Skip to main content

Tauchunfälle, Beinahe-Ertrinken, Unterkühlung

  • Chapter
Die Intensivmedizin

Auszug

Der schwere Tauchunfall ist ein potenziell lebensbedrohliches Ereignis, das bei Tauchern und anderweitig überdruckexponierten Personen in der Dekompressionsphase auftreten kann. Durch einen raschen Abfall des Umgebungsdruckes kommt es zur Bildung freier Gasblasen in Blut und Geweben und dadurch zur Dekompressionserkrankung (DCI, von engl. »decompression illness« oder auch »decompression injury«). Abhängig vom Entstehungsmechanismus werden Dekompressionskrankheit (DCS: »decompression sickness«) und arterielle Gasembolie (AGE) unterschieden [1, 2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

Literatur

  1. Muth CM, Shank ES, Larsen B (2000) Der schwere Tauchunfall: Pathophysiologie — Symptomatik — Therapie. Anaesthesist 49:302–316

    Article  PubMed  CAS  Google Scholar 

  2. Welslau W, Beuster B, Förster W, Frey G, Kemmer A, van Laak U, Muth CM, Peusch-Dreyer, Radermacher P, Taher A, Wendling J, Wenzelnker N (2003) Leitlinie Tauchunfall. Anästhesiol Intensivmed 44: 1–26

    Google Scholar 

  3. Wenzel J, Muth CM. Physikalische und physiologische Grundlagen des Tauchens (2002) Dtsch Z Sportmed 53:162–169

    Google Scholar 

  4. Francis T Jr, Gorman DF (1993) Pathogenesis of decompression disorders. In: Bennett P, Elliott D (eds) The physiology and medicine of diving, 4th edn. Saunders, Phildadelphia London, pp455–480

    Google Scholar 

  5. Schaefer KE, McNulty WP jr., Carey C, Liebow AA (1958) Mechanisms in development of interstitial emphysema and air embolism on decompression from depth. J Appl Physiol 13:15–29

    Google Scholar 

  6. Muth CM, Shank ES (2000) Gas embolism. N Engl J Med 342:476–482

    Article  PubMed  CAS  Google Scholar 

  7. Smith RM, Neumann TS (1997). Abnormal serum biochemistries in association with arterial gas embolism. J Emerg Med 15:285–289

    Article  PubMed  CAS  Google Scholar 

  8. Boussuges A, Succo E, Juhan-Vague I, Sainty JM. Activation of coagulation in decompression illness (1998) Aviat Space Environ Med 69: 129–132

    Google Scholar 

  9. Huang KL, Lin YC (1997) Activation of complement and neutrophils increases vascular permeability during air embolism. Aviat Space Environ Med 68:300–305

    PubMed  CAS  Google Scholar 

  10. Ward CA, Koheil A, McDullough D, Johnson WR, Fraser WD (1986) Activation of complement at plasma-air or serum-air interface of rabbits. J Appl Physiol 60:1651–1658

    PubMed  CAS  Google Scholar 

  11. Shank ES, Muth CM (2000) Decompression illness, iatrogenic gas embolism, and carbon monoxide poisoning:The role of hyperbaric oxygen therapy. Int Anesthesiol Clin 38:111–138.

    Article  PubMed  CAS  Google Scholar 

  12. Melamed Y, Shupak A, Bitterman H (1992) Medical problems associated with underwater diving. N Engl J Med 326:30–34 Prägnante und immer noch aktuelle Übersicht über die wichtigsten Grundlagen der Tauchmedizin.

    Article  PubMed  CAS  Google Scholar 

  13. Leitch DR, Green RD (1986) Pulmonary barotrauma in divers and the treatment of cerebral arterial gas embolism. Aviat Space Environ Med 57:931–938

    PubMed  CAS  Google Scholar 

  14. Moon RE, Sheffield PJ (1997) Guidelines for treatment of decompression illness. Aviat Space Environ Med 68:234–243

    PubMed  CAS  Google Scholar 

  15. Shank ES, Muth CM (2001) Case report on a diver with decompression injury, elevation of serum transaminases, and rhabdomyolysis. Ann Emerg Med 37:533–536

    Article  PubMed  CAS  Google Scholar 

  16. Tetzlaff K, Shank ES, Muth CM (2003) Evaluation and management of decompression illness — An intensivists’ perspective. Intensive Care Med 29:2128–2136

    Article  PubMed  Google Scholar 

  17. Muth CM, Radermacher P, Shank ES (2002) When HBO meets the ICU — intensive care patients in the hyperbaric environment. In: Bakker DJ, Cramer FS (eds) Hyperbaric surgery. Best Publishing, Flagstaff, USA, pp 111–158

    Google Scholar 

  18. Modell JH (1993) Drowning N Engl J Med 328:253–256

    Article  CAS  Google Scholar 

  19. DeNicola LK, Falk JL, Swanson ME, Gayle MO, Kissoon N (1997) Submersion injuries in children and adults. Crit Care Clin 13:477–502

    Article  Google Scholar 

  20. Weinstein MD, Krieger BP (1996) Near-drowning: epidemiology, pathophysiology, and initial treatment. J Emerg Med 14:461–467

    Article  PubMed  CAS  Google Scholar 

  21. Modell JH, Graves SA, Ketover A(1976) Clinical course of 91 consecutive near-drowning victims. Chest 70:231–238

    Article  PubMed  CAS  Google Scholar 

  22. Pearn JH (1980) Secondary drowning in children. Br Med J 281:1103–1105

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  23. Giammona ST, Modell JH (1967) Drowning by total immersion. Effects on pulmonary surfactant of distilled water, isotonic saline, and sea water. Am J Dis Child 114:612–616

    Article  PubMed  CAS  Google Scholar 

  24. Halmagyi DFJ, Colebatch HJH (1961) Ventilation and circulation after fluid aspiration. JAppl Physiol 16:35–40

    CAS  Google Scholar 

  25. Ruiz BC, Calderwood HW, Modell JH, Brogdon JE (1973) Effect of ventilatory patterns on arterial oxygenation after near-drowning with fresh water: a comparative study in dogs. Anesth Analg 52: 570–576

    PubMed  CAS  Google Scholar 

  26. Gries A (2001) Notfallmanagement bei Beinahe-Ertrinken und akzidenteller Hypothermie. Anaesthesist 50:887–901

    Article  PubMed  CAS  Google Scholar 

  27. Bolte RG, Black PG, Bowers RS, Thorne JK, Corneli HM (1988) The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 260:377–379

    Article  PubMed  CAS  Google Scholar 

  28. Watson RS, Cummings P, Quan L, Bratton S, Weiss NS (2001) Cervical spine injuries among submersion victims. J Trauma 51:658–662

    Article  PubMed  CAS  Google Scholar 

  29. Vasil J (1969) Brain edema following resuscitation of drowned children. Cesk Pediatr 24:556–557

    PubMed  CAS  Google Scholar 

  30. Conn AW, Montes JE, Barker GA, Edmonds JF (1980) Cerebral salvage in near-drowning following neurological classification by triage. Can Anaesth Soc J 27:201–210

    Article  PubMed  CAS  Google Scholar 

  31. Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G (2005) European Resuscitation Council.European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 67: S39–86

    Article  PubMed  Google Scholar 

  32. Sarnaik AP, Preston G, Lieh-Lai M, Eisenbrey AB (1985) Intracranial pressure and cerebral perfusion pressure in near-drowning. Crit Care Med 13:224–227

    Article  PubMed  CAS  Google Scholar 

  33. Modell JH, Davis JH (1969) Electrolyte changes in human drowning victims. Anesthesiology 30:414–420

    Article  PubMed  CAS  Google Scholar 

  34. Staudinger T, Bankier A, Strohmaier W, Weiss K, Locker GJ, Knapp S, Roggla M, Laczika K, Frass M (1997) Exogenous surfactant therapy in a patient with adult respiratory distress syndrome after near drowning. Resuscitation 35:179–182

    Article  PubMed  CAS  Google Scholar 

  35. Ender PT, Dolan MJ (1997) Pneumonia associated with near-drowning. Clin Infect Dis 25:896–907

    Article  PubMed  CAS  Google Scholar 

  36. Fretschner R, Klöss T, Borowczak C, Berkel H (1993) Erstversorgung und Prognose nach Ertrinkungsunfällen. Anästhesiol Intensivmed Notfallmed Schmerzther 28:363–368

    PubMed  CAS  Google Scholar 

  37. Wittmers LE Jr (2001) Pathophysiology of cold exposure. Minn Med 84:30–36

    PubMed  Google Scholar 

  38. Danzl DF, Pozos RS (1994). Accidental hypothermia. N Engl J Med 331: 1756–1760

    Article  PubMed  CAS  Google Scholar 

  39. Mallet ML (2002) Pathophysiology of accidental hypothermia. QJM 95:775–785

    Article  PubMed  CAS  Google Scholar 

  40. Giesbrecht GG (2000) Cold stress, near drowning and accidental hypothermia: a review. Aviat Space Environ Med 71:733–752

    PubMed  CAS  Google Scholar 

  41. Giesbrecht GG (2001) Prehospital treatment of hypothermia. Wilderness Environ Med 12:24–31

    Article  PubMed  CAS  Google Scholar 

  42. Ehrmann U, Shank ES, Hauser B, Gröger M, Radermacher P, Muth CM. Infrared earthermometry in drowning — not a good choice. 25th International Congress on Intensive Care and Emergency Medicine Brussels, Belgium, 2005

    Google Scholar 

  43. Goheen MS, Ducharme MB, Kenny GP, Johnston CE, Frim J, Bristow GK, Giesbrecht GG (1997) Efficacy of forced-air and inhalation rewarming by using a human model for severe hypothermia. J Appl Physiol 83:1635–1640.

    PubMed  CAS  Google Scholar 

  44. Tveita T (2000) Rewarming from hypothermia. Newer aspects on the pathophysiology of rewarming shock. Int J Circumpolar Health 59: 260–266

    PubMed  CAS  Google Scholar 

  45. Giesbrecht GG, Paton B (1998) Review article on inhalation rewarming. Resuscitation 38:59–60

    Article  PubMed  CAS  Google Scholar 

  46. Muth CM, Mainzer B, Peters J (1996) The use of countercurrent heat exchangers diminishes accidental hypothermia during abdominal aortic aneurysm surgery. Acta Anaesthesiol Scand 40:1197–1202

    Article  PubMed  CAS  Google Scholar 

  47. Spooner K, Hassani A (2000) Extracorporeal rewarming in a severely hypothermic patient using venovenous haemofiltration in the accident and emergency department. J Accid Emerg Med 17:422–424

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  48. Walpoth BH, Walpoth-Aslan BN, Mattle HP, Radanov BP, Schroth G, Schaeffler L, Fischer AP, von Segesser L, Althaus U (1997) Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 33:1500–1505

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Muth, CM. (2008). Tauchunfälle, Beinahe-Ertrinken, Unterkühlung. In: Burchardi, H., Larsen, R., Kuhlen, R., Jauch, KW., Schölmerich, J. (eds) Die Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-72296-0_73

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-72296-0_73

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-72295-3

  • Online ISBN: 978-3-540-72296-0

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics