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| Capita Selecta Duikgeneeskunde: Decompression strategies, Doppler assessment and DCI treatment, May 2012 / PROGRAMME  ………… …Capita Selecta Duikgeneeskunde 
Decompression strategies, Doppler assessment and DCI treatment A refresher course for physicians of LVH, NVA, NVAB, NVD, VSG and other care professionals. Date: May 10 to 17, 2012 Location: Marsa Shakra, Egypt Aim This course aims to give insight to the dive physician in decompression phenomena and the underlying theoretical background, decompression and risk management, in the theory and application of the various methods of VGE measurement with practical exercises in the precordial Doppler technique, in the pathophysiology of bubble damage, the pathophysiology and differential diagnostics of DCI and its treatment by first aid and clinical treatment, especially by HBOT. It also clarifies the problems in consultancy and patient referral. After having attended the course, the participant masters the decompression theory at an advanced level, he has knowledge of- and some basic practical skills in the Doppler techniques and their limitations, can medically manage large dive events, also with Nitrox, and has theoretical knowledge of the use of gas-mixtures. Furthermore, he is able to diagnose DCI, and has the knowhow to treat dive casualties. The course can be seen as an advanced refresher course. Having attended an elementary course on diving medicine is recommended (SHF or VSG). Subjects. Decompression phenomena and underlying theoretical background, of construction of tables and algorithms of DCs and their physiological attributes, in the theory and application of the various methods of measurement of VGE with practical exercise in the precordial Doppler technique, VGE and AGE, the pathophysiology of bubble damage, predisposing factors, stress-factors, dive conditions, types of dives, recreational and commercial, (breathing) equipment, gas mixtures, risk assessment and decompression management, epidemiology of dive incidents, medical examination, the pathophysiology and differential diagnostics of DCI (with cases) and its treatment by first aid (cases) and clinical treatment (cases), especially by HBOT, consultancy and patient referring. Teachers Jean Claude Le Péchon, MSc, MEng, Dr. Nico A.M. Schellart, Prof. Dr. Wouter Sterk, Dr. Adel Taher. Staff Dr. Nico Schellart course manager; Eduard van Riet Paap, MSc, course administrator; Nelleke Schellart, MD, dive administrator. Recommendation The course is recommended by the Expertgroep Duikgeneeskunde of the Vereniging voor Sportgeneeskunde. Accreditation This will be requested for LVH, NVA, NVD, NVAB and VSG. The content of the course fulfils the standards of DMAC, EDTC, ECHM 2010. The program comprises 17 oral contact hours. The course members obtain a certificate after completion of the whole course. Copyright © Copyright bij het AMC te Amsterdam en de cursusleider (NS). Alle rechten voorbehouden. Materiaal van dit document mag niet gereproduceerd worden, in welke vorm dan ook, tenzij vooraf toestemming is verkregen van de copyrechthouders (info n.a.schellart@amc.uva.nl). ForewordGeneral: mission of the “AMC Capita Selecta Duikgeneeskunde”. The Capita Selecta Duikgeneeskunde, refresher courses dive medicine, are given by the Academic Medical Centre (AMC), a one-board-cooperation of the medical faculty of the University of Amsterdam (UvA) and the academic hospital with the UvA. This hospital has a special position within the Dutch academic hospitals; it is the cradle, also in Europe of a related discipline, hyperbaric medicine, performed in the “Boerema Tank”. This new type of refresher courses, offered to dive physicians, has a typical ‘Alma Mater’ character. In the first place, the AMC Capita Selecta present extensively and discipline-wise education in dive and caisson medicine. In addition, they give education in new developments as they occur in the academic hospitals and medical faculties. This implies that, within the lessons, the characteristics of disorders are discussed, including their differential diagnostics and treatment, form the point of view of the present academic state of the art. In short, the Capita are marked by a natural mix of education in the dive medicine of the respective discipline and up-to-date education in the discipline itself, for instance in cardiology, ophthalmology etc. Also, the Capita will pay attention to the requirements of the medical examination. The Capita are aimed for “basisartsen” (non-specialized physicians), first line physicians, sport and occupational physicians, professional dive physicians, clinical doctors and paramedical academics. In general, the teachers have their affiliation with academic hospitals and medical faculties, and have an international reputation in patient care, academic education and/or medical research as becomes clear from their papers. To have a lower thresholds, the venue is easy to reach and centrally located, and moreover the course is low-budget. Responsibility The Capita Selecta Duikgeneeskunde are given under the responsibility of the Academic Medical Centre, Univ. of Amsterdam (course leader Nico Schellart). The organization is by the Stichting Duik Research (SDR)1) and Biomed. Eng & Physics, AMC (Prof. Dr. Ir. A.G.J.M. van Leeuwen, chair). Announcements Ongoing small announcements about the course can be found at www.duikresearch.org or are communicated by E-mail. 1) SDR is a non-profit organisation aimed to promote dive safety. Work for SDR is done voluntarily. © Copyright 2011. All rights reserved. Material of this document may not be reproduced in any form without permission of AMC and the course manager.    
   
Jean-Claude Le Péchon Nico Schellart Wouter Sterk Adel Taher The lecturers Jean-Claude Le Péchon graduated as biochemical engineer from INSA in Lyon in 1963 and as marine biologist from Nice University. He has been employed at the Musée Océanographique of Monaco as a scientific diver as well as in the Conshelf III Experiment (the undersea habitat sponsored by Jacques-Yves Cousteau). Later he joined CEMA in Marseilles (J.Y. Cousteau) to do research on breathing gases and to develop procedures for very deep dives (1000 m with animals; 500 m with humans) and was a test diver in the Saturation II simulated dive at 400 msw. From 1973 to 1986, he served with CG DORIS, an offshore and civil engineering diving company. In 1986 he founded JCLP Hyperbarie, a global consultancy agency/ bureau specialized in questions related to life support and safety under pressure (commercial diving, tunneling, space and hyperbaric medicine). He has been involved in more than 75 tunneling projects with compressed gas mixtures, up to 6.9 bar and as well as in saturation diving technology. Although retired, he is still teaching physiology and the technology of diving- and hyperbaric medicine at several universities in France and all over the world. He is a National Instructor for SCUBA diving (Air, Nitrox and Trimix) and holds a deep sea commercial diver certification since 1974. He has published many papers in magazines, books and international congresses etc., and often speaks at international congresses on different topics concerning diving, hyperbaric medicine and compressed gas work. Nico Schellart, graduated (c.l.) as biologist, specialized in physiological biomedical physics. He investigated visual information processing of the retina, resulting in a PhD in 1973 (UvA). He is an associate professor with the dept. of Biomedical Engineering and Physics of the AMC and associate editor of “Medical and Biological Engineering and Computation”. He has investigated multi-sensory information processing in the brain, both animal and human. Since 1998 he performed clinical EEG and MEG research of the visual and auditory system. He has studied the brain and the visual system under hypoxic and hyperoxic conditions both in the lab and in the field and introduced HBO treatment for patients with cerebral radiation damage. He published these dysbaric and HBOT studies in addition to his neuroscience papers and has contributed to a number of textbooks. He was publisher of a free electronic Textbook on Medical Physics and teaches diving physiology. He has tested the technical and physiological performance of dozens of dive computers (www.duikresearch.org), and is a recreational scuba- and freediver. Wouter Sterk obtained his MD at the University of Amsterdam in1966 and joined the Diving Medical Centre of the Royal Dutch Navy until 1975. In 1973 he received a PhD at the University of Utrecht with the thesis entitled: “Respiratory mechanics of diver and diving apparatus”. In 1975 he registered as anesthesiologist after obtaining his training at the Academic Hospital of the University of Utrecht. From 1975 on he is DMO for diving companies, caisson and tunneling projects and director of Dadcodat. In 1993 he was appointed as Professor in Underwater Physiology at Leiden University. From 1995 to 2009 he was medical director of the Institute for Hyperbaric Medicine with several settlements in the Netherlands and afterwards until 2010 Interim medical director at the DDRC Hyperbaric Medical Centre, Plymouth, UK. Worldwide, he supervised various tunneling projects and is one of the most experienced operators of the precordial Doppler technique. He developed the current professional diving tables in use by the Dutch National Dive Center (NDC) and an enthusiastic recreational diver. Adel Taher, a diving instructor at the time, was the driving behind the multi-place and multi-lock chamber in Sharm el Sheik as he saw the need for a facility to specialize in diving related accidents. The chamber was built in the USA. He is, in addition to being director of the Hyperbaric Medical Centre in Sharm el Sheik also the founder and director of the diving chamber of Dahab. With over 250 diver-HBO treatments per year, he is without any doubt world leader and trained many physicians in hyperbaric medicine. Dr Adel is member of many international medical diving committees, and lectur about his work at congresses, universities etc. all over the world. He is also the director of DAN-Egypt, a member of the UHMS and of the EUBS (as the other lecturers). He also was the driving force behind the EUBS Annual Scientific Meeting in Sharm el Sheik in 2008. General programme Thursday, May 10 13.50u. Direct flight from Amsterdam to Marsa Alam, bus-transfer to Marsa Shagra, dinner and briefing, room check-in. Friday, May 11. breakfast, check-in for the dive programme, diving, lunch and diving. lessons 15h30-18h30, dinner. Saterday, May 12. Diving 1), breakfast, 10h00-11h50 lessons, lunch and diving. 16h00-18h30. lessons, dinner. Sunday, May 13. Diving, breakfast, 10h00-11h50 lessons, lunch and diving. 16h00-18h00. lessons, dinner. Monday, May 14. Diving, breakfast, 10h00-11h50 lessons, lunch and diving. 16h00-18h00. lessons, dinner. Tuesday, May 15. Diving, breakfast, 10h00-11h50 lessons, lunch and diving. 16h00-17h30. lessons, dinner. Wednesday, May 16. Free day for excursions, snorkelling, preferably no diving. Joint dinner with distribution of the certificates. Thursday, May 17 Return flight Marsa Alam—Amsterdam (arrival 01h40 Friday morning) For the first day we advice dives in the bay or directly north or south of the bay (boat) in view of the start of the afternoon lessons. Breakfast: 7h00 - 9h30 Lunch: 12h00 - 14h00 Dinner: 18h30 – 20h30. Coffee bar: 6h00 – 24h00. 1) when diving in the bay, it is well possible to have breakfast first. Educational programme Decompression strategies, Doppler assessment and DCI treatment May 11Course introduction, Nico Schellart Decompression theory Nico Schellart (inert gases, Bűhlmann etc. fundamentals of dive tables, M-values) Use of dive procedures, Jean Claude Le Péchon (air-dives, Nitrox, other gas mixtures, role of oxygen while decompressing). Bubble theory and models, Nico Schellart (surface tension, surfactant hypothesis, VPM, RGBM, numbers) Bubbles in the circulation and other tissues, Wouter Sterk (arterial, venous, extravasculair). Examination (8 min) and evaluation
May 12Decompression illness, Adel Taher, (VGE, AGE, classification, bends, neurology, senses etc., differential diagnostics, with cases); The practise of Doppler techniques Wouter Sterk and Nico Schellart, (precordial, doppler echography and second harmonic technique (NS), bubble grade scales, KISS (NS), evolution of bubbels after ascent). Types of dives, Jean Claude Le Péchon, (Recreational : SCUBA, Rebreathers; Commercial : Surface supplied, TUP technology). Epidemiology of dive incidents in the Egypt Red Sea, Adel Taher Examination (8 min) and Evaluation (17 min) Doppler practical work, Wouter Sterk
(cases)
Decompression practical management Jean Claude Le Péchon, (standard depths, ascent pace, in-water stops (Air, Oxygen, Nitrox, Other mixes), Surface decompression,) Use of dive computers Nico Schellart, (algorithms, physiological parameters, practical aspects, type of profiles, risk evaluation, training, epidemiology and statistics) Decompression of deep and extreme deep dives Jean Claude Le Péchon, (run-times, using an open bell, staged versus continuous ascents, saturation decompression, HPNS) Examination (8 min) and Evaluation
(first aid, cases of dive accidents, medical dive accidents management, cases). Effects of bubbles on tissues and organs, Wouter Sterk, (vascular, endothelial, inflammation, non-vascular, white matter, cartilage, bone, long-lasting). DCI Risk assessment of recreational and professional diving activities, Jean Claude Le Péchon, (DCI risk, other safety factors, prevention, management of DCI in remote places, is “In-water-immediate-recompression” an appropriate response? With which procedure?); Examination (8 min) and Evaluation
May 15HBOT and dive characteristics (with case studies), Adel Taher, (types of dives, including tech-diving, Nitrox, etc. and non-standard diver conditions, e.g. alcohol use etc.). Environmental risks and human stress factors, Jean Claude Le Péchon and Nico Schellart Marsa Alam Baromedical Center, excursion (statistics en cases) Examination (8 min) and Evaluation
Evaluation and distribution of certificates. Total 17 h of lessons and direct educational instruction.
Disclaimer: AMC Capita Selecta is bound to execute the program, but program changes are under reserve. Informatie over het duikprogramma en de accommodatie
De cursus wordt gehouden in Marsa Shagra Red Sea Diving Safari bij Marsa Alam aan de Zuid-Egyptische kust van de Rode Zee. Dit is een prachtig duikresort gelegen aan een mooie baai, ooit gevormd door een meestal droogstaande wadi, inclusief woestijn-mangrove. De accommodatie is geheel ingericht op duiken en heeft vele boten in allerlei maten. De riffen van Marsa Alam worden beschouwd als een van de beste van de Rode Zee. Het huisrif ligt aan een schitterende, grillig gevormde baai met een “rif-lijn” van 1 km en steekt qua biodiversiteit ver uit boven elk ander huisrif in de buurt over een afstand van vele tientallen km. Het kan zich beslist meten met andere tophuisriffen in de wereld. Dit rif is dus ook perfect voor snorkelen, ongeacht het weer. Bij rustige zee kan er ook buitengaats gesnorkeld worden. De Rode Zee is een van de helderste zeeën ter wereld en daarom zijn er nog koralen te vinden tot 100 m diepte. Vergelijkenderwijs zijn de koralen in zeer goede staat en dus nog heel kleurrijk; koraalbleking heeft hier nauwelijks toegeslagen. Dit komt omdat hier nauwelijks opwarming heeft plaats gevonden in een klimaat met bijna het hele jaar door felle zon. De biodiversiteit van de fauna is wat betreft bijv. hard en zacht koraal, andere evertebraten en vissen vrijwel ongeëvenaard op het noordelijk halfrond. In een week tijd (juni) zag ik (NS) 2 soorten roggen, 3 soorten haaien, waaronder de hamerhaai (meerdere keren), de gebruikelijke tonijnachtigen, barracuda’s, Napoleonvissen, een schol marlijnen (sail fishes) en schildpadden van diverse maten. Anderen uit de groep zagen zeekoeien (dugongs). Ook mantaroggen hebben hier hun habitat. Men kan duiken vanaf de kust of zich laten brengen net buiten de baai en zo gewenst ook weer laten ophalen door een zodiak. Er zijn mogelijkheden te over om naar meer afgelegen baaien en duikstekken in open zee te gaan (voor de grote pelagische soorten), zoals het bekende Elphin Stone Reef op een half uur varen. Op de cursusvrije dag (de dag voor vertrek) kunt u naar bijv. Luxor, Karnak en het Dal der Koningen. Het resort ligt op een half uur van het vliegveld.
Als u een CMAS 2* of PADI Advanced brevet heeft kunt u 5 dagen ongelimiteerd duiken op het huisrif inclusief gebruik van de kleine speedboten. Voor echte duikexcursies (0.5 uur heen-varen en meer) wordt een toeslag van enkele tientjes gevraagd. Fles (12 L; beide typen aansluitingen beschikbaar), lucht en lood zijn inbegrepen, maar huur van de duikapparatuur kent een toeslag. Ook kan op aanvraag een duikcursus gevolgd worden op de les-vrije uren. Meer informatie vindt u op www.redsea-divingsafari.com en http://www.divingworld.nl.
duik-resort Administratieve en financiële informatie
Het eind van het hoogseizoen is de maand mei. Dit omdat de dagtemperaturen dan niet al te hoog zijn. Men kan in deze maand nog volstaan met een chalet met fan i.p.v. AC. De kosten zijn gebaseerd op de prijs Diving World en een surplus, met name bedoeld is om docenten geheel te vrijwaren van kosten. Met meer dan 22 cursisten daalt dit surplus en kunt u geld terug krijgen (onder voorbehoud). Het pakket omvat cursus, vlucht en transfers in Egypte, all inclusive stay (3 buffets) en duikpakket (dagen ongelimiteerd duiken op het huisrif inclusief). Koffie, thee, water en frisdrank zijn vrij van ’s ochtends 6 uur tot 12 uur ‘s avonds. Het pakket is exclusief visum (15 $, luchthaven), 7 € voor HBO-kamer, 3$/dag parkbelasting (beide bij inchecken voor duiken te voldoen), reis-, annulerings- en duikverzekering (verzekeringen zelf te verzorgen). In onderstaande opgaven zijn alle bedragen per persoon. Pakket 1: AC&minibar chalet op basis 3 personen € 1370 Pakket 2: AC&minibar chalet op basis 2 personen € 1410 Pakket 3: AC&minibar chalet op basis 1 persoon € 1580 Pakket 4: fan-chalet op basis 3 personen € 1330 Pakket 5: fan-chalet op basis 2 personen € 1370 Pakket 6: fan-chalet op basis 1 persoon € 1540 Pakket 7: fan-chalet met gedeeld sanitair, op basis 3 personen € 1290 Pakket 8: fan-chalet met gedeeld sanitair, op basis 2 personen € 1330 Pakket 9: fan-chalet, met gedeeld sanitair, op basis 1 persoon € 1500 Korting voor GEEN-duikpakket € 160 Korting voor GEEN cursus € 350 Korting AMC personeelslid € 25 Korting niet-arts (incl. Mad-B duiker, paramedisch personeel Hyperbaar centrum) € 75 Korting NOB 3* instructeur, Instructeur trainer en Docenten, of gelijkwaardig van PADI. Bij deze korting kan geen gebruik worden gemaakt van de AMC en niet-arts korting. € 175
Bedenk dat er maar 30 cursus plaatsen zijn. Reisgenoten (niet-cursisten) zijn van harte welkom. Alle pakketten zijn op basis van beschikbaarheid. Uw inschrijving is definitief als wij uw inschrijfformulier en uw aanbetaling hebben ontvangen. De volgorde van inschrijving is de datum van ontvangst van uw aanbetaling. Cursisten die op de vooraankondiging hebben gereageerd hebben echter voorrang. Bedenk dat na 15 december 2011 (zie inschrijfformulier) prijsaanpassingen van vluchten, overheden, hotels en valutakoersen kunnen worden doorberekend. Naarmate bijv. de vluchten voller worden, worden de stoelen duurder, dus hoe dichter op de vertrekdatum, hoe hoger de meerprijs (pp. min. 50 €). U ontvangt een bevestiging van uw inschrijving en aanbetaling. Inschrijvingen met betaling worden in volgorde van binnenkomst behandeld in het kader van beschikbaarheid kamers en vluchten. Pagina 9-12 bevat een foto-impressie en nadere info over Marsa Shagra Red Sea Diving Safari. Inschrijfformulier Capita Selecta Duikgeneeskunde, Decompression strategies, Doppler assessment and DCI treatment, 10-17 mei, 2012, Marsa Shakra, Egypte
alle rechter velden zijn verplicht Hieronder berekent u uw totale prijs. Uw prijsspecificatie Bent u met een of twee reisgenoot vermenigvuldig dan alles 1, 2 of 3 x conform het of de gekozen pakketten; elektronisch invullen. prijs Gekozen accommodatie is pakket #………………………………voor mij en 0,1 of 2 reisgenoten €………. Gekozen accommodatie is pakket #………………………………voor mijn 1 of 2 reisgenoten €………. Accreditatie toeslag(en) €………. Korting GEEN duikpakket (voor wie?) ……………………………………………………… minus €………. Korting voor GEEN cursus (voor wie?) ……………………………………………………… minus €………. Korting cursist niet-arts minus €………. Korting cursist AMC medewerker minus €………. Korting cursist NOB/PADI opleider (bewijs van kwalificatie meesturen) minus €……….
Hierbij verklaar ik mij akkoord met het Totale Bedrag en verplicht mij de aanbetaling van 395 € p/p te voldoen voor 15 december 2011 * Datum………………………....Naam ………………………………..…..Handtekening………………….………. Totale Bedrag. * Betaalt u de aanbetaling na 15 december, dan worden de kosten p/p minimaal 50 € hoger i.v.m. met een duurdere ticket en kamer.
Uw betalingen kunt u overmaken naar: - ING bankrekening 5856014 t.n.v. Stichting Duik Research te Aerdenhout onder vermelding van: Egypte - voor buitenlandse rekeningen: IBAN code NL05INGB000005856014, BIC code (SWIFT code) of the ING Bank is INGBNL2A, the Netherlands. Voorwaarden
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