Valsalva maneuver - Wikipedia

The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose ... Valsalvamaneuver FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Techniqueforequalisingpressureinthemiddleears Thisarticleneedsadditionalcitationsforverification.Pleasehelpimprovethisarticlebyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.Findsources: "Valsalvamaneuver" – news ·newspapers ·books ·scholar ·JSTOR(March2016)(Learnhowandwhentoremovethistemplatemessage) ValsalvamaneuverAmanperformstheValsalvamaneuverwhilehisearisexaminedwithanotoscope.[editonWikidata] TheValsalvamaneuverisperformedbyaforcefulattemptofexhalationagainstaclosedairway,usuallydonebyclosingone'smouthandpinchingone'snoseshutwhileexpellingairoutasifblowingupaballoon.Variationsofthemaneuvercanbeusedeitherinmedicalexaminationasatestofcardiacfunctionandautonomicnervouscontroloftheheart,ortocleartheearsandsinuses(thatis,toequalizepressurebetweenthem)whenambientpressurechanges,asinscubadiving,hyperbaricoxygentherapy,orairtravel.[1] Amodifiedversionisdonebyexpiringagainstaclosedglottis.ThiswillelicitthecardiovascularresponsesdescribedbelowbutwillnotforceairintotheEustachiantubes.[citationneeded] Contents 1History 2Physiologicalresponse 3Applications 3.1Normalizingmiddle-earpressures 3.2Strengthtraining 3.3Painmanagement 3.4Regulationofheartrhythm 3.5Medicaldiagnostics 3.5.1Cardiology 3.5.2Neurology 3.5.3Palpationofsupraclavicularlymphnodes 3.5.4Oral–antralcommunication 3.5.5Urogenitalmedicine 4Complications 4.1Preretinal 4.2Cardiovascularandgastroinestinal 5Valsalvadeviceinspacesuits 6Seealso 7References 8Externallinks History[edit] ThetechniqueisnamedafterAntonioMariaValsalva,[2]aseventeenth-centuryphysicianandanatomistfromBolognawhoseprincipalscientificinterestwasthehumanear.HedescribedtheEustachiantubeandthemaneuvertotestitspatency(openness).Healsodescribedtheuseofthismaneuvertoexpelpusfromthemiddleear.[citationneeded] Physiologicalresponse[edit] Bloodpressure(systolic)andpulserateduringanormalresponsetoaValsalvamaneuver.Fortymillimetermercurypressureisappliedat5secondsandrelievedat20seconds. Thenormalphysiologicalresponseconsistsoffourphases.[3] Initialpressurerise Onapplicationofexpiratoryforce,pressurerisesinsidethechestforcingbloodoutofthepulmonarycirculationintotheleftatrium.Thiscausesamildriseinstrokevolumeduringthefirstfewsecondsofthemaneuver. Reducedvenousreturnandcompensation Returnofsystemicbloodtotheheartisimpededbythepressureinsidethechest.Theoutputoftheheartisreducedandstrokevolumefalls.Thisoccursfrom5toabout14secondsintheillustration.Thefallinstrokevolumereflexivelycausesbloodvesselstoconstrictwithsomeriseinpressure(15to20seconds).Thiscompensationcanbequitemarkedwithpressurereturningtonearorevenabovenormal,butthecardiacoutputandbloodflowtothebodyremainslow.Duringthistimethepulserateincreases(compensatorytachycardia). Pressurerelease Thepressureonthechestisreleased,allowingthepulmonaryvesselsandtheaortatore-expandcausingafurtherinitialslightfallinstrokevolume(20to23seconds)duetodecreasedleftatrialreturnandincreasedaorticvolume,respectively.Venousbloodcanoncemoreenterthechestandtheheart,cardiacoutputbeginstoincrease. Returnofcardiacoutput Bloodreturntotheheartisenhancedbytheeffectofentryofbloodwhichhadbeendammedback,causingarapidincreaseincardiacoutput(24secondson).Thestrokevolumeusuallyrisesabovenormalbeforereturningtoanormallevel.Withreturnofbloodpressure,thepulseratereturnstowardsnormal. Deviationfromthisresponsepatternsignifieseitherabnormalheartfunctionorabnormalautonomicnervouscontroloftheheart.Valsalvaisalsousedbydentistsfollowingextractionofamaxillarymolartooth.Themaneuverisperformedtodetermineifaperforationorantralcommunicationexists. Applications[edit] Normalizingmiddle-earpressures[edit] Whenrapidambientpressureincreaseoccursasindivingoraircraftdescent,thispressuretendstoholdtheEustachiantubesclosed,preventingpressureequalizationacrosstheeardrum,withpainfulresults.[4][5][6]Toavoidthispainfulsituation,divers,caissonworkersandaircrewattempttoopentheEustachiantubesbyswallowing,whichtendstoopenthetubes,allowingtheeartoequalizeitself. Ifthisfails,thentheValsalvamaneuvermaybeused.Thismaneuver,whenusedasatooltoequalizemiddleearpressure,carrieswithittheriskofauditorydamagefromoverpressurizationofthemiddleear.[1][5][7][8]TheValsalvamaneuvergeneratesabout20–40 mmofHgpressure.[9]Itissafer,iftimepermits,toattempttoopentheEustachiantubesbyswallowingafewtimes,oryawning,orbyusingtheValsalvatechniqueofbreathingaverysmallamountofairgentlyintonostrilsheldclosedbythefingersassoonasmildpressureisfelt,beforeitincreasestothepointthatitsreleasewouldbepainful.Theeffectivenessofthe"yawning"methodcanbeimprovedwithpractice;somepeopleareabletoachievereleaseoropeningbymovingtheirjawforwardorforwardanddown,ratherthanstraightdownasinaclassicalyawn,[5]andsomecandosowithoutmovingtheirjawatallbyactivatingthetensortympanimuscle,whichisheardbytheindividualasadeep,rumblingsound.Openingcanoftenbeclearlyheardbythepractitioner,thusprovidingfeedbackthatthemaneuverwassuccessful. Duringswallowingoryawning,severalmusclesinthepharynx(throat)acttoelevatethesoftpalateandopenthethroat.Oneofthesemuscles,thetensorvelipalatini,alsoactstoopentheEustachiantube.Thisiswhyswallowingoryawningissuccessfulinequalizingmiddleearpressure.Contrarytopopularbelief,thejawdoesnotpinchthetubesshutwhenitisclosed.Infact,theEustachiantubesarenotlocatedcloseenoughtothemandibletobepinchedoff.Peopleoftenrecommendchewinggumduringascent/descentinaircraft,becausechewinggumincreasestherateofsalivation,andswallowingtheexcesssalivaopenstheEustachiantubes. InaclinicalsettingtheValsalvamaneuverwillcommonlybedoneeitheragainstaclosedglottis,oragainstanexternalpressuremeasuringdevice,thuseliminatingorminimizingthepressureontheEustachiantubes.StrainingorblowingagainstresistanceasinblowingupballoonshasaValsalvaeffectandthefallinbloodpressurecanresultindizzinessandevenfainting. Strengthtraining[edit] TheValsalvamaneuveriscommonlybelievedtobetheoptimalbreathingpatternforproducingmaximalforceandisfrequentlyusedinpowerliftingtostabilizethetrunkduringexercisessuchasthesquat,deadlift,andbenchpress,andinbothliftsofOlympicweightlifting.[10]Additionally,competitivestrongmenoftenusetheValsalvamaneuverinthingssuchaslogpress,yokewalks,andstoneloading,aswellasanyotherstrongmanmovements.[citationneeded] Painmanagement[edit] TheValsalvamaneuvercanbeusedasameanstoreducepainduringlumbarpuncture.[11][how?] Regulationofheartrhythm[edit] TheValsalvamaneuvermaybeusedtoarrestepisodesofsupraventriculartachycardia.[12][13][unreliablemedicalsource?]Bloodpressure(BP)risesatonsetofstraining-becausetheincreasedintrathoracicpressure(ITP)isaddedtothepressureintheaorta.ItthenfallsbecausetheITPcompressestheveins,decreasingthevenousreturnandcardiacoutput.Thisinhibitsthebaroreceptorscausingtachycardiaandariseinperipheralvascularresistance(PVR).WhentheglottisisopenedandtheITPreturnstonormal,cardiacoutputisrestoredbuttheperipheralvesselsareconstricted.Thebloodpressurethereforerisesabovenormalandthisstimulatedthebaroreceptors,causingbradycardiaandadropinBPtonormallevel.[14] Medicaldiagnostics[edit] Cardiology[edit] Thissectionneedsadditionalcitationsforverification.Pleasehelpimprovethisarticlebyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.(July2018)(Learnhowandwhentoremovethistemplatemessage) Themaneuvercansometimesbeusedtodiagnoseheartabnormalities,especiallywhenusedinconjunctionwithanechocardiogram.[15][unreliablemedicalsource?]Forexample,theValsalvamaneuver(phaseII)increasestheintensityofhypertrophiccardiomyopathymurmurs,namelythoseofdynamicsubvalvularleftventricularoutflowobstruction.Atthesametime,theValsalvamaneuver(phaseII)decreasestheintensityofmostothermurmurs,includingaorticstenosisandatrialseptaldefect.DuringthefirstfewsecondsoftheValsalvamaneuver(phaseI)theoppositefindingswillbethecase.[citationneeded] AUK-basedrandomizedcontrolledtrial(REVERT)demonstratedthatinpatientswithcardiovascularlystablesupraventriculartachycardia,amodifiedValsalvamaneuverstartedinsemi-recumbentpositionfollowedbyrepositioningofthepatienttoasupinepositionwithapassivelegraiseimmediatelyafterthestrainhasandincreased43%successratecomparedtotheonly17%effectivenessoftheconventionalValsalvamaneuverinterminatingSVT.[16] EffectofValsalva(phaseII) Cardiacfinding Decreasesmurmur Aorticstenosis Pulmonicstenosis Tricuspidregurgitation Increasesmurmur Hypertrophiccardiomyopathy Mitralvalveprolapse Earlieronsetofmurmur Mitralvalveprolapse Neurology[edit] TheValsalvamaneuverisusedtoaidintheclinicaldiagnosisofproblemsorinjuryinthenervesofthecervicalspine.[17]UponperformingtheValsalvamaneuver,intraspinalpressureslightlyincreases.Thus,neuropathiesorradicularpainmaybefeltorexacerbated,andthismayindicateimpingementonanervebyanintervertebraldiscorotherpartoftheanatomy.HeadacheandpainuponperformingtheValsalvamaneuverisalsooneofthemainsymptomsinArnold–Chiarimalformation.TheValsalvamaneuvermaybeofuseincheckingforaduraltearfollowingcertainspinaloperationssuchasamicrodiscectomy.Anincreaseinintra-spinalpressurewillcausecerebralspinalfluid(CSF)toleakoutoftheduracausingaheadache.[citationneeded] TheValsalvamaneuverhasbeenassociatedwithtransientglobalamnesia.[18][19][20][21][22] Palpationofsupraclavicularlymphnodes[edit] Asthelymphnodesmaybeburied,askingthepatienttoperformtheValsalvamaneuvercanpushthecupolaofthelungupwardbringingdeep-seatednodestoamoreaccessiblepositionforpalpation.[23]Palpationmayidentifyanenlargementofthesupraclavicularlymphnodeswhichisadiagnosticindicatorofcancer.Theprevalenceofmalignancyinthepresenceofsupraclavicularlymphadenopathyisreportedtobeintherangeof54%to85%.[24] Oral–antralcommunication[edit] AvariantoftheValsalvamaneuverisusedtoaiddiagnosisoforal–antralcommunication,i.e.theexistenceofaconnectionbetweentheoralcavityandthemaxillarysinus.[25] Urogenitalmedicine[edit] TheValsalvamaneuverisusedtoaiddiagnosisofintrinsicsphinctericdeficiency(ISD)inurodynamictests.Valsalvaleakpointpressureistheminimumvesicularpressurethatisassociatedwithurineleakage.Althoughthereisnoconsensusonthethresholdvalue,values> 60 cm H2Oarecommonlyconsideredtoindicatehypermobilityofthebladderneckandnormalsphincterfunction.[26]Also,whenexaminingwomenwithpelvicorganprolapse,askingthepatienttoperformtheValsalvamaneuverisusedtodemonstratemaximumpelvicorgandescent.[27] Complications[edit] Preretinal[edit] ValsalvaretinopathyispathologicalsyndromeassociatedwiththeValsalvamaneuver.[28][29]Itpresentsaspreretinalhemorrhage(bleedinginfrontoftheretina)inpeoplewithahistoryoftransientincreaseintheintrathoracicpressureandmaybeassociatedwithheavylifting,forcefulcoughing,strainingonthetoilet,orvomiting.Thebleedingmaycausevisuallossifitobstructsthevisualaxis,andpatientsmaynotefloatersintheirvisualfield.Usuallythiscausesnopermanentvisualimpairments,andsightisfullyrestored. Cardiovascularandgastroinestinal[edit] Cardiacarrest[30]andothercardiovascularcomplications[31]canoccurduetoattemptingtoinducedefecationusingtheValsalvamaneuver.Anothercomplicationofthepracticeishiatalhernia.[citationneeded] Valsalvadeviceinspacesuits[edit] Astronautshowingtheuseofthe"Valsalva" Mainarticle:Valsalvadevice SomespacesuitscontainadevicecalledtheValsalvadevicetoenablethewearertoblocktheirnosetoperformtheValsalvamaneuverwhenwearingthesuit.AstronautDrewFeusteldescribesitas"aspongydevicecalledaValsalvathatistypicallyusedtoblockthenoseincaseapressurereadjustmentisneeded".[32]Oneuseofthedeviceistoequalizepressureduringsuitpressurization.[33] Seealso[edit] Underwaterdivingportal Barostriction Earclearing Politzerization Müller'smaneuver Vagalmaneuver Handgripmaneuver References[edit] ^abTaylor,D(1996)."TheValsalvaManoeuvre:Acriticalreview".SouthPacificUnderwaterMedicineSocietyJournal.26(1).ISSN 0813-1988.OCLC 16986801.Retrieved14March2016. ^synd/2316atWhoNamedIt? ^Luster,EA;Baumgartner,N;Adams,WC;Convertino,VA(1996)."EffectsofhypovolemiaandpostureonresponsestotheValsalvamaneuver".Aviation,Space,andEnvironmentalMedicine.67(4):308–13.PMID 8900980. ^Brubakk,A.O.;Neuman,T.S.(2003).BennettandElliott'sphysiologyandmedicineofdiving(5thRev ed.).UnitedStates:SaundersLtd.ISBN 978-0-7020-2571-6.[page needed] ^abcKay,E."Preventionofmiddleearbarotrauma".Retrieved11June2008. ^Kay,E."TheDiver'sEar–UnderPressure"(Flashvideo).Retrieved11June2008. ^Roydhouse,N.(1978)."Thesqueeze,theearandprevention".SouthPacificUnderwaterMedicineSocietyJournal.8(1).ISSN 0813-1988.OCLC 16986801.Retrieved11June2008. ^Roydhouse,N.;Taylor,D.(1996)."TheValsalvaManoeuvre.(lettertoeditor)".SouthPacificUnderwaterMedicineSocietyJournal.26(3).ISSN 0813-1988.OCLC 16986801.Retrieved11June2008. ^Lee,K.J.(2015-10-22).KJLee'sEssentialOtolaryngology,11thedition.McGrawHillProfessional.ISBN 9780071849937. 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^Zuber,M.;Cuculi,F.;Oechslin,E.;Erne,P.;Jenni,R.(2008)."Istransesophagealechocardiographystillnecessarytoexcludepatentforamenovale?".ScandinavianCardiovascularJournal.42(3):222–5.doi:10.1080/14017430801932832.PMID 18569955.S2CID 205813072. ^"TheREVERTTrial:AModifiedValsalvaManeuvertoConvertSVT".REBELEM-EmergencyMedicineBlog.September14,2015. ^Johnson,RH;Smith,AC;Spalding,JM(1969)."BloodpressureresponsetostandingandtoValsalva'smanoeuvre:Independenceofthetwomechanismsinneurologicaldiseasesincludingcervicalcordlesions".ClinicalScience.36(1):77–86.PMID 5783806. ^Lewis,S(1998)."Aetiologyoftransientglobalamnesia".TheLancet.352(9125):397–9.doi:10.1016/S0140-6736(98)01442-1.PMID 9717945.S2CID 12779088. ^Sander,Kerstin;Sander,Dirk(2005)."Newinsightsintotransientglobalamnesia:recentimagingandclinicalfindings".TheLancetNeurology.4(7):437–44.doi:10.1016/S1474-4422(05)70121-6.PMID 15963447.S2CID 19997499. ^Moreno-lugris;Martínez-Alvarez,J;Brañas,F;Martínez-Vázquez,F;Cortés-Laiño,JA(1996)."Transientglobalamnesia.Case-controlstudyof24cases".RevistadeNeurología.24(129):554–7.PMID 8681172. ^Nedelmann;Eicke,BM;Dieterich,M(2005)."Increasedincidenceofjugularvalveinsufficiencyinpatientswithtransientglobalamnesia".JournalofNeurology.252(12):1482–6.doi:10.1007/s00415-005-0894-9.PMID 15999232.S2CID 25268484. ^AkkawiNM,AgostiC,RozziniL,AnzolaGP,PadovaniA(2001)."Transientglobalamnesiaandvenousflowpatterns".TheLancet.357(9256):639.doi:10.1016/S0140-6736(05)71434-3.PMID 11558519.S2CID 5978618. ^"Lymphadenopathy".ClinicalMethods:TheHistory,Physical,andLaboratoryExaminations(third ed.).Butterworths.1January1980.ISBN 9780409900774. ^"Assessmentoflymphadenopathy—Differentialdiagnosisofsymptoms".BMJBestPractice. ^"HowDoIManageOroantralCommunication?KeyPoints".19March2013.Retrieved13October2015. ^O'Shaughnessy,Michael(4January2019)."Urinaryincontinence,medicalandsurgicalaspects".{{citejournal}}:Citejournalrequires|journal=(help) ^Bump,RichardC.;Mattiasson,Anders;Bø,Kari;Brubaker,LindaP.;Delancey,JohnO.L.;Klarskov,Peter;Shull,BobL.;Smith,AnthonyR.B.(1996)."Thestandardizationofterminologyoffemalepelvicorganprolapseandpelvicfloordysfunction".AmericanJournalofObstetricsandGynecology.175(1):10–7.CiteSeerX 10.1.1.472.9918.doi:10.1016/S0002-9378(96)70243-0.PMID 8694033. ^Gibran,SK;Kenawy,N;Wong,D;Hiscott,P(2007)."ChangesintheretinalinnerlimitingmembraneassociatedwithValsalvaretinopathy".BritishJournalofOphthalmology.91(5):701–2.doi:10.1136/bjo.2006.104935.PMC 1954736.PMID 17446519. ^ConnorAJ(2010)."Valsalva-relatedretinalvenousdilationcausedbydefaecation".ActaOphthalmologica.88(4):e149.doi:10.1111/j.1755-3768.2009.01624.x.PMID 19747224.S2CID 26590048. ^Fisher-HubbardAO,KeshaK,DiazF,NjiwajiC,ChiP,SchmidtCJ(2016)."CommodeCardia-DeathbyValsalvaManeuver:ACaseSeries".JournalofForensicSciences.61(6):1541–1545.doi:10.1111/1556-4029.13196.hdl:2027.42/134829.PMID 27716918.S2CID 4727369. ^IkedaT,OomuraM,SatoC,AnanC,YamadaK,KamimotoK(2016)."Cerebralinfarctionduetocardiacmyxomadevelopedwiththelossofconsciousnessimmediatelyafterdefecation-acasereport".RinshoShinkeigaku.56(5):328–333.doi:10.5692/clinicalneurol.cn-000856.PMID 27151226. ^"USastronautgrappleswith'tearsinspace'".spacedaily.com.25May2011.Retrieved27May2011. ^SamCristoforetti[@AstroSamantha](22November2011)."It'saValsalvadevice,toequalizeearsaspressureinsuitincreases"(Tweet).Retrieved22November2012–viaTwitter. Externallinks[edit] WikimediaCommonshasmediarelatedtoValsalvamaneuver. 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HelixEnergySolutionsGroup InternationalMarineContractorsAssociation Toolsandequipment Abrasivewaterjet Airlift Baitedremoteunderwatervideo In-watersurfacecleaning Brushcart Cavitationcleaning Pressurewashing Pigging Liftingbag Remotelyoperatedunderwatervehicle Thermallance Tremie Waterjetting Underwaterweapons Limpetmine Speargun Hawaiiansling Polespear Underwaterfirearm Gyrojet Mk1UnderwaterDefenseGun Powerhead Underwaterpistols Heckler&KochP11 SPP-1underwaterpistol Underwaterrevolvers AAIunderwaterrevolver Underwaterrifles ADSamphibiousrifle APSunderwaterrifle ASM-DTamphibiousrifle Recreationaldiving Recreationaldivesites Indexofrecreationaldivesites Listofwreckdivingsites Outlineofrecreationaldivesites Specialties Altitudediving Cavediving Deepdiving Icediving Muckdiving Open-waterdiving Rebreatherdiving Sidemountdiving Solodiving Technicaldiving Underwaterphotography Wreckdiving Diverorganisations BritishSub-AquaClub(BSAC) CaveDiversAssociationofAustralia(CDAA) CaveDivingGroup(CDG) ComhairleFo-Thuinn(CFT) ConfédérationMondialedesActivitésSubaquatiques(CMAS) FederaciónEspañoladeActividadesSubacuáticas(FEDAS) FédérationFrançaised'ÉtudesetdeSportsSous-Marins(FFESSM) InternationalAssociationforHandicappedDivers(IAHD) NationalAssociationforCaveDiving(NACD) QuintanaRooSpeleologicalSurvey(QRSS) WoodvilleKarstPlainProject(WKPP) Divingtourismindustry Divecenter DivinginEastTimor DivingintheMaldives Environmentalimpactofrecreationaldiving Scubadivingtourism ScubadivingintheCaymanIslands Sharktourism Sinkingshipsforwreckdivingsites UnderwaterdivingonGuam Divingeventsandfestivals Diversnight UnderwaterBikeRace Divingsafety Humanfactorsindivingequipmentdesign Humanfactorsindivingsafety Life-supportsystem Safety-criticalsystem Scubadivingfatalities Divinghazards Listofdivinghazardsandprecautions Environmental Current Delta-P Entanglementhazard Overhead Siltout Waveaction Equipment Freeflow Useofbreathingequipmentinanunderwaterenvironment Failureofdivingequipmentotherthanbreathingapparatus Singlepointoffailure Physiological Coldshockresponse Decompression Nitrogennarcosis Oxygentoxicity Seasickness Uncontrolleddecompression Diverbehaviourandcompetence Lackofcompetence Overconfidenceeffect Panic Taskloading Traitanxiety Willfulviolation Consequences Barotrauma Decompressionsickness Drowning Hypothermia Hypoxia Hypercapnia Hyperthermia Non-freezingcoldinjury Divingprocedures Ascendinganddescending Emergencyascent Boatdiving Canoeandkayakdiving Buddydiving buddycheck Decompression Decompressionpractice Pylestop Ratiodecompression Divebriefing Divelog Diveplanning Ruleofthirds Scubagasplanning Divercommunications Divinghandsignals Divinglinesignals Divervoicecommunications Diverrescue Divertraining DoingItRight Driftdiving Gasblendingforscubadiving Nightdiving Rebreatherdiving Solodiving Watersafety Riskmanagement Checklist Hazardidentificationandriskassessment Hazardanalysis Jobsafetyanalysis Riskassessment Riskcontrol 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Occupationalhygiene Exposureassessment Occupationalexposurelimit Workplacehealthsurveillance Safetyculture Codeofpractice Divingsafetyofficer Divingsuperintendent Healthandsafetyrepresentative Operationsmanual Safetymeeting Standardoperatingprocedure DivingmedicineDivingdisorders Listofsignsandsymptomsofdivingdisorders Cramp Motionsickness Surfer'sear Pressurerelated Alternobaricvertigo Barostriction Barotrauma Airembolism Aerosinusitis Barodontalgia Dentalbarotrauma Pulmonarybarotrauma Compressionarthralgia Decompressionillness Dysbarism Oxygen Freedivingblackout Hyperoxia Hypoxia Oxygentoxicity Inertgases Avascularnecrosis Decompressionsickness Isobariccounterdiffusion Taravana Dysbaricosteonecrosis High-pressurenervoussyndrome Hydrogennarcosis Nitrogennarcosis Carbondioxide Hypercapnia Hypocapnia Breathinggascontaminants Carbonmonoxidepoisoning Immersionrelated Asphyxia Drowning Hypothermia Immersiondiuresis Instinctivedrowningresponse Laryngospasm Saltwateraspirationsyndrome Swimming-inducedpulmonaryedema Treatment Demandvalveoxygentherapy Firstaid Hyperbaricmedicine Hyperbarictreatmentschedules In-waterrecompression Oxygentherapy Therapeuticrecompression Personnel DivingMedicalExaminer DivingMedicalPractitioner DivingMedicalTechnician Hyperbaricnursing Screening Atrialseptaldefect Effectsofdrugsonfitnesstodive Fitnesstodive Psychologicalfitnesstodive ResearchResearchersindivingphysiologyandmedicine ArthurJ.Bachrach AlbertR.Behnke PaulBert GeorgeF.Bond RobertBoyle AlbertA.Bühlmann JohnR.Clarke GuybonChesneyCastellDamant KennethWilliamDonald WilliamPaulFife JohnScottHaldane RobertWilliamHamiltonJr. LeonardErskineHill BrianAndrewHills FelixHoppe-Seyler ChristianJ.Lambertsen SimonMitchell CharlesMomsen NealW.Pollock JohnRawlinsR.N. CharlesWesleyShilling EdwardD.Thalmann JacquesTriger Divingmedicalresearchorganisations AerospaceMedicalAssociation DiversAlertNetwork(DAN) DivingDiseasesResearchCentre(DDRC) DivingMedicalAdvisoryCouncil(DMAC) EuropeanDivingTechnologyCommittee(EDTC) EuropeanUnderwaterandBaromedicalSociety(EUBS) NationalBoardofDivingandHyperbaricMedicalTechnology NavalSubmarineMedicalResearchLaboratory RoyalAustralianNavySchoolofUnderwaterMedicine RubiconFoundation SouthPacificUnderwaterMedicineSociety(SPUMS) SouthernAfricanUnderwaterandHyperbaricMedicalAssociation(SAUHMA) UnderseaandHyperbaricMedicalSociety(UHMS) UnitedStatesNavyExperimentalDivingUnit(NEDU) Law Civilliabilityinrecreationaldiving Divingregulations Dutyofcare Listoflegislationregulatingunderwaterdiving Investigationofdivingaccidents UNESCOConventionontheProtectionoftheUnderwaterCulturalHeritage Historyofunderwaterdiving Historyofdecompressionresearchanddevelopment Historyofscubadiving Listofresearchersinunderwaterdiving LyonsMaritimeMuseum Timelineofdivingtechnology Archeologicalsites SSCommodore USSMonitor QueenAnne'sRevenge WhydahGally Underwaterartandartists TheDiver JasondeCairesTaylor Engineersandinventors WilliamBeebe GeorgesBeuchat JohnR.Clarke JacquesCousteau CharlesAnthonyDeane JohnDeane TedEldred HenryFleuss ÉmileGagnan Joseph-MartinCabirol ChristianJ.Lambertsen YvesLePrieur JohnLethbridge ErnestWilliamMoir JosephSalimPeress AugustePiccard JoeSavoie WillardFranklynSearle GordonSmith AugustusSiebe JacquesTriger Equipment Aqua-Lung RVCalypso SP-350Denise Nikonos Porpoiseregulator Standarddivingdress Vintagescuba Diverpropulsionvehicles AdvancedSEALDeliverySystem CosmosCE2Fseries DryCombatSubmersible Humantorpedo MotorisedSubmersibleCanoe NeckerNymph R-2Mala-classswimmerdeliveryvehicle SEALDeliveryVehicle ShallowWaterCombatSubmersible SiluroSanBartolomeo Welfreighter WetNellie Militaryandcovertoperations RaidonAlexandria(1941) SinkingoftheRainbowWarrior Scientificprojects 1992cagelessshark-divingexpedition Mission31 IncidentsDiveboatincidents SinkingofMVConception FireonMVRedSeaAggressor Diverrescues Alpazatcaverescue ThamLuangcaverescue Earlydiving JohnDay(carpenter) CharlesSpalding EbenezerWatson Freedivingfatalities LoïcLeferme AudreyMestre NicholasMevoli NataliaMolchanova Offshoredivingincidents ByfordDolphindivingbellaccident DrillMasterdivingaccident StarCanopusdivingaccident StenaSeaspreaddivingaccident VentureOnedivingaccident WaageDrillIIdivingaccident Wildrakedivingaccident Professionaldivingfatalities RogerBaldwin JohnBennett VictorF.GuielJr. FrancisP.Hammerberg CraigM.Hoffman PeterHenryMichaelHolmes JohnsonSeaLinkaccident EdwinClaytonLink GerardAnthonyPrangley PierSkipness RobertJohnSmyth AlbertD.Stover RichardA.Walker LotharMichaelWard JoachimWendler BradleyWestell ArneZetterström Scubadivingfatalities 1973MountGambiercavedivingaccident RicardoArmbruster AllanBridge DavidBright BerryL.Cannon CottonCoulson CláudioCoutinho E.YaleDawson DeonDreyer MilanDufek SheckExley MauriceFargues FernandoGarfellaPalmer GuyGarman SteveIrwin JimJones HenryWayKendall ArturKozłowski YuriLipski KirstyMacColl AgnesMilowka FrançoisdeRoubaix ChrisandChrissyRouse DaveShaw WesleyC.Skiles DeweySmith RobStewart EsbjörnSvensson JosefVelek PublicationsManuals NOAADivingManual U.S.NavyDivingManual BasicCaveDiving:ABlueprintforSurvival UnderwaterHandbook BennettandElliott'sphysiologyandmedicineofdiving EncyclopediaofRecreationalDiving Thenewscienceofskinandscubadiving ProfessionalDiver'sHandbook BasicScuba StandardsandCodesofPractice CodeofPracticeforScientificDiving(UNESCO) DIN7876 IMCACodeofPracticeforOffshoreDiving ISO24801Recreationaldivingservices—Requirementsforthetrainingofrecreationalscubadivers Generalnon-fiction TheDarknessBeckons Goldfinder TheLastDive ShadowDivers TheSilentWorld:AStoryofUnderseaDiscoveryandAdventure Research ListofDiversAlertNetworkpublications Diveguides TrainingandregistrationDivertraining Competenceandassessment Competency-basedlearning Refreshertraining Skillassessment Divertrainingstandard Divinginstructor Divingschool Occupationaldivertraining Commercialdivertraining Militarydivertraining Publicsafetydivertraining Scientificdivertraining Recreationaldivertraining Introductorydiving Teachingmethod Musclememory Overlearning Stressexposuretraining Skills Combatsidestroke Divernavigation Divertrim Earclearing Frenzelmaneuver Valsalvamaneuver Finningtechniques Scubaskills Buddybreathing Lowimpactdiving DiamondReefSystem Surface-supplieddivingskills Underwatersearches RecreationalscubacertificationlevelsCoredivingskills AdvancedOpenWaterDiver Autonomousdiver CMAS*scubadiver CMAS**scubadiver Introductorydiving LowImpactDiver MasterScubaDiver OpenWaterDiver Superviseddiver Leadershipskills Diveleader Divemaster Divinginstructor MasterInstructor Specialistskills RescueDiver Solodiver Divertrainingcertificationandregistrationorganisations EuropeanUnderwaterFederation(EUF) 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ComhairleFo-Thuinn(CFT) ConfédérationMondialedesActivitésSubaquatiques(CMAS) FederaciónEspañoladeActividadesSubacuáticas(FEDAS) FédérationFrançaised'ÉtudesetdeSportsSous-Marins(FFESSM) FederazioneItalianaAttivitàSubacquee(FIAS) GlobalUnderwaterExplorers(GUE) InternationalAssociationforHandicappedDivers(IAHD) InternationalAssociationofNitroxandTechnicalDivers(IANTD) InternationalDivingEducatorsAssociation(IDEA) InternationalLifeSavingFederation(ILS) IsraeliDivingFederation(TIDF) NationalAcademyofScubaEducators(NASE) NationalAssociationofUnderwaterInstructors(NAUI) NederlandseOnderwatersportBond(NOB) ProfessionalAssociationofDivingInstructors(PADI) ProfessionalDivingInstructorsCorporation(PDIC) Sub-AquaAssociation(SAA) ScubaDivingInternational(SDI) ScubaEducatorsInternational(SEI) ScottishSubAquaClub(ScotSAC) ScubaSchoolsInternational(SSI) TürkiyeSualtıSporlarıFederasyonu(TSSF) UnitedDivingInstructors(UDI) YMCASCUBAProgram Scientificdivercertificationauthorities AmericanAcademyofUnderwaterSciences(AAUS) CMASScientificCommittee Technicaldivercertificationagencies AmericanNitroxDiversInternational(ANDI) BritishSub-AquaClub(BSAC) ConfédérationMondialedesActivitésSubaquatiques(CMAS) DivingScienceandTechnology(DSAT) FederazioneItalianaAttivitàSubacquee(FIAS) InternationalAssociationofNitroxandTechnicalDivers(IANTD) ProfessionalAssociationofDivingInstructors(PADI) ProfessionalDivingInstructorsCorporation(PDIC) TrimixScubaAssociation(TSA) TechnicalExtendedRange(TXR) Cavediving CaveDiversAssociationofAustralia(CDAA) CaveDivingGroup(CDG) GlobalUnderwaterExplorers(GUE) NationalAssociationforCaveDiving(NACD) NationalSpeleologicalSociety#CaveDivingGroup(CDG) NationalAssociationofUnderwaterInstructors(NAUI) TechnicalDivingInternational(TDI) Militarydivertrainingcentres DefenceDivingSchool NavyDivingSalvageandTrainingCenter UnderwaterEscapeTrainingUnit Militarydivertrainingcourses UnitedStatesMarineCorpsCombatantDiverCourse UnderwatersportsSurfacesnorkeling Finswimming Snorkeling/breath-hold Spearfishing Underwaterfootball Underwaterhockey Australia Turkey Underwaterrugby Colombia UnitedStates Underwatertargetshooting Breath-hold Aquathlon Apnoeafinswimming Freediving Underwatericehockey OpenCircuitScuba Immersionfinswimming Sportdiving Underwatercycling Underwaterorienteering Underwaterphotography Rebreather Underwaterphotography Sportsgoverningorganisationsandfederations International AIDAInternational ConfédérationMondialedesActivitésSubaquatiques) National AIDAHellas AustralianUnderwaterFederation BritishFreedivingAssociation BritishOctopushAssociation BritishUnderwaterSportsAssociation ComhairleFo-Thuinn FederaciónEspañoladeActividadesSubacuáticas FédérationFrançaised'ÉtudesetdeSportsSous-Marins SouthAfricanUnderwaterSportsFederation TürkiyeSualtıSporlarıFederasyonu UnderwaterSocietyofAmerica) Competitions 14thCMASUnderwaterPhotographyWorldChampionship UnderwaterdiversPioneersofdiving EduardAdmetllaiLázaro Aquanaut JamesF.Cahill 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Underwaterphotographers DougAllan TamaraBenitez GeorgesBeuchat AdrianBiddle JonathanBird EricCheng NevilleColeman JacquesCousteau JohnD.Craig BenCropp BernardDelemotte DavidDoubilet CandiceFarmer JohnChristopherFine DermotFitzGerald RodneyFox RicFrazier StephenFrink PeterGimbel MontyHalls HansHass HenryWayKendall RudieKuiter JosephB.MacInnis LuisMarden AgnesMilowka NoelMonkman PeteOxford SteveParish ZaleParry PierrePetit LeniRiefenstahl PeterScoones BrianSkerry WesleyC.Skiles E.LeeSpence PhilippeTailliez RonTaylor ValerieTaylor AlbertTillman JohnVeltri StanWaterman MicheleWestmorland JohnErnestWilliamson J.LamarWorzel Underwaterexplorers Caves GrahamBalcombe SheckExley MartynFarr JochenHasenmayer JillHeinerth JarrodJablonski WilliamHogarthMain TomMount JackSheppard BillStone Reefs ArthurC.Clarke Wrecks LeighBishop JohnChatterton CliveCussler BillNagle ValerievanHeest AristotelisZervoudis Aquanauts AndrewAbercromby JosephM.Acaba ClaytonAnderson RichardR.Arnold SerenaAuñón-Chancellor MichaelBarratt(astronaut) RobertA.Barth RobertL.Behnken RandolphBresnik TimothyJ.Broderick JustinBrown BerryL.Cannon ScottCarpenter GregoryChamitoff SteveChappell CatherineColeman RobinCook CraigB.Cooper FabienCousteau PhilippeCousteau TimothyCreamer JonathanDory PedroDuque SylviaEarle JeanetteEpps SheckExley AlbertFalco AndrewJ.Feustel MichaelFincke SatoshiFurukawa RonaldJ.GaranJr. MichaelL.Gernhardt ChristopherE.Gerty DavidGruber ChrisHadfield JeremyHansen JoséM.Hernández JohnHerrington PaulHill AkihikoHoshide MarkHulsbeck EmmaHwang NorishigeKanai LesKaufman ScottKelly KarenKohanowich TimothyKopra DominicLanducci JonLindbergh KjellN.Lindgren MichaelLópez-Alegría JosephB.MacInnis SandraMagnus ThomasMarshburn MatthiasMaurer K.MeganMcArthur CraigMcKinley JessicaMeir SimoneMelchior DorothyMetcalf-Lindenburger AndreasMogensen KarenNyberg JohnD.Olivas TakuyaOnishi LucaParmitano NicholasPatrick TimPeake ThomasPesquet MarcReagan GarrettReisman KathleenRubins DickRutkowski TaraRuttley DavidSaint-Jacques JosefSchmid RobertSheats DeweySmith SteveSquyres HeidemarieStefanyshyn-Piper RobertSténuit HervéStevenin NicoleStott JamesTalacek DanielM.Tani RobertThirsk BillTodd MarkT.VandeHei KoichiWakata RexJ.Walheim ShannonWalker JohnMorganWells JoachimWendler DouglasH.Wheelock PeggyWhitson DafyddWilliams JeffreyWilliams SunitaWilliams GregoryR.Wiseman KimiyaYui Writersandjournalists MichaelC.Barnette VictorBerge PhilippeDiolé GaryGentile BretGilliam BobHalstead TrevorJackson SteveLewis JohnMattera Rescuers CraigChallen RichardHarris RickStanton JohnVolanthen Frogmen LionelCrabb IanEdwardFraser SydneyKnowles JamesJosephMagennis Commercialsalvors KeithJessop ScienceofunderwaterdivingDivingphysics Breathingperformanceofregulators Buoyancy Archimedes'principle Neutralbuoyancy Concentration Diffusion Moleculardiffusion Force Oxygenfraction Permeation Psychrometricconstant Solubility Henry'slaw Saturation Solution Supersaturation Surfacetension Hydrophobe Surfactant Temperature 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Deep-submergencevehicle Aluminaut DSVAlvin AmericansubmarineNR-1 Bathyscaphe Archimède FNRS-2 FNRS-3 Harmonyclassbathyscaphe SeaPole-classbathyscaphe TriesteII DeepseaChallenger Ictineu3 JAGO Jiaolong Konsul-classsubmersible RussiansubmarineLosharik Mir Nautile Pisces-classdeepsubmergencevehicle DSVSeaCliff DSVShinkai DSVShinkai2000 DSVShinkai6500 DSVTurtle DSV-5Nemo Deep-submergencerescuevehicle LR5 LR7 MSM-1 Mystic-classdeep-submergencerescuevehicle DSRV-1Mystic DSRV-2Avalon NATOSubmarineRescueSystem Priz-classdeep-submergencerescuevehicle RussiandeepsubmergencerescuevehicleAS-28 RussiansubmarineAS-34 ASRVRemora SRV-300 SubmarineRescueDivingRecompressionSystem Type7103DSRV URF(SwedishNavy) Specialinterestgroups ArtificialReefSocietyofBritishColumbia CMASEurope CoralReefAlliance DivingEquipmentandMarketingAssociation DiversAlertNetwork GreenFins FingerLakesUnderwaterPreserveAssociation HistoricalDivingSociety KarstUnderwaterResearch NauticalArchaeologyProgram 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