UNASSIGNED: Accidental injuries sustained during helocasting remain unexamined.
UNASSIGNED: Conditions prevalent during a helocasting exercise performed at a still water body and the resulting casualties were analyzed.
UNASSIGNED: Despatch from greater-than-ideal height (>7 m) and speed (>5 knots) causes a high-velocity impact of the body with water in a non-aerodynamic configuration, exposing maximal body area at penetration. The brunt is borne by the torso/back, specifically, the lungs, ribs, and posterior aspect of the spine. The injuries result from direct trauma, sudden deceleration, barotrauma, and hyperflexion. Computerized tomography (CT) is the imaging of choice in the assessment of these injuries. Prompt evacuation to an equipped center, whilst stabilizing the spine in the suspected, proves pivotal to the outcome.
UNASSIGNED: Adverse slamming dynamics cause accidental injuries in helocasting. Thorax and spine are predominantly traumatized, both directly and indirectly, and are assessed best using CT. Timely spine stabilization and evacuation prove vital. Accurate assessment of height/speed and adherence to their ideal limits, at despatch, may avert such injuries.

The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence regarding postoperative precautions for patients following endoscopic skull base surgery for intradural pathology. These topics include the administration of postoperative nasal hygiene; patient mobilization and activity level; the resumption of continuous positive airway pressure in patients with obstructive sleep apnea; and the timing and capacity with which a patient may be subjected to barotrauma, such as air travel postoperatively. This EPS was developed following the recommended methodology and approval process as previously outlined. Given the diverse practices and limited agreement on the accepted principles regarding postoperative precautions for patients following skull base surgery, this EPS seeks to summarize the existing literature and provide clinically relevant guidance to bring clarity to these differing practice patterns. Following a modified Delphi approach, four statements were developed, all of which reached consensus. Because of the paucity of literature on these topics, these statements represent a summation of the limited literature and the experts\' opinions. These statements and the accompanying evidence are summarized below, along with an assessment of future needs.

The case concerns the alleged failure by the resisting administration to fulfill obligations arising from the contract and employment relationship, as well as the violation of safety regulations leading to the workplace accident reported by an Airforce Sergeant. Following the accident, the soldier complains of developing barotraumatic hearing loss with tinnitus and reactive post-traumatic stress disorder to the traumatic event. The case provides an opportunity to analyze the relevance of forensic medical assessment and its integration with psychodiagnostic examination for the correct nosographic classification aimed at evaluating and quantifying biological damage.

Catch-and-release angling exposes fish to challenges that may result in sub-lethal effects or mortality. Lake trout (Salvelinus namaycush) undergo high rates of release because of size-based harvest regulations or voluntary angler behaviour. Here, we examine short-term impairment in lake trout angled during the summer (n = 74) and fall spawning period (n = 33) to inform best practices for angling. Immediately following capture or 0.5 h post-capture, fish underwent reflex and barotrauma assessments, and a small blood sample was collected. Fish were also fitted with an externally mounted biologger equipped with depth, temperature and tri-axial acceleration sensors, that was tethered to allow retrieval of the logger after 14 min. In the summer, reflex impairment and barotrauma at 0 and 0.5 h were significantly correlated. Loss of orientation and bloating were the most observed indicators. Larger fish and those captured at increased depth had higher barotrauma scores, while prolonged fight times decreased the barotrauma score regardless of sampling time. Plasma cortisol, lactate and glucose increased 0.5 h after capture, and extracellular and intracellular pH decreased, all signs that angling was inducing a metabolic response. However, no relationships were found between blood indices and mortality (18.9%). The time required to reach maximum depth after release was longer for fish with increased air exposure but shorter for those with longer fight times. During the fall, fish displayed no mortality or reflex impairment. Anal prolapse was the most observed indicator of barotrauma but only observed in females. Blood indices were most altered 0.5 h after capture, with increased cortisol values for fish that were female, particularly large or captured at deeper depth. Locomotor activity was highest for males and increased with depth. Together, our findings suggest that the effects of catch-and-release angling may be dependent on several factors, including sex, season and angling depth.

Scuba diving and other modes of device-supported diving are popular activities that can be especially demanding and hazardous for people with preexisting physical conditions. Due to the high ambient pressure, the temperature differences, and potential unpredictable events, which have manifold effects on the organism, diving carries a high risk of life-threatening disease. A special risk is present if the body does not readily equalize air pressure changes. Therefore, prior to diving, all divers should undergo detailed education regarding the physical principles of the sport as well as specific physical examination. Consultation of an otolaryngologist is of exceptional relevance because many otorhinolaryngologic diseases can lead to (usually temporary) unfitness to dive. The role of the modern otorhinolaryngologist trained in diving medicine is to correctly advise the patient and restore fitness for diving via conservative or invasive methods.
UNASSIGNED: Gerätetauchen ist ein populärer Sport und wird auch von Personen mit gesundheitlichen Risikofaktoren betrieben. Aufgrund des hohen Umgebungsdrucks, des Temperaturunterschieds und möglicher unvorhergesehener Ereignisse, die vielfältige Auswirkungen auf den Organismus haben, besteht beim Tauchen ein hohes Risiko für lebensbedrohliche Verläufe. Ein besonderes Risiko besteht, wenn der Körper Luftdruckschwankungen nicht ohne Weiteres ausgleichen kann. Taucher/-innen sollten vor einem Tauchgang ausführlich über die physikalischen Grundlagen des Tauchsports aufgeklärt werden und eine tauchmedizinische Untersuchung durchlaufen. Eine HNO-ärztliche Untersuchung ist zentral, da viele HNO-ärztliche Erkrankungen zu einer – meist – vorübergehenden Tauchunfähigkeit führen. Die Aufgabe eines modernen tauchmedizinisch versierten HNO-Arztes ist daher, die Patienten richtig zu beraten und vorübergehende Tauchtauglichkeit durch konservative oder invasive Maßnahmen wiederherzustellen.

In recent years, reports of health problems associated with nitrous oxide consumption have significantly increased. In Germany, nitrous oxide (N2O) is easily available in cartridges without legal restrictions. The main reason for its popularity in the party scene are the euphoric, psychedelic effects of the gas. In addition to severe and sometimes irreversible health problems associated with long-term use of nitrous oxide, e.g., anemia and nerve damage, life-threatening or fatal consequences of acute nitrous oxide consumption can also occur: accidents under the influence of nitrous oxide, pneumothorax, pneumopericardium and shock due to an explosive increase in airway pressure when inhaled directly from the cartridge. But the most common cause of severe complications is asphyxia as the gas is usually inhaled pure from large balloons and without oxygen. The resulting hypoxia during use may be perpetuated by the diffusion hypoxia that occurs during the reoxygenation period. Nitrous oxide as a cause in accidental or intoxication events is usually not detectable but can only be identified as a trigger based on the patient\'s history or the circumstances. Acute medical treatment is symptomatic.
UNASSIGNED: In den letzten Jahren haben Berichte über lachgaskonsumassoziierte Gesundheitsstörungen erheblich zugenommen. Lachgas (N2O) ist in Deutschland problemlos legal und nahezu ubiquitär in Kartuschen erhältlich. Grund für die Beliebtheit in der Partyszene sind v. a. die euphorisierend-psychedelischen Effekte des Gases. Neben ernsthaften und manchmal irreversiblen gesundheitlichen Problemen bei Langzeitanwendung (Blutbild- und Nervenschädigungen) ereignen sich immer wieder auch akutmedizinisch bedeutsame, lebensbedrohliche oder tödliche Folgen des Lachgaskonsums: Unfälle unter Lachgaseinfluss, Pneumothorax, Pneumoperikard und Schock durch explosionsartige Druckerhöhung in den Atemwegen bei Inhalation direkt aus der Kartusche, aber v. a. hypoxische Komplikationen, da das Gas meist pur und ohne Sauerstoffbeimengung aus großen Ballons inhaliert wird. Die während der Anwendung auftretende Hypoxie kann zudem durch die in der Abflutungsphase auftretende Diffusionshypoxie perpetuiert werden. Lachgas als Ursache ist bei Unfällen oder Intoxikationsgeschahen meist nicht nachweisbar, sondern nur anamnestisch oder durch die Umstände als Auslöser zu identifizieren. Die akutmedizinische Therapie ist symptomatisch.

A case is described in which appendicitis presented in a 73-year-old woman the day after a colonoscopy. Possible mechanisms for appendicitis aggravated by colonoscopy include barotrauma, irritation by residual glutaraldehyde type solution used for cleaning the endoscope, fecalith, and/or appendicolith being pushed into the orifice of the appendix by insufflation during the colonoscopy. This rare complication is likely most often unavoidable due to the pressure required to properly visualize the colon (which typically ranges from 9 to 57 mmHg) and the manipulation required to visualize and cannulate the ileocecal valve. Physicians should consider possibility of acute appendicitis after colonoscopy when evaluating abdominal pain after a recent colonoscopy.

Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients.

UNASSIGNED: Breath-hold divers, also known as freedivers, are at risk of specific injuries that are unique from those of surface swimmers and compressed air divers. Using peer-reviewed scientific research and expert opinion, we created a guide for medical providers managing breath-hold diving injuries in the field. Hypoxia induced by prolonged apnea and increased oxygen uptake can result in an impaired mental state that can manifest as involuntary movements or full loss of consciousness. Negative pressure barotrauma secondary to airspace collapse can lead to edema and/or hemorrhage. Positive pressure barotrauma secondary to overexpansion of airspaces can result in gas embolism or air entry into tissues and organs. Inert gas loading into tissues from prolonged deep dives or repetitive shallow dives with short surface intervals can lead to decompression sickness. Inert gas narcosis at depth is commonly described as an altered state similar to that experienced by compressed air divers. Asymptomatic cardiac arrhythmias are common during apnea, normally reversing shortly after normal ventilation resumes. The methods of glossopharyngeal breathing (insufflation and exsufflation) can add to the risk of pulmonary overinflation barotrauma or loss of consciousness from decreased cardiac preload. This guide also includes information for medical providers who are tasked with providing medical support at an organized breath-hold diving event with a list of suggested equipment to facilitate diagnosis and treatment outside of the hospital setting.

BACKGROUND: Barometric pressure changes during flight or diving may cause facial barotrauma. Neuropathy of the fifth (CN5) or the seventh (CN7) cranial nerves is a rare manifestation of this condition. The aim of this study was to analyze risk factors for baroneuropathies of CN5 and CN7.
METHODS: A search of PubMed and Cochrane Library databases was conducted to identify all published cases of CN5 and CN7 neuropathies. Only original case reports and series that documented events of neuropathies associated with the trigeminal nerve or facial nerve while flying, diving, or mountain climbing were included. Assessed variables included sex, medical history, age, setting (flight or diving), atmospheric pressure changes, number of episodes, symptoms, treatment, and recovery.
RESULTS: We identified a total of 48 articles described >125 episodes in 67 patients. Mean age was 33.5 ± 12.1 years with a male predominance (76.1 %). Cases were equally distributed between flight and diving (50.7 %, 46.3 %, respectively). CN5 involvement was observed in 77.6 % of patients, with ear pain and facial numbness as the most common symptoms. The latter was correlated with positive otolaryngology medical history. CN7 was involved in 88.1 % of patients. Flying, as opposed to diving was correlated with spontaneous resolution of symptoms (86.7 % vs. 42.3 % of cases resolved spontaneously, respectively, p = 0.001).
CONCLUSIONS: Flight is an equal risk factor to diving with respect to CN5 and CN7 barotrauma. Involvement of CN7 was observed in most cases, but possibly due to report-bias. Positive medical history is a risk factor for facial numbness.