safety of their buddies, dive instructors, dive masters and other individuals who are also affected by diving incidents.
An evaluation should be done by the relevant medical specialist, preferably in consultation with a diving medicine practitioner, if he/she is not experienced in diving medicine.
A test dive is also recommended before planning a diving holiday when returning to diving after surgery or anaesthesia.
References & Suggested Reading
There is no definite data on how soon patients recover from the blunted sensorium that occurs with general anaesthesia. This is highly variable and influenced by numerous factors, including the type of premedication, the inhalation anaesthetic agent used, the length of the operation, the intra-operative medications administered and any post-operative recovery problems. In the elderly, long-term effects of general anaesthesia have been reported to decrease cognition for up to three months post-operatively.
The ability to dive depends on the diagnosis for which the anaesthetic was given and the disability from the surgical procedure will determine when you can resume diving. If one was put to sleep for some non-debilitating diagnosis (e.g. dental procedures) one should be able to resume diving after 24-48 hours. Longer periods of diving cessation may be recommended, depending on the procedure performed and the presence of complications.
The drugs used to induce general anaesthesia do not take long for your body to metabolise. It is recommended that at least 24 hours elapse after general anaesthesia before resuming daily activities. Diving should be safe after 48 hours, provided that the patient is not taking any sedatives. Entonox, often used in sedation for minor procedures, has a very short half-life and diving may be resumed after 12-24 hours. After local, spinal or epidural anaesthesia, recovery of full strength and normal sensation in the affected areas are vital.
The purpose of the assessment of fitness to return to diving after illness, surgery or injury is primarily to determine any factors which may affect in water safety.
Post-Operative Recovery
The most important hazard is the reduced exercise capacity dependent on the extent of the intervention and any post-operative conditions which could impair diving. Reduced physical fitness after surgery from inactivity and bedrest, pain, restricted function of organs, impairment of the motor system, and anaemia are several factors which play a role.
A diver may also put him/herself and his/her dive buddies at risk due to the impairment of his/her physical and psychological performance, owing to the medication being taken post-operatively. Medications which cause central nervous system depression can alter consciousness or hamper the diver’s decision-making ability.
Some systemic analgesics and narcotic pain relievers are contraindicated in diving. Their side effects include dizziness, drowsiness, impairment of mental performance and alterations in mood. These are dose-related and the lower the amount, the less frequent and severe the adverse reactions. Opiates can impair psychomotor performance and in high doses are known to cause respiratory depression which will be further potentiated by the narcotic effect of nitrogen as well as the increased work of breathing at depth due to increased gas density. Resultant carbon dioxide retention enhances the risk of oxygen toxicity. Nausea, a common side effect of medication, may further complicate matters. Paracetemol is considered a safe and non-steroidal anti-inflammatory drug and is relatively safe, as no medical contraindication for its use exists.
However, the major determinant is not the anaesthetic, but rather the reason for the anaesthetic. Diving is not a good idea immediately after surgery,irrespective of the anaesthetic.
When approaching the time to resume diving, one first has to consider the illness or condition being operated on and any relation of it to the diving environment. Any physical limitations as a result of the surgery, either short-term (like the rate that the wound heals and complications such as infection, wound disruption or temporary loss of function) or long-term disability (reducing the diver’s functional ability), should then be considered.
Thirdly, implants of any nature should be evaluated. Any air- or gas-filled implant poses a risk of exploding or rupturing, due to the effect of Boyle’s law. Metallic, silicone, composite and fluid-filled sacs do not contain any gas and are therefore not compressible and shouldn’t be a contraindication to diving. The following guidelines are used to advise on the return to diving for selected surgical interventions:
Ear, nose and throat surgeries
When undergoing septal deviation corrective surgery you should be able to return to diving three months after the successful surgery, provided there is no restricted nasal breathing and normal Eustachian tube function exists.
After surgical closure of a tympanic perforation (tympanoplasty), you may resume diving three months following the surgery, if the transplant has healed well and the Eustachian tube function is normal. Any extensive surgery on the middle ear and mastoid present a definite contraindication for diving due to the danger of tympanic rupture and prosthesis dislocation which will likely result in deafness. This includes hearing improving surgery.
Surgery of the lips, oral cavity, palate, or upper and lower jaw may cause insufficient hold and/or sealing of the regulator mouthpiece, which may predispose the diver to aspiration and panic. Therefore, candidates should perform a test dive and be able to hold and seal off the mouthpiece.
Respiratory surgeries
Pulmonary resection leads to differences in flow resistance and lung distensibility with the risk of lung barotrauma. After segmental resection or lobectomy, diving may be permitted three months post-operatively. Vital capacity should be 70-80% of the normal value with normal lung function testing results (FEV1/FEV; FVC at least 0.7). This decision must be made in consultation with a pulmonologist, preferably with diving medicine
experience. A pneumonectomy (excision of the lung or one or more lobes)
resection with a vital capacity less than 70% of the nominal value is an absolute contraindication to diving.
Special considerations on an individualised basis are taken in cases where barotrauma of the lungs (“burst lung”) has been surgically treated through pleurectomy (surgical excision of the lung pleura), but, in general, an incident of pulmonary barotrauma is a contraindication for further scuba diving and in most cases it is advised not to continue diving.
Pleurodesis (obliteration of the pleural cavity) ensures protection from a pneumothorax, but at the expense of an increasing risk of a cerebral arterial gas embolism (CAGE) and mediastinal emphysema.
Patients who have had a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. A post-operative wait of 12 weeks is advised, including studies to rule out air trapping.
Cardiovascular surgeries
Following any cardiac surgery with entry into the chest cavity, with no symptoms and a normal exercise test with normal haemodynamics and no rhythm disturbances, you may be cleared for diving three to six months postoperatively in consultation with the relevant specialist.
After surgery without entering the chest cavity, a six to eight week waiting period is advised or whenever the diver has physically rehabilitated to reach 13 metabolic equivalents (METs) on the treadmill. With peripheral revascularisation surgery, one can resume diving as soon as the wounds have healed and no symptoms are experienced.
Long-term anti-coagulation therapy does not represent any specific danger to diving and is not a contraindication to diving, but can lead to dangerous haemorrhages and therefore poses an increased bleeding risk and possibly worse outcomes in cases of trauma, barotrauma of the ear, sinuses or lungs, and spinal decompression sickness (DCS).
Nervous system surgeries
After successful treatment of aneurysms of the cerebral vessels and clearance from the neurosurgeon, one may be permitted to dive.
Any craniotomy (surgical opening of the skull) that is not definitely closed is an
absolute contraindication to diving. Burr hole cases or any complete reconstruction of the cranial vault and ventriculo-peritoneal (VP)- or ventriculo-atrial (VA)-shunts should allow a period of six months and be free of any residual symptoms or epileptic fits.
Internal organ surgeries
People with stomas or indwelling urethral catheters are able to dive, provided they have received thorough counselling regarding hygiene problems and personal care.
After surgical correction of a hernia, six weeks (in simple cases) to three months should be allowed before returning to diving. The patient should also be warned about lifting heavy dive gear and the risk of recurrence of the hernia.
The post-operative wait after laparotomy depends greatly upon the cause for the surgery and the extent of the surgery involved. A post-operative period of six to 12 weeks is recommended, with approval by the surgeon.
With gynaecological procedures, as a rule, six weeks is needed followed by a follow-up and clearance by the specialist. Otherwise, diving can resume when the vaginal stump has healed.
In all cases, the diver should be self-sufficient with adequate exercise capacity and fitness following complete healing, complete rehabilitation, have normal swimming ability and be able to assist his/her buddy, if necessary.
Musculoskeletal surgeries
After conservative or surgical treatment of joint dislocations or instabilities and fractures, diving may be resumed following the complete healing with normal swimming ability and no restrictions of function. This usually suggests a period of six weeks to three months with clearance from the relevant surgeon.
Weight-bearing, exits and entries should be carefully considered before certifying the return to diving.
Eye surgeries
Particular caution should be exercised in cases following intraocular surgery, because negative pressure could lead to a dehiscence of the operation scar with grave consequences.
After cataract surgery, dehiscence of the corneoscleral scar may be a risk and therefore a post-operative period of three months should be allowed before returning to diving. A six-to-12-month period is suggested following penetrating keratoplasty and radial keratoplasty and three months are suggested for lamellar keratoplasty.
It is recommended that divers wait a minimum of one month before resuming diving after laser-assisted in situ keratomileusis (LASIK) refractive surgery.
Plastic surgery
A three-to-six-month waiting period is advised after breast augmentation surgery. Botulinum toxin injections, used for cosmetic purposes, can in some cases prevent adequate sealing of the mouthpiece.
In Summary
Whether or not a person who has had surgery should be certified as “fit to dive” should be decided on the merits of each case.
Returning to diving depends mainly on the type of surgery performed, whether the diver is symptomatic, the medication requirements, the restrictions placed on the patient by the surgical procedure and the length of time the diver is post-operatively free of problems. Most candidates can probably return to diving. Of greatest importance is the impact on safety. Apart from the general condition and physical fitness, the following should be taken into consideration: decision-making ability, the ability to self-rescue and rescue other divers as well as residual disabilities that would limit the diver’s ability to gear up and move in the water. Prospective divers should in all cases provide full disclosure to the dive instructor and certifying agency, bearing in mind the safety of their buddies, dive instructors, dive masters and other individuals who are also affected by diving incidents.
An evaluation should be done by the relevant medical specialist, preferably in consultation with a diving medicine practitioner, if he/she is not experienced in diving medicine.
A test dive is also recommended before planning a diving holiday when returning to diving after surgery or anaesthesia.
References & Suggested Reading
- Wendling, J., Elliott, D.H., & Nome, T. Medical Assessment of Working Divers. 1stedition. 2004. Biel, Switzerland: Hyperbaric Editions.
- Edmonds, C., Lowry, C., Pennefather, J. & Walker, R. eds. Diving and Subaquatic
- Medicine. 4th edition. 2002. London.
- www.scubaboard.com
Posted in Alert Diver Fall Editions
Tagged with DReams, Resume diving, After anaesthesia, Surgeries, Diving suspended
Tagged with DReams, Resume diving, After anaesthesia, Surgeries, Diving suspended
Categories
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Dining: Zandile Ndhlovu, The Black Mermaid
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March