Somali Medical Forums

Medical Student Forums => Problem-Based Learning Center => Topic started by: Kassim on December 03, 2007, 03:27:06 AM

Title: Case (18)
Post by: Kassim on December 03, 2007, 03:27:06 AM
A32 years old male, brought to ED by a friend.   He is complaining of weakness in his thighs, which progressed to paraplegia and a loss of bladder control.  Neurologic examination revealed total paralysis below the waist with some weakness of his  upper limb. A sensory level at T9 was present. past mendical history was unremarkable
The friend reports that JAMAC was fine before the diving.

What is the Dx
How would you manage?
Title: Re: Case (18)
Post by: Admin on December 03, 2007, 08:06:37 PM
(http://www.bellavistahotel.gr/images/scuba.jpg)Well another interesting case:
If a diver present with paraplegia and bladder sphincter control disturbance think of Spinal Cord Decompression Sickness (SCDS), especially those using Self-Contained Underwater Breathing Apparatus Hence called SCUBA Diving!.

The pathophysiology of the disease is that these gases will form bubbles that demage tissues and blood supply.

The decompression sickness classified into 2 types:
Type I includes joint pain, skin marbling, small patchy hemorrhages, and lymphatic obstruction.
Type II dominated by injury to the central nervous system, mainly spinal, and inner ear and lung involvement.

So the diagnosis of this case is: Spinal Cord Decompresion Sickness Type II
How to manage this case?
According to pathophysiology, to get rid of these bubbles we give Hyperbaric oxygen which is higher than atmospheric pressure this will increase partial pressure of oxygen in the tissue of the body thus increasing oxygen transport capacity of the blood. after the bubbles disappear the patient should breathe 100% oxygen.
It's the same way when treating air embolisms
Dr.Mahdi
Title: Re: Case (18)
Post by: Kassim on December 05, 2007, 07:44:19 AM
yes that is the correct answer.
basicly what happen is as the diver descends deep , nitrogen is intensively absorbed by the blood and dissolved in the organism until the partial pressure inside and the ambient pressure are equalized. during the ascending the reverse process takes place.
The speed of desaturation is a major problem in diving medicine. 
If the diver ascends too fast and before complete desaturation, nitrogen begins to form bubbles in the organism. These bubbles are very dangerous because they can plug small arteries and cause AE
Title: Re: Case (18)
Post by: Admin on December 05, 2007, 07:50:41 AM
Thanks Kassim for the explanation
This case is locked with 15 points granted to Admin
Regards
Dr.Mahdi