{"id":11385556,"date":"2009-10-15T00:00:00","date_gmt":"2009-10-14T22:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized-cs_cz\/neurologicke-dekompresni-onemocneni-dci\/"},"modified":"2009-10-15T00:00:00","modified_gmt":"2009-10-14T22:00:00","slug":"neurologicke-dekompresni-onemocneni-dci","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/neurologicke-dekompresni-onemocneni-dci\/","title":{"rendered":"Neurologick\u00e9 dekompresn\u00ed onemocn\u011bn\u00ed (DCI )"},"content":{"rendered":"

Pot\u00e1p\u011b\u010d<\/strong>
Tentokr\u00e1t se jednalo o 27-letou instruktorku p\u0159\u00edstrojov\u00e9ho pot\u00e1p\u011bn\u00ed, kter\u00e1 vlastn\u00ed 4 roky opr\u00e1vn\u011bn\u00ed v\u00e9st pot\u00e1p\u011b\u010dsk\u00e9 kurzy. Od z\u00edsk\u00e1n\u00ed sv\u00e9 certifikace provedla tato technick\u00e1 pot\u00e1p\u011b\u010dka v\u00edce ne\u017e 250 ponor\u016f. Uvedla, \u017ee bere l\u00e9ky proti pocit\u016fm \u00fazkosti. P\u0159edt\u00edm nem\u011bla \u017e\u00e1dnou nehodu, neutrp\u011bla \u017e\u00e1dn\u00e9 zran\u011bn\u00ed a t\u011b\u0161\u00ed se dobr\u00e9mu zdrav\u00ed. Tato akce byla jej\u00edm prvn\u00edm dekompresn\u00edm ponorem s \u00fakolem prov\u00e9st n\u011bkolik cvi\u010den\u00ed.<\/p>\n

Ponor<\/strong>
Pl\u00e1n ponoru vy\u017eadoval od pot\u00e1p\u011b\u010dky, aby vykonala sv\u016fj prvn\u00ed dekompresn\u00ed ponor s proveden\u00edm n\u011bkolika cvi\u010den\u00ed v hloubce 140 stop (46 metr\u016f) po dobu 20 minut. D\u00fdchac\u00edm plynem byl vzduch p\u0159i pou\u017eit\u00ed p\u0159\u00edstroje s otev\u0159en\u00fdm okruhem; na sob\u011b m\u011bla such\u00fd oblek (drysuit) pro tepelnou ochranu a byla vybavena p\u0159\u00edstrojem pro kontrolu vztlaku.
V such\u00e9m obleku ji\u017e d\u0159\u00edve uskute\u010dnila v\u00edce ne\u017e 20 ponor\u016f do hloubek od 20 do 60 stop (6 a\u017e 18 metr\u016f). P\u0159ed t\u00edmto cvi\u010dn\u00fdm ponorem pravideln\u011b pou\u017e\u00edvala pot\u00e1p\u011b\u010dsk\u00e9 tabulky, podle kter\u00fdch si sv\u00e9 ponory p\u0159esn\u011b pl\u00e1novala; pro tento konkr\u00e9tn\u00ed ponor se m\u011bla \u0159\u00eddit sv\u00fdm pot\u00e1p\u011b\u010dsk\u00fdm po\u010d\u00edta\u010dem. Ponoru se z\u00fa\u010dastnili dva studenti, instruktor a asistent instruktora.
Pot\u00e1p\u011b\u010dka dos\u00e1hla ur\u010den\u00e9 hloubky a za\u010dala s pl\u00e1novan\u00fdm  n\u00e1cvikem po\u017eadovan\u00fdch dovednost\u00ed, ke kter\u00fdm pat\u0159ilo troj\u00ed uzav\u0159en\u00ed ventilu a plav\u00e1n\u00ed bez masky. Viditelnost byla omezen\u00e1, pot\u00e1p\u011b\u010dce bylo chladno a za\u010dala poci\u0165ovat tlak such\u00e9ho obleku, co\u017e u n\u00ed zvy\u0161ovalo nep\u0159\u00edjemn\u00fd pocit nepohodl\u00ed a neklidu. V\u0161echna cvi\u010den\u00ed sice provedla dob\u0159e, ale za\u017eila narkotick\u00fd stav: krom\u011b v\u0161eobecn\u00e9ho pocitu \u00fazkosti m\u011bla tzv. tunelov\u00e9 vid\u011bn\u00ed, zpomalilo se j\u00ed my\u0161len\u00ed a pozd\u011bji uvedla, \u017ee v\u0161echny p\u0159edm\u011bty kolem m\u011bly oran\u017eov\u00fd odst\u00edn. Dekomprese a v\u00fdstup trvaly p\u0159ibli\u017en\u011b hodinu. Pot\u00e1p\u011b\u010di pou\u017e\u00edvali kysl\u00edkov\u00e9 sm\u011bsi se st\u00e1le vy\u0161\u0161\u00edmi parci\u00e1ln\u00edmi tlaky kysl\u00edku na stanoven\u00fdch zast\u00e1vk\u00e1ch; b\u011bhem posledn\u00ed zast\u00e1vky v hloubce 20 stop (6 metr\u016f) pou\u017eil\u00ed 100% kysl\u00edk. Navzdory zm\u00edn\u011bn\u00fdm pot\u00ed\u017e\u00edm pot\u00e1p\u011b\u010dka ohl\u00e1sila, \u017ee ponor prob\u011bhl podle pl\u00e1nu. Instruktor potvrdil, \u017ee pot\u00e1p\u011b\u010dka m\u011bla pocit, \u017ee v\u0161echna cvi\u010den\u00ed provedla dob\u0159e. \u017d\u00e1dn\u00fd jin\u00fd \u00fa\u010dastn\u00edk tohoto ponoru si nest\u011b\u017eoval ani na narkotick\u00e9 pocity, ani na \u017e\u00e1dn\u00e9 jin\u00e9 pot\u00ed\u017ee.
Po v\u00fdstupu z vody si tato pot\u00e1pe\u010dka v\u0161imla, \u017ee m\u00e1 na k\u016f\u017ei skvrny v m\u00edstech, kde ji tla\u010dil jej\u00ed such\u00fd oblek (mo\u017en\u00e1 tam omezoval krevn\u00ed ob\u011bh). Kdy\u017e to zjistila, uv\u011bdomila si, \u017ee b\u011bhem ponoru nedod\u00e1vala do sv\u00e9ho such\u00e9ho obleku dostatek vzduchu. Nabyla p\u0159esv\u011bd\u010den\u00ed, \u017ee narkotick\u00e9 pocity byly b\u011bhem ponoru tak siln\u00e9 proto, \u017ee si neuv\u011bdomila, jak siln\u011b ji jej\u00ed such\u00fd oblek stla\u010duje. B\u011bhem ponoru nem\u011bla \u017e\u00e1dn\u00e9 probl\u00e9my se vztlakem.<\/p>\n

Komplikace<\/strong>
Asi hodinu po ponoru za\u010dala poci\u0165ovat tupou bolest v prav\u00e9 ruce, kterou prov\u00e1zelo m\u00edrn\u00e9 znecitliv\u011bn\u00ed a brn\u011bn\u00ed. O dvacet minut pozd\u011bji ji za\u010dala su\u017eovat tup\u00e1 pulzuj\u00edc\u00ed a jakoby k\u0159e\u010dovit\u00e1 bolest v prav\u00e9m z\u00e1p\u011bst\u00ed a lokti.
Sv\u00e9 p\u0159\u00edznaky sd\u011blila sv\u00e9mu instruktorsk\u00e9mu kolegovi a ihned nasadili kysl\u00edkovou prvn\u00ed pomoc, p\u0159i kter\u00e9 d\u00fdchala 100% kysl\u00edk pomoci d\u00fdchac\u00ed automatiky. B\u011bhem dal\u0161\u00edch 30 minut ji za\u010dalo bolet prav\u00e9 rameno a poci\u0165ovala sv\u011bd\u011bn\u00ed v cel\u00e9 horn\u00ed \u010d\u00e1sti t\u011bla i v podpa\u017ed\u00ed. K tomu se p\u0159idala \u010derven\u00e1 nepravideln\u011b “mramorovan\u00e1” vyr\u00e1\u017eka na obou ramenou, na b\u0159ichu a na prav\u00e9 noze a ruce. Rovn\u011b\u017e c\u00edtila velkou \u00fanavu a m\u011bla siln\u00e9 nutk\u00e1n\u00ed na zvracen\u00ed.<\/p>\n

Diagn\u00f3za a terapie<\/strong>
D\u00fdch\u00e1n\u00edm kysl\u00edku se jej\u00ed p\u0159\u00edznaky nepatrn\u011b zm\u00edrnily a b\u011bhem t\u00e9to doby byla p\u0159epravena do nejbli\u017e\u0161\u00ed nemocnice, kde se p\u0159i \u00favodn\u00edm vy\u0161et\u0159en\u00ed konstatovaly pocity z\u00e1vrat\u011b a extr\u00e9mn\u00ed \u00fanavy. Pot\u00e9 byla p\u0159evezena do druh\u00e9 nemocnice, kter\u00e1 m\u00e1 rekompresn\u00ed komoru pro l\u00e9\u010dbu pot\u00e1p\u011b\u010d\u016f. Jej\u00ed terapie v komo\u0159e za\u010dala p\u011bt hodin po zji\u0161t\u011bn\u00ed prvn\u00edch p\u0159\u00edznak\u016f.
Po ukon\u010den\u00ed prvn\u00ed rekomprese se sice jej\u00ed ko\u017en\u00ed p\u0159\u00edznaky pon\u011bkud zm\u00edrnily, ale st\u00e1le j\u00ed \u010dinilo pot\u00ed\u017ee chodit nebo st\u00e1t bez ciz\u00ed pomoci. Dostalo se j\u00ed l\u00e9\u010dby podle 6. tabulky americk\u00e9ho n\u00e1mo\u0159nictva, co\u017e m\u011blo velmi dobr\u00fd v\u00fdsledek – d\u00edky tomu se zbavila bolest\u00ed, brn\u011bn\u00ed, necitlivosti a ko\u017en\u00ed vyr\u00e1\u017eky.
N\u00e1sledn\u00fd den v\u0161ak op\u011bt zaznamenala m\u00edrn\u00e9 bolesti kloub\u016f i sval\u016f, proto \u0161la op\u011bt do zdravotn\u00edho st\u0159ediska a hyperbarick\u00e9ho za\u0159\u00edzen\u00ed na nov\u00e9 vy\u0161et\u0159en\u00ed a pro p\u0159\u00edpadnou dal\u0161\u00ed terapii. Uvedla, \u017ee se j\u00ed vr\u00e1tily pocity z\u00e1vrat\u011b a zdravotn\u00ed person\u00e1l tak\u00e9 vypozoroval, \u017ee chod\u00ed i stoj\u00ed velmi nejst\u011b. N\u00e1sledovala druh\u00e1 d\u00e1vka podle 6. tabulky. V\u00fdsledkem bylo pom\u011brn\u011b nev\u00fdznamn\u00e9 sn\u00ed\u017een\u00ed z\u00e1vrat\u00ed i bolest\u00ed, ale v\u0161echny tyto p\u0159\u00edznaky postupn\u011b \u00fapln\u011b zmizely b\u011bhem n\u00e1sleduj\u00edc\u00edch t\u0159\u00ed t\u00fddn\u016f. Za dva m\u011bs\u00edce se tato instruktorka vr\u00e1tila k prov\u00e1d\u011bn\u00ed pot\u00e1p\u011b\u010dsk\u00e9ho v\u00fdcviku v baz\u00e9nu, nicm\u00e9n\u011b pot\u00e1p\u011bn\u00ed do hloubek se zdr\u017eela po dobu \u010dty\u0159 m\u011bs\u00edc\u016f. Pot\u00e9 se k t\u00e9to \u010dinnosti vr\u00e1tila a od t\u00e9 doby neozn\u00e1mila n\u00e1vrat \u017e\u00e1dn\u00fdch p\u0159\u00edznak\u016f.<\/p>\n

Diskuse<\/strong>
P\u0159\u00edznaky, kter\u00e9 se objev\u00ed kr\u00e1tce po ponoru, jsou v\u017edy podez\u0159el\u00e9, obzvl\u00e1\u0161t\u011b kdy\u017e jsou neobvykl\u00e9, nebo kdy\u017e se takov\u00e9 p\u0159\u00edznaky objev\u00ed poprv\u00e9. Ko\u017en\u00ed projevy kesonovy nemoci jako vyr\u00e1\u017eka, mramorov\u00fd vzhled k\u016f\u017ee nebo skvrnit\u00e9 oblasti nejsou p\u0159\u00edli\u0161 \u010dast\u00e9, ale ve zpr\u00e1v\u00e1ch DAN se \u010dasto spojuj\u00ed s pot\u00e1p\u011bn\u00edm ve studen\u00e9 vod\u011b.
Podle V\u00fdro\u010dn\u00ed zpr\u00e1vy DAN o dekompresn\u00edch onemocn\u011bn\u00edch, smrteln\u00fdch nehod\u00e1ch p\u0159i pot\u00e1p\u011bn\u00ed a v\u00fdzkumn\u00fdch pot\u00e1p\u011b\u010dsk\u00fdch projektech se objev\u00ed v\u011bt\u0161ina p\u0159\u00edznak\u016f dekompresn\u00edho onemocn\u011bn\u00ed (DCI) b\u011bhem prvn\u00edch t\u0159\u00ed hodin po ponoru. Brzk\u00fd v\u00fdskyt a rychl\u00fd v\u00fdvoj t\u011bchto p\u0159\u00edznak\u016f \u010dasto signalizuje v\u00e1\u017en\u00fd p\u0159\u00edpad DCI a n\u011bkdy m\u016f\u017ee b\u00fdt obt\u00ed\u017en\u00e9 zah\u00e1jit okam\u017eit\u011b spr\u00e1vnou l\u00e9\u010dbu. I kdy\u017e byli tito vy\u0161koleni pot\u00e1p\u011b\u010di ne\u010dekan\u00fdmi p\u0159\u00edznaky posti\u017een\u00e9 pot\u00e1p\u011b\u010dky p\u0159ekvapeni, okam\u017eit\u011b za\u010dali s kysl\u00edkovou prvn\u00ed pomoc\u00ed a teprve pot\u00e9 s p\u0159epravou do nejbli\u017e\u0161\u00ed nemocnice. To z\u0159ejm\u011b sehr\u00e1lo d\u016fle\u017eitou roli v postupn\u00e9m \u00fapln\u00e9m vyl\u00e9\u010den\u00ed t\u00e9to zran\u011bn\u00e9 pot\u00e1p\u011b\u010dky.
P\u0159eprava pot\u00e1p\u011b\u010dky do za\u0159\u00edzen\u00ed, kter\u00e9 dok\u00e1\u017ee rozpoznat a spr\u00e1vn\u011b l\u00e9\u010dit DCI bylo dal\u0161\u00edm d\u016fle\u017eit\u00fdm faktorem tohoto p\u0159\u00edpadu. Je pot\u0159eba co nejrychleji vyhledat m\u00edstn\u00ed zdravotn\u00ed p\u00e9\u010di – i kdy\u017e v prvn\u00edm za\u0159\u00edzen\u00ed nedok\u00e1zali poskytnout plnohodnotnou pot\u00e1p\u011b\u010dskou terapii, v\u0161echny nemocnice dok\u00e1\u017e\u00ed prov\u00e9st odborn\u00e9 neurologick\u00e9 vy\u0161et\u0159en\u00ed, maj\u00ed intraven\u00f3zn\u00ed infuzn\u00ed roztoky, kysl\u00edk a v p\u0159\u00edpad\u011b pot\u0159eby mohou zajistit p\u0159epravu se zdravotn\u00edm dozorem. Zm\u00edn\u011bn\u00e1 prvn\u00ed nemocnice nebyla v\u00fdjimkou, jej\u00ed person\u00e1l dok\u00e1zal pot\u00e1p\u011b\u010dku stabilizovat a potvrdil pot\u0159ebu rekomprese.
P\u0159\u00edznaky DCI mohou p\u0159ed l\u00e9\u010debnou terapi\u00ed i po n\u00ed zesilovat i ustupovat. Nav\u00edc nemus\u00ed b\u00fdt po jedin\u00e9m l\u00e9\u010debn\u00e9m z\u00e1sahu zcela jasn\u00e9. To plat\u00ed hlavn\u011b u p\u0159\u00edpad\u016f, kdy se u n\u011bkoho vyvine bolest v jednom kloubu nebo svalu ve v\u0161eobecnou \u00fanavu a v pot\u00ed\u017ee s ch\u016fz\u00ed \u010di st\u00e1n\u00edm, jak tomu bylo u t\u00e9to pot\u00e1p\u011b\u010dky. Je nutno to prodiskutovat s o\u0161et\u0159uj\u00edc\u00edm l\u00e9ka\u0159em a v p\u0159\u00edpad\u011b nejistoty zavolat do DAN a poradit se. Rozpozn\u00e1n\u00ed p\u0159\u00edznak\u016f, kysl\u00edkov\u00e1 prvn\u00ed pomoc, zdravotn\u00ed vy\u0161et\u0159en\u00ed a p\u0159\u00edslu\u0161n\u00e1 terapie jsou jednotliv\u00e9 sou\u010d\u00e1sti celkov\u00e9ho obrazu, t.j. reakce na DCI.<\/p>\n

Co k tomu \u0159ekla samotn\u00e1 pot\u00e1p\u011b\u010dka<\/strong>
Tato zku\u0161enost mi p\u0159ipomn\u011bla, jak d\u016fle\u017eit\u00e1 je ka\u017ed\u00e1 mali\u010dkost. Kdy\u017e si v\u0161e prom\u00edtnu zp\u011bt, vzpom\u00edn\u00e1m si, \u017ee jsem se v tom such\u00e9m obleku nec\u00edtila pohodln\u011b u\u017e p\u0159ed ponorem. Ale nev\u011bnovala jsem pozornost jedn\u00e9 d\u016fle\u017eit\u00e9 skute\u010dnosti, sice nutnosti, aby m\u011b oblek nikde netla\u010dil, co\u017e je situace, kter\u00e1 m\u016f\u017ee br\u00e1nit dokonal\u00e9mu krevn\u00edmu ob\u011bhu a samoz\u0159ejm\u011b zvy\u0161uje pocit nepohodl\u00ed p\u0159i ponoru. Tla\u010den\u00ed obleku a studen\u00e1 voda mo\u017en\u00e1 p\u0159isp\u011bly ke ko\u017en\u00ed vyr\u00e1\u017ece, kterou jsem dostala. A kdy\u017e jsem poci\u0165ovala siln\u00e9 narkotick\u00e9 p\u0159\u00edznaky, m\u011bla jsem b\u00fdt mnohem konzervativn\u011bj\u0161\u00ed p\u0159i zast\u00e1vk\u00e1ch, to znamen\u00e1, \u017ee jsem je m\u011bla d\u011blat del\u0161\u00ed ne\u017e jen minim\u00e1ln\u00ed po\u017eadovanou dobu, nebo\u0165 ten ponor byl pro mne dost n\u00e1ro\u010dn\u00fd.
Z\u00e1v\u011brem mus\u00edm \u0159\u00edci, \u017ee to byla z\u0159ejm\u011b nejcenn\u011bj\u0161\u00ed zku\u0161enost z cel\u00e9ho m\u00e9ho dosavadn\u00edho pot\u00e1p\u011bn\u00ed. Ne \u017ee bych ji n\u011bkomu doporu\u010dovala, ale d\u00edky t\u00e9to ud\u00e1losti si mnohem l\u00e9pe uv\u011bdomuji podm\u00ednky, kter\u00e9 “okolo” pot\u00e1p\u011bn\u00ed existuj\u00ed a tak\u00e9 v\u00edm, jak mohu sn\u00ed\u017eit faktory, kter\u00e9 by mohly v\u00e9st k nemoci z dekomprese, obzvl\u00e1\u0161t\u011b p\u0159i technick\u00e9m pot\u00e1p\u011bn\u00ed.
Pot\u00e1p\u011bn\u00ed mne st\u00e1le ohromn\u011b bav\u00ed, ale kdy\u017e se pot\u00e1p\u00edm te\u010f, po\u0159\u00e1dn\u011b si v\u0161e promysl\u00edm a sna\u017e\u00edm se vyvarovat jak\u00e9koliv situaci, kter\u00e1 by mohla zp\u016fsobit n\u011bjak\u00e9 probl\u00e9my.<\/p>\n","protected":false},"excerpt":{"rendered":"

Pot\u00e1p\u011b\u010d Tentokr\u00e1t se jednalo o 27-letou instruktorku p\u0159\u00edstrojov\u00e9ho pot\u00e1p\u011bn\u00ed, kter\u00e1 vlastn\u00ed 4 roky opr\u00e1vn\u011bn\u00ed v\u00e9st pot\u00e1p\u011b\u010dsk\u00e9 kurzy. Od z\u00edsk\u00e1n\u00ed sv\u00e9 certifikace provedla tato technick\u00e1 pot\u00e1p\u011b\u010dka…<\/p>\n","protected":false},"author":1,"featured_media":11374122,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[384],"tags":[],"authors":[1193],"class_list":["post-11385556","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clanky","authors-joel-dovenbarger-cs_cz"],"acf":[],"yoast_head":"\nNeurologick\u00e9 dekompresn\u00ed onemocn\u011bn\u00ed (DCI ) - Alert Diver<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/neurologicke-dekompresni-onemocneni-dci\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Neurologick\u00e9 dekompresn\u00ed onemocn\u011bn\u00ed (DCI ) - Alert Diver\" \/>\n<meta property=\"og:description\" content=\"Pot\u00e1p\u011b\u010d Tentokr\u00e1t se jednalo o 27-letou instruktorku p\u0159\u00edstrojov\u00e9ho pot\u00e1p\u011bn\u00ed, kter\u00e1 vlastn\u00ed 4 roky opr\u00e1vn\u011bn\u00ed v\u00e9st pot\u00e1p\u011b\u010dsk\u00e9 kurzy. 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