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Hands Clean
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"Hands Clean"
Single by Alanis Morissette
from the album Under Rug Swept
B-side
"Fear of Bliss" "Sister Blister" "Awakening Americans" "Unprodigal Daughter" "Symptoms"
Released
8 January 2002 (2002-01-08) (United States)
Format
CD single
Recorded
2001
Length
4:31 (album version)
3:50 (radio edit)
Label
Maverick
Songwriter(s)
Alanis Morissette
Producer(s)
Alanis Morissette
Alanis Morissette singles chronology
"King Of Pain"
(2000) "Hands Clean"
(2002) "Precious Illusions"
(2002)
"Hands Clean" is a song recorded by Canadian singer-songwriter Alanis Morissette, for her fifth studio album, Under Rug Swept, which she released in 2002. It was written, composed, and produced by Morissette herself, and released as the album's lead single on 8 February 2002. It features a shuffling, largely acoustic-rock framework. Lyrically, "Hands Clean" caused controversy, since it is reportedly the singer’s recollection of a forbidden sexual relationship she shared with a much older man when she was approximately 14 years of age.
The song received generally positive reviews from music critics, some of whom immediately chose the track as an album standout compared to some of her previous material. "Hands Clean" did well through the charts. The song peaked at number 23 on the U.S. Billboard Hot 100. The song also peaked at number three on the U.S. Adult Top 40 and topped the charts in New Zealand (Morissette's first number one - and, to date, her last single to appear on the New Zealand charts) and Canada. An accompanying music video was released in 2002 for the single.
Contents
1 Background and release
2 Composition and lyrical content
3 Critical reception
4 Chart performance
5 Music video
5.1 Background and synopsis
5.2 Reception
6 Track listing
7 Official versions
8 Charts
8.1 End of year chart
9 References
10 External links
Background and release[edit]
After releasing Supposed Former Infatuation Junkie, the 1998 follow-up to her 1995 breakthrough album Jagged Little Pill, Alanis Morissette joined MTV for an unplugged album, released in 1999.[1] After that, Morissette stopped either writing or composing for a few months, before developing a new album, through 2000 and 2001.[2] According to Jennifer Vineyeard of MTV News, the album's topic is "love, sex, cruelty - with the added vantage of years spent growing up and getting over the man who vexed her so."[3] When Morissette wrote, composed, and produced Under Rug Swept, which she did all by herself, the singer claimed that she was inspired by many events in her life, such as the break up with her boyfriend, her contract's renegotiation with Maverick, among other issues.[2] I started writing alone, and within the first week I'd written seven songs. So it was all really fast and accelerated, and I think 'Hands Clean' was maybe the 10th song that I wrote and I just wrote it with a guitar in a room.[3] After writing 27 songs for the album,[4] "Hands Clean" was picked to be the first single of the album, being released on 8 February 2002.[5]
Composition and lyrical content[edit]
"Hands Clean," written, composed, and produced entirely by Alanis Morissette, features a shuffling, largely acoustic-rock framework[6] and a "pure-pop" hook.[4] It is written in the key of G major, with a moderate tempo of 96 beats per minute. The introduction follows the chord progression of C–D–G/B–C that repeats throughout the song except for the bridge that is Em-C-G-D two times. Morissette's vocal range spans from the low-note of G4 to the high-note of G6.[7] The narrative voice of the song alternates; the verses are written from the presumed viewpoint of the other person in a relationship, an older man talking to a younger lover ("If it weren't for your maturity none of this would have happened/If you weren't so wise beyond your years I would've been able to control myself" [...] "I know you depend on me like a young thing would to a guardian/I know you sexualize me like a young thing would and I think I like it"), whereas the chorus and bridge represent her own feelings ("We'll fast forward to a few years later/And no one knows except the both of us/And I have honored your request for silence/And you've washed your hands clean of this").[6][8]
Lyrically, "Hands Clean" explores a past relationship and how its effects linger.[6] Jon Pareles of Rolling Stone went farther, writing that the song is about "an apparently matter-of-fact reminiscence of underage sex with a music-business mentor, an affair 'under rug swept.'"[8] However, he commented that the song holds not a hint of Lolita guilt, forbidden passion, or resentment compared to her furious take on the same situation in "Right Through You" on Jagged Little Pill.[8] Website Jam! Music dug deeper, writing that it "tells the story of her attempts to come to grips with an intergenerational affair that started when she was as young as 14,"[9] a statement also made by other critics.[10] In an interview for Q Magazine, Morissette confessed, "The grudge I hold is against myself for having been quiet for so long [...] I've covered his ass for so many years. So now it's almost like ... I wanted to liberate myself from not beating myself up any longer. It's almost irrespective of his involvement now; it's more about me and my relationship with my own past."[9]
In a track-by-track commentary on her album, Morissette further commented about the track:
“
"My intention in writing this song was to get to a place where I could be as truthful and as honest as I possibly could be about certain relationships in my past. It's definitely not with the intention of seeking any sort of revenge for the person who is at the heart of the song that I'm singing about, but it was in my silencing myself to protect somebody else that I was ultimately completely abandoning myself. And any time I speak untruths in my life, and often-times I feel by not speaking the truth, by being silent, there's an element of an untruth in that. Withholding the truth sometimes can feel just as horrible as a lie to me. So as I get older, I think I want more and more to introduce the bliss of speaking transparently and truthfully and as honestly as I possibly can, knowing that the truth in this case is my truth only."[11]
”
Critical reception[edit]
While choosing the song as a highlight from Under Rug Swept, Stephen Thomas Erlewine of Allmusic compared its lyrics to her earlier hit "You Oughta Know," also noting that "this would all seem calculated, an attempt to regain her chart status, if Morissette wasn't so unabashedly earnest, seemingly unembarrassed by her confessions."[12] Stephen Thompson from The A.V. Club praised the track for being "a breezy new single" and "infectious enough to surpass the direst moment of 'Under Rug Swept.'"[13] David Browne of Entertainment Weekly wrote that the song "could even be seen as a sequel to 'You Oughta Know,'"[14] while Nikki Tranter of Popmatters compared the lyrical content on the song to her previous songs "Plastic" and "Jealous," from her first album, Alanis.[15] Larry Flick of Billboard Magazine noted that the track show[s] Morissette proudly wearing her affection for concise, pure-pop hooks,"[4] while Mark Blake of Q called it "one of the album's peaks."[16] Kitty Empire of NME wrote a mixed review to the track, although calling it "a tolerable enough tune, mind, for those who think their chocolate craving says something poignant about their inner selves."[17]
Chart performance[edit]
"Hands Clean" was a commercial success in many territories, reaching the top-ten in over six countries, while also reaching the top-twenty in seven others. In the United States, the song debuted at number 65 on the week of 8 February 2002,[18] moving to number 49 the following week.[18] The song cracked the top-forty in its third week, climbing to number 39[citation needed] and peaked five weeks later at number 23,[19] due to an increase in radio play.[20] In other Billboard component charts, the song managed to reach number 19 on the Mainstream Top 40 and number 3 on the Adult Top 40. In Canada, "Hands Clean" became her sixth number-one single.[21] In the United Kingdom, the song managed to debut at number twelve, becoming her highest since "Thank U" (1998) as well as her last top-twenty single on the UK charts.[22]
In Australia, "Hands Clean" debuted and peaked at number 9, on 8 February 2002. It became her highest charting single there since "Ironic" in 1996, and her last to reach the top ten.[23] In New Zealand, the song experienced more success, debuting at number 48, but peaking at number one ten weeks later. It became Morissette's most successful single and first number-one hit,[24] while also receiving gold certification by the Recording Industry Association of New Zealand (RIANZ). The song also experienced commercial success in some European countries, such as Italy, where it reached number 3,[25] Norway, peaking at number 7,[26] and Switzerland, reaching number 5.[27]
Music video[edit]
Background and synopsis[edit]
Francis Lawrence directed the music video for "Hands Clean." It was televised and broadcast for the single's worldwide release.
The video begins with Alanis sitting in a sushi bar when she spies a man (played by Chris Sarandon) as he enters. She has a flashback to a time when she spurned his unwanted advances, and it had an effect on her. We see Alanis's memories played out on a television screen, and so the process begins, recorded for public viewing and re-viewing. We see her writing about the relationship, guitar in hand, creating a song which she then records and takes to a record producer (played by Ian Gomez), who presses it as a CD. She is soon posing for the CD sleeve photograph and shooting a video, which is played all over the world, just as the CD is being flown across oceans, in order to be put on display at hip record stores, where it is snapped up by many eager hands, including a girl in a beanie (played by Masiela Lusha). At the video's conclusion, set a year after its beginning, Morissette again sees her former suitor enter the same sushi bar. Through her song, and the process of it becoming a hit and then a memory, she has come to terms with her past relationship. On seeing this person who had a profound effect on her this second time, she is able to move on: before departing the restaurant, she picks up a napkin and wipes her hands clean.
Reception[edit]
The video was generally praised for being short and simple. It has received 9.5 million views on YouTube by May 2017.[28]
Track listing[edit]
Australian CD 1 / UK CD 1
(242432)
"Hands Clean" (album version) – 4:29
"Fear of Bliss" (non-LP track) – 4:36
"Sister Blister" (non-LP track) – 4:10
Australian CD 2 / EU maxi-single
(42433)
"Hands Clean" – 4:29
"Awakening Americans" – 4:25
"Unprodigal Daughter" – 4:09
"Symptoms" – 4:15
UK CD 2
"Hands Clean" – 4:29
"Unprodigal Daughter" – 4:09
"Symptoms" – 4:15
US CD single
(574CD2)
"Hands Clean" – 4:29
"Awakening Americans" – 4:25
"Symptoms" – 4:15
Official versions[edit]
"Hands Clean" (album version) – 4:29
"Hands Clean" (acoustic version) – 4:08
"Hands Clean" (radio edit) – 3:50
"Hands Clean" (sound check)
The album version has a repeat of the chorus before an instrumental solo plays until the end, while the radio edit only plays the chorus once at the end before the instrumental solo.
Charts[edit]
Chart (2002)
Peak
position
Australia (ARIA)[23] 9
Austria (Ö3 Austria Top 40)[29] 12
Belgium (Ultratop 50 Flanders)[30] 40
Belgium (Ultratop 50 Wallonia)[31] 38
Brazil (ABPD)[32] 5
Canada (Nielsen SoundScan)[21] 1
Europe (Eurochart Hot 100) 19
France (SNEP)[33] 66
Germany (Media Control)[34] 18
Ireland (IRMA)[35] 13
Italy (FIMI)[25] 3
Netherlands (MegaCharts)[36] 15
New Zealand (RIANZ)[24] 1
Norway (VG-Lista)[26] 7
Portugal (Portuguese Singles Chart)[37] 4
Romania (Airplay Top 100)[38] 99
Scotland (Official Chart Company)[22] 9
Spain (AFYVE)[39] 14
Sweden (Sverigetopplistan)[40] 32
Switzerland (Hitparade)[27] 5
UK Singles (Official Chart Company)[22] 12
US Billboard Hot 100[21] 23
US Billboard Mainstream Top 40[21] 19
US Billboard Adult Top 40[21] 3
End of year chart[edit]
End of year chart (2002)
Position
U.S. Billboard Hot 100[41] 95
References[edit]
Jump up ^ "Alanis Morissette | Biography | Allmusic". Allmusic. Retrieved 30 July 2014.
^ Jump up to: a b Sullivan, Kate (March 2002). "Well-Rounded Little Pill". Spin. SPIN Media LLC. 18 (3): 88. ISSN 0886-3032. Retrieved July 30, 2014.
^ Jump up to: a b Vineyeard, Jennifer. "Alanis Morissette: The Silence is Over". MTV News. Archived from the original on 9 August 2014. Retrieved 30 July 2014.
^ Jump up to: a b c "Alanis Excels On Her Own". Billboard. February 8, 2002. Retrieved 31 July 2014.
Jump up ^ "Hands Clean - Alanis Morissette | Allmusic". Allmusic. Retrieved 31 July 2014.
^ Jump up to: a b c "'Under Rug Swept:' A Track Listing". Billboard. Nielsen Business Media, Inc. 114 (3): 89. 8 February 2002. ISSN 0006-2510. Retrieved 24 August 2014.
Jump up ^ "Alanis Morissette "Hands Clean" Guitar Tab - Download & Print". MusicNotes.com. Retrieved 24 August 2014.
^ Jump up to: a b c Pareles, Jon (8 February 2002). "Alanis Morissette: Under Rug Swept: Music Reviews: Rolling Stone". Rolling Stone. RealNetworks, Inc. Archived from the original on 2 May 2009. Retrieved 24 August 2014.
^ Jump up to: a b "Alanis comes clean on teen affair". Jam! Canoe. 7 December 2004. Retrieved 24 August 2014.
Jump up ^ "Alanis Morissette - Under Rug Swept - Plugged In". Plugged In. Archived from the original on 26 August 2014. Retrieved 24 August 2014.
Jump up ^ "Alanis Morissette talks about songs from 'UNDER RUG SWEPT'". MSO. Archived from the original on 24 January 2009. Retrieved 24 August 2014.
Jump up ^ Erlewine, Stephen Thomas (8 February 2002). "Under Rug Swept - Alanis Morissette | Allmusic". Allmusic. Retrieved 24 August 2014.
Jump up ^ Thompson, Stephen (8 February 2002). "Alanis Morissette: Under Rug Swept: Music Review: The A.V. Club". The A.V. Club. Retrieved 24 August 2014.
Jump up ^ Browne, David (8 February 2002). "Under Rug Swept | Music Reviews and News | EW.com". Entertainment Weekly. Retrieved 24 August 2014.
Jump up ^ Tranter, Nikki (14 May 2002). "Alanis Morissette: Under Rug Swept: PopMatters". PopMatters. PopMatters Media, Inc. Retrieved 24 August 2014.
Jump up ^ Blake, Mark. "Q4music.com - Alanis Morissette: Under Rug Swept". Q. Archived from the original on 1 November 2004. Retrieved 24 August 2014.
Jump up ^ Empire, Kitty (12 September 2005). "NME Reviews - Morissette, Alanis : Hands Clean | NME.COM". NME. Retrieved 24 August 2014.
^ Jump up to: a b "Billboard Hot 100". Billboard. Nielsen Business Media, Inc. 114 (6): 67. 8 February 2002. ISSN 0006-2510. Retrieved 24 August 2014.
Jump up ^ "Billboard Hot 100". Billboard. Nielsen Business Media, Inc. 114 (12): 75. 23 March 2002. ISSN 0006-2510. Retrieved 24 August 2014.
Jump up ^ "Grammy Surge Pushes 'O Brother' To The Top". Billboard. 14 March 2002. Retrieved 24 August 2014.
^ Jump up to: a b c d e "Alanis Morissette: Awards - AllMusic". Allmusic. Rovi Corporation. Retrieved 2012-08-20.
^ Jump up to: a b c "Alanis Morissette UK chart history". Official Charts Company. Retrieved 2012-08-20.
^ Jump up to: a b "Alanis Morissette - Hands Clean". Australian Recording Industry Association. Hung Medien. Retrieved 2012-08-21.
^ Jump up to: a b "Alanis Morissette - Hands Clean". Recording Industry Association of New Zealand. Hung Medien. Retrieved 2012-08-21.
^ Jump up to: a b "Alanis Morissette - Hands Clean". Federation of the Italian Music Industry. Hung Medien. Retrieved 2012-08-21.
^ Jump up to: a b "Alanis Morissette - Hands Clean". Verdens Gang. Hung Medien. Retrieved 2012-08-21.
^ Jump up to: a b "Alanis Morissette - Hands Clean". Media Control. Hung Medien. Retrieved 2012-08-21.
Jump up ^ https://www.youtube.com/watch?v=2dH289KxkGw
Jump up ^ "Alanis Morissette - Hands Clean" (in German). IFPI Austria. Hung Medien. Retrieved 2012-08-21.
Jump up ^ "Alanis Morissette - Hands Clean" (in Dutch). Ultratop. Hung Medien. Retrieved 2012-08-21.
Jump up ^ "Alanis Morissette - Hands Clean" (in French). Ultratop. Hung Medien. Retrieved 2012-08-21.
Jump up ^ "Brazil" (PDF). ABPD. October 6, 2001. Retrieved April 1, 2014.
Jump up ^ "Alanis Morissette - Hands Clean" (in French). Syndicat National de l'Édition Phonographique. Hung Medien. Retrieved 2012-08-21.
Jump up ^ "Alanis Morissette German Charts" (in German). Media Control. musicline.de. Retrieved 2012-08-21.
Jump up ^ "Top 50 Singles, Week Ending 23 February 2002". Irish Recorded Music Association. Chart-Track. Retrieved 2012-08-21.
Jump up ^ "Alanis Morissette - Hands Clean" (in Dutch). MegaCharts. Hung Medien. Retrieved 2012-08-21.
Jump up ^ "Top40-charts.com". Retrieved November 24, 2015.
Jump up ^ "Archiva Romanian Top 100". Archived from the original on 17 December 2004. Retrieved 2012-08-21.
Jump up ^ Salaverri, Fernando (September 2005). Sólo éxitos: año a año, 1959–2002 (1st ed.). Spain: Fundación Autor-SGAE. ISBN 8480486392.
Jump up ^ "Alanis Morissette - Hands Clean". Swedish Recording Industry Association. Hung Medien. Retrieved 2012-08-21.
Jump up ^ "Billboard Top 100 - 2002". Archived from the original on 7 January 2014. Retrieved 2013-11-15.
External links[edit]
Plugged in Online
Lyrics of this song at MetroLyrics
show
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Alanis Morissette
Awards and nominations
Discography
Songs
Studio albums
Alanis
Now Is the Time
Jagged Little Pill
Supposed Former Infatuation Junkie
Under Rug Swept
So-Called Chaos
Jagged Little Pill Acoustic
Flavors of Entanglement
Havoc and Bright Lights
Compilation albums
Feast on Scraps
iTunes Originals
The Collection
Other releases
Space Cakes
The Singles Box
The Prayer Cycle
Live releases
Jagged Little Pill, Live
MTV Unplugged
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Concert tours
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Junkie Tour
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One Tour
So-Called Chaos Tour
Au Naturale Tour
Diamond Wink Tour
Flavors of Entanglement Tour
Guardian Angel Tour
Intimate and Acoustic
Musicals
Jagged Little Pill
Related articles
Wade Morissette (brother)
Book:Alanis Morissette
show
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t
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Alanis Morissette songs
Discography
Alanis
"Feel Your Love"
"Too Hot"
"Walk Away"
Now Is the Time
"An Emotion Away"
"No Apologies"
Jagged Little Pill
"All I Really Want"
"You Oughta Know"
"Hand in My Pocket"
"You Learn"
"Head over Feet"
"Ironic"
Supposed Former Infatuation Junkie
"Thank U"
"That I Would Be Good"
"Unsent"
"So Pure"
"Joining You"
MTV Unplugged
"King of Pain"
Under Rug Swept
"21 Things I Want in a Lover"
"Hands Clean"
"Flinch"
"So Unsexy"
"Precious Illusions"
"Surrendering"
"Utopia"
So-Called Chaos
"Eight Easy Steps"
"Out Is Through"
"Everything"
The Collection
"Crazy"
Flavors of Entanglement
"Underneath"
"Not as We"
"In Praise of the Vulnerable Man"
Havoc and Bright Lights
"Guardian"
"Lens"
"Receive"
Soundtrack songs
"Uninvited"
"Wunderkind"
Other songs
"My Humps"
Retrieved from "https://en.wikipedia.org/w/index.php?title=Hands_Clean&oldid=865227666"
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Barotrauma
From Wikipedia, the free encyclopedia
Jump to: navigation, search
injury caused by pressure
Barotrauma
Synonyms
Squeeze, Decompression illness, Lung overpressure injury
Mild barotrauma to a diver caused by mask squeeze
Classification and external resources
Specialty
emergency medicine, occupational medicine, hyperbaric medicine
ICD-10
T70.0, T70.1
ICD-9-CM
993.0, 993.1
DiseasesDB
3491
eMedicine
emerg/53
MeSH
D001469
[edit on Wikidata]
Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with the body, and the surrounding gas or fluid.[1][2] The initial damage is usually due to over-stretching the tissues in tension or shear, either directly by expansion of the gas in the closed space, or by pressure difference hydrostatically transmitted through the tissue. Tissue rupture may be complicated by the introduction of gas into the local tissue or circulation through the initial trauma site, which can cause blockage of circulation at distant sites, or interfere with normal function of an organ by its presence.
Barotrauma generally manifests as sinus or middle ear effects, decompression sickness (DCS), lung overpressure injuries, and injuries resulting from external squeezes.
Barotrauma typically occurs when the organism is exposed to a significant change in ambient pressure, such as when a scuba diver, a free-diver or an airplane passenger ascends or descends, or during uncontrolled decompression of a pressure vessel such as a diving chamber or pressurised aircraft, but can also be caused by a shock wave. Ventilator induced lung injury (VILI) is a condition caused by over-expansion of the lungs by mechanical ventilation used when the body is unable to breathe for itself, and is associated with relatively large tidal volumes and relatively high peak pressures. Barotrauma due to over-expansion of an internal gas filled space may also be termed volutrauma. Bats can be killed by lung barotrauma when flying in low pressure regions close to operating wind turbine blades.[3]
Contents
[hide]
1 Presentation
2 Causes
2.1 Pressure differences while diving
2.2 Blast-induced barotrauma
2.3 Ventilator-induced barotrauma
2.4 Use of a hyperbaric chamber.
3 Diagnosis
3.1 Ear barotrauma
3.2 Barosinusitis
3.3 Mask squeeze
3.4 Helmet squeeze
3.5 Pulmonary barotrauma
4 Prevention
4.1 In divers
4.1.1 Medical screening
4.1.2 Training
4.2 In mechanical ventilation
5 Treatment
5.1 First aid
5.2 Emergency treatment
5.3 Medication
5.4 Outcomes
6 Barotrauma in animals
6.1 Swim bladder overexpansion
7 See also
8 References
Presentation[edit]
Examples of organs or tissues easily damaged by barotrauma are:
Middle ear (barotitis or aerotitis)[1][2][4][5][6][7]
Paranasal sinuses[1][2][5] (causing Aerosinusitis)
Lungs[1][2][8][9]
Eyes[1][2] (the under-pressure air space is inside the diving mask[10])
Skin[1][2] (when wearing a diving suit which creates an air space)
Brain and cranium (temporal lobe injury secondary to temporal bone rupture)[11]
Teeth (causing Barodontalgia, i.e. barometric pressure related dental pain,[12][13][14][15][16] or dental fractures[17][18][19])
Genital (squeeze and associated complications of P-valve use)[20]
Causes[edit]
Pressure differences while diving[edit]
When diving, the pressure differences which cause the barotrauma are changes in hydrostatic pressure: There are two components to the surrounding pressure acting on the diver: the atmospheric pressure and the water pressure. A descent of 10 metres (33 feet) in water increases the ambient pressure by an amount approximately equal to the pressure of the atmosphere at sea level. So, a descent from the surface to 10 metres (33 feet) underwater results in a doubling of the pressure on the diver. This pressure change will reduce the volume of a gas filled space by half. Boyle's law describes the relationship between the volume of the gas space and the pressure in the gas.[1][21]
Barotraumas of descent are caused by preventing the free change of volume of the gas in a closed space in contact with the diver, resulting in a pressure difference between the tissues and the gas space, and the unbalanced force due to this pressure difference causes deformation of the tissues resulting in cell rupture.[2]
Barotraumas of ascent are also caused when the free change of volume of the gas in a closed space in contact with the diver is prevented. In this case the pressure difference causes a resultant tension in the surrounding tissues which exceeds their tensile strength. Besides tissue rupture, the overpressure may cause ingress of gases into the tissues and further afield through the circulatory system.[2] This pulmonary barotrauma (PBt) of ascent is also known as pulmonary over-inflation syndrome (POIS), lung over-pressure injury (LOP) and burst lung.[21] Consequent injuries may include arterial gas embolism, pneumothorax, mediastinal, interstitial and subcutaneous emphysemas, not usually all at the same time.
Breathing gas at depth from underwater breathing apparatus results in the lungs containing gas at a higher pressure than atmospheric pressure. So a free-diver can dive to 10 metres (33 feet) and safely ascend without exhaling, because the gas in the lungs had been inhaled at atmospheric pressure, whereas a diver who inhales at 10 metres and ascends without exhaling has lungs containing twice the amount of gas at atmospheric pressure and is very likely to suffer life-threatening lung damage.[2][21]
Explosive decompression of a hyperbaric environment can produce severe barotrauma, followed by severe decompression bubble formation and other related injury. The Byford Dolphin incident is an example.
Blast-induced barotrauma[edit]
An explosive blast and explosive decompression create a pressure wave that can induce barotrauma. The difference in pressure between internal organs and the outer surface of the body causes injuries to internal organs that contain gas, such as the lungs, gastrointestinal tract, and ear.[22]
Lung injuries can also occur during rapid decompression, although the risk of injury is lower than with explosive decompression.[23][24]
Ventilator-induced barotrauma[edit]
See also: Biotrauma
Mechanical ventilation can lead to barotrauma of the lungs. This can be due to either:[25]
absolute pressures used in order to ventilate non-compliant lungs.
shearing forces, particularly associated with rapid changes in gas velocity.
The resultant alveolar rupture can lead to pneumothorax, pulmonary interstitial emphysema (PIE) and pneumomediastinum.[26]
Barotrauma is a recognised complication of mechanical ventilation that can occur in any patient receiving mechanical ventilation, but is most commonly associated with acute respiratory distress syndrome. It used to be the most common complication of mechanical ventilation but can usually be avoided by limiting tidal volume and plateau pressure to less than 30 to 50 cm water column (30 to 50 mb). As an indicator of transalveolar pressure, which predicts alveolar distention, plateau pressure or peak airway pressure (PAP) may be the most effective predictor of risk, but there is no generally accepted safe pressure at which there is no risk.[26][27] Risk also appears to be increased by aspiration of stomach contents and pre-existing disease such as necrotising pneumonia and chronic lung disease. Status asthmaticus is a particular problem as it requires relatively high pressures to overcome bronchial obstruction.[27]
When lung tissues are damaged by alveolar over-distension, the injury may be termed volutrauma, but volume and transpulmonary pressure are closely related. Ventilator induced lung injury is often associated with high tidal volumes (Vt).[28]
Use of a hyperbaric chamber.[edit]
Patients undergoing hyperbaric oxygen therapy must equalize their ears to avoid barotrauma. High risk of otic barotrauma is associated with unconscious patients.[29]
Diagnosis[edit]
Blood gas analyser
In terms of barotrauma the diagnostic workup for the affected individual would include the following:
Laboratory:[30]
Creatine kinase (CPK) level: Increases in CPK levels indicate tissue damage associated with decompression sickness.
Complete blood count (CBC)
Arterial blood gas (ABG) determination
Imaging:[30]
Chest radiography can show pneumothorax, and is indicated if there is chest discomfort or breathing difficulty
Computed tomography (CT) scans and magnetic resonance imaging (MRI) may be indicated when there is severe headache or severe back pain after diving.
CT is the most sensitive method to evaluate for pneumothorax. It can be used where barotrauma-related pneumothorax is suspected and chest radiograph findings are negative.
Echocardiography can be used to detect the number and size of gas bubbles in the right side of the heart.
Ear barotrauma[edit]
Barotrauma can affect the external, middle, or inner ear. Middle ear barotrauma (MEBT) is the most common being experienced by between 10% and 30% of divers and is due to insufficient equilibration of the middle ear. External ear barotrauma may occur on ascent if high pressure air is trapped in the external auditory canal either by tight fitting diving equipment or ear wax. Inner ear barotrauma (IEBT), though much less common than MEBT, shares a similar mechanism. Mechanical trauma to the inner ear can lead to varying degrees of conductive and sensorineural hearing loss as well as vertigo. It is also common for conditions affecting the inner ear to result in auditory hypersensitivity.[31]
Barosinusitis[edit]
The sinuses similar to other air-filled cavities are susceptible to barotrauma if their openings become obstructed. This can result in pain as well as epistaxis (nosebleed).[32]
Mask squeeze[edit]
If a diver's mask is not equalized during descent the relative negative pressure can produce petechial hemorrhages in the area covered by the mask along with subconjunctival hemorrhages.[32]
Helmet squeeze[edit]
A problem mostly of historical interest, but still relevant to surface supplied divers who dive with the helmet sealed to the dry suit. If the air supply hose is ruptured near or above the surface, the pressure difference between the water around the diver and the air in the hose can be several bar. The non-return valve at the connection to the helmet will prevent backflow if it is working correctly, but if absent, as in the early days of helmet diving, or if it fails, the pressure difference will tend to squeeze the diver into the rigid helmet, which can result in severe trauma. The same effect can result from a large and rapid increase in depth if the air supply is insufficient to keep up with the increase in ambient pressure.[33]
Pulmonary barotrauma[edit]
Further information: List of signs and symptoms of diving disorders § Arterial gas embolism and pulmonary barotrauma
Lung over-pressure injury in ambient pressure divers using underwater breathing apparatus is usually caused by breath-holding on ascent. The compressed gas in the lungs expands as the ambient pressure decreases causing the lungs to over-expand and rupture unless the diver allows the gas to escape by maintaining an open airway, as in normal breathing. The lungs do not sense pain when over-expanded giving the diver little warning to prevent the injury. This does not affect breath-hold divers as they bring a lungful of air with them from the surface, which merely re-expands safely to near its original volume on ascent.[2] The problem only arises if a breath of ambient pressure gas is taken at depth, which may then expand on ascent to more than the lung volume. Pulmonary barotrauma may also be caused by explosive decompression of a pressurised aircraft.[34]
Prevention[edit]
In divers[edit]
Barotrauma may be caused when diving, either from being crushed, or squeezed, on descent or by stretching and bursting on ascent; both can be avoided by equalising the pressures. A negative, unbalanced pressure is known as a squeeze, crushing eardrums, dry suit, lungs or mask inwards and can be equalised by putting air into the squeezed space. A positive unbalanced pressure expands internal spaces rupturing tissue and can be equalised by letting air out, for example by exhaling. Both may cause barotrauma. There are a variety of techniques depending on the affected area and whether the pressure inequality is a squeeze or an expansion:
Ears and sinuses: There is a risk of stretched or burst eardrums, usually crushed inwards during descent but sometimes stretched outwards on ascent. The diver can use a variety of methods to let air into or out of the middle ears via the Eustachian tubes. Sometimes swallowing will open the Eustachian tubes and equalise the ears.[35]
Lungs: There is a risk pneumothorax, arterial gas embolism, and mediastinal and subcutanous emphysemas during ascent, which are commonly called burst lung or lung overpressure injury by divers. To equalise the lungs, all that is necessary is not to hold the breath during ascent. This risk does not occur when breath-hold diving from the surface, unless the diver breathes from an ambient pressure gas source underwater; breath-hold divers do suffer squeezed lungs on descent, crushing in the chest cavity, but, while uncomfortable, this rarely causes lung injury and returns to normal at the surface. Some people have pathologies of the lung which prevent rapid flow of excess air through the passages, which can lead to lung barotrauma even if the breath is not held during rapid depressurisation. These people should not dive as the risk is unacceptably high. Most commercial or military diving medical examinations will look specifically for signs of this pathology.[36]
Diving mask squeeze enclosing the eyes and nose: The main risk is rupture of the capillaries of the eyes and facial skin because of the negative pressure difference between the gas space and blood pressure,[10] or orbital emphysema from higher pressures.[37][clarification needed] This can be avoided by breathing air into the mask through the nose. Goggles covering only the eyes are not suitable for deep diving as they cannot be equalised.
Dry suit squeeze. The main risk is skin getting pinched and bruised by folds of the dry suit when squeezed on descent. Most dry suits can be equalised against squeeze via a manually operated valve fed from a low pressure gas supply. Air must be manually injected during the descent to avoid squeeze and is manually or automatically vented on the ascent to maintain buoyancy control.[38]
Diving helmet squeeze: Helmet squeeze will occur if the gas supply hose is severed above the diver and the non-return valve at the helmet gas inlet fails or is not fitted. Severity will depend on the hydrostatic pressure difference.[39] A very rapid descent, usually by accident, may exceed the rate at which the breathing gas supply can equalise the pressure causing a temporary squeeze. The introduction of the non-return valve and high maximum gas supply flow rates have all but eliminated both these risks. In helmets fitted with a neck dam, the dam will admit water into the helmet if the internal pressure gets too low; this is less of a problem than helmet squeeze but the diver may drown if the gas supply is not reinstated quickly.[33]:90 This form of barotrauma is avoidable by controlled descent rate, which is standard practice for commercial divers, who will use shotlines, diving stages and wet bells to control descent and ascent rates.
Medical screening[edit]
Main article: Fitness to dive
Professional divers are screened for risk factors during initial and periodical medical examination for fitness to dive.[40] In most cases recreational divers are not medically screened, but are required to provide a medical statement before acceptance for training in which the most common and easy to identify risk factors must be declared. If these factors are declared, the diver may be required to be examined by a medical practitioner, and may be disqualified from diving if the conditions indicate.[41]
Asthma, Marfan syndrome, and COPD pose a very high risk of pneumothorax.[clarification needed] In some countries these may be considered absolute contraindications, while in others the severity may be taken into consideration. Asthmatics with a mild and well controlled condition may be permitted to dive under restricted circumstances.[42]
Training[edit]
See also: Recreational diver training, Scuba skills, and Surface supplied diving skills
A significant part of entry level diver training is focused on understanding the risks and procedural avoidance of barotrauma.[43] Professional divers and recreational divers with rescue training are trained in the basic skills of recognizing and first aid management of diving barotrauma.[44][45]
In mechanical ventilation[edit]
Isolated mechanical forces may not adequately explain ventilator induced lung injury (VILI). The damage is affected by the interaction of these forces and the pre-existing state of the lung tissues, and dynamic changes in alveolar structure may be involved. Factors such as plateau pressure and positive end-expiratory pressure (PEEP) alone do not adequately predict injury. Cyclic deformation of lung tissue may play a large part in the cause of VILI, and contributory factors probably include tidal volume, positive end-expiratory pressure and respiratory rate. There is no protocol guaranteed to avoid all risk in all applications.[28]
Treatment[edit]
Treatment of diving barotrauma depends on the symptoms. Lung over-pressure injury may require a chest drain to remove air from the pleura or mediastinum. Recompression with hyperbaric oxygen therapy is the definitive treatment for arterial gas embolism, as the raised pressure reduces bubble size, low inert gas partial pressure accelerates inert gas solution and high oxygen partial pressure helps oxygenate tissues compromised by the emboli. Care must be taken when recompressing to avoid a tension pneumothorax.[46] Barotraumas that do not involve gas in the tissues are generally treated according to severity and symptoms for similar trauma from other causes.
First aid[edit]
Pre-hospital care for lung barotrauma includes basic life support of maintaining adequate oxygenation and perfusion, assessment of airway, breathing and circulation, neurological assessment, and managing any immediate life-threatening conditions. High-flow oxygen up to 100% is considered appropriate for diving accidents. Large-bore venous access with isotonic fluid infusion is recommended to maintain blood pressure and pulse.[47]
Emergency treatment[edit]
Pulmonary barotrauma:[48]
Endotracheal intubation may be required if the airway is unstable or hypoxia persists when breathing 100% oxygen.
Needle decompression or tube thoracostomy may be necessary to drain a pneumothorax or haemothorax
Foley catheterization may be necessary for spinal cord AGE if the person is unable to urinate.
Intravenous hydration may be required to maintain adequate blood pressure.
Therapeutic recompression is indicated for severe AGE. The diving medical practitioner will need to know the vital signs and relevant symptoms, along with the recent pressure exposure and breathing gas history of the patient. Air transport should be below 1,000 feet (300 m) if possible, or in a pressurized aircraft which should be pressurised to as low an altitude as reaonably possible.
Sinus squeeze and middle ear squeeze are generally treated with decongestants to reduce the pressure differential, with anti-inflammatory medications to treat the pain. For severe pain, narcotic analgesics may be appropriate.[48]
Suit, helmet and mask squeeze are treated as trauma according to symptoms and severity.
Medication[edit]
The primary medications for lung barotrauma are oxygen, oxygen-helium or nitrox, isotonic fluids, anti-inflammatory medications, decongestants, and analgesics.[49]
Outcomes[edit]
Following barotrauma of the ears or lungs from diving the diver should not dive again until cleared by a diving doctor. After ear injury examination will include a hearing test and a demonstration that the middle ear can be autoinflated. Recovery can take weeks to months.[50]
Barotrauma in animals[edit]
Whales and dolphins suffer severely disabling barotrauma when exposed to excessive pressure changes induced by navy sonar, oil industry airguns, explosives, undersea earthquakes and volcanic eruptions.[citation needed]
Injury and mortality of fish, marine mammals, including sea otters, seals, dolphins and whales, and birds by underwater explosions has been recorded in several studies.[51] Bats can suffer fatal barotrauma in the low pressure zones behind the blades of wind turbines due to their more fragile mammalian lung structure in comparison with the more robust Avian lungs, which are less affected by pressure change.[52][53]
Swim bladder overexpansion[edit]
Barotrauma injury to tiger angelfish - head end. note distended swim bladder and gas space in abdominal cavity
Barotrauma injury to tiger angelfish - tail end
Fish with isolated swim bladders are susceptible to barotrauma of ascent when brought to the surface by fishing. The swim bladder is an organ of buoyancy control which is filled with gas extracted from solution in the blood, and which is normally removed by the reverse process. If the fish is brought upwards in the water column faster than the gas can be resorbed, the gas will expand until the bladder is stretched to its elastic limit, and may rupture. Barotrauma can be directly fatal or disable the fish rendering it vulnerable to predation, but rockfish are able to recover if they are returned to depths similar to those they were pulled up from, shortly after surfacing. Scientists at NOAA developed the Seaqualizer to quickly return rockfish to depth.[54] The device could increase survival in caught-and-released rockfish.
See also[edit]
Underwater diving portal
Alternobaric vertigo
Barodontalgia
Dental barotrauma
Diving hazards and precautions
Dysbarism
Jet ventilation
Meteoropathy
Uncontrolled decompression
Rheotrauma
Atelectotrauma
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Jump up ^ Joint Medical Subcommittee of ECHM and EDTC (24 June 2003). Wendling, Jürg; Elliott, David; Nome, Tor, eds. Fitness to Dive Standards - Guidelines for Medical Assessment of Working Divers (PDF). pftdstandards edtc rev6.doc (Report). European Diving Technology Committee. Retrieved 18 May 2017. CS1 maint: Uses authors parameter (link)
Jump up ^ Richardson, Drew. "The RSTC Medical statement and candidate screening model". South Pacific Underwater Medicine Society (SPUMS) Journal Volume 30 No.4 December 2000. South Pacific Underwater Medicine Society. pp. 210–213. Retrieved 26 January 2013.
Jump up ^ Adir, Yochai; Bove, Alfred A. (2016). Yochai Adir and Alfred A. Bove, eds. "Can asthmatic subjects dive?" (PDF). Number 1 in the Series "Sports-related lung disease". European Respiratory Review. pp. 214–220. doi:10.1183/16000617.0006-2016. Retrieved 10 June 2016. CS1 maint: Uses editors parameter (link)
Jump up ^ Staff (1 October 2004). "Minimum course standard for Open Water Diver training" (PDF). World Recreational Scuba Training Council. pp. 8–9. Retrieved 16 January 2017.
Jump up ^ "Diving Regulations 2009". Occupational Health and Safety Act 85 of 1993 – Regulations and Notices – Government Notice R41. Pretoria: Government Printer. Archived from the original on 4 November 2016. Retrieved 3 November 2016 – via Southern African Legal Information Institute.
Jump up ^ Staff (29 October 2009). "International Diver Training Certification: Diver Training Standards, Revision 4" (PDF). Diver Training Standards. Malestroit, Brittany: International Diving Schools Association. Retrieved 6 November 2016.
Jump up ^ Stephenson, Jeffrey. "Pathophysiology, treatment and aeromedical retrieval of SCUBA – related DCI". Journal of Military and Veterans' Health. 17 (3). ISSN 1835-1271. Retrieved 13 January 2017.
Jump up ^ Kaplan, Joseph. Alcock, Joe, ed. "Barotrauma Treatment & Management". emedicine.medscape.com. Retrieved 15 January 2017.
^ Jump up to: a b Kaplan, Joseph. Alcock, Joe, ed. "Barotrauma Treatment & Management: Emergency Department Care". emedicine.medscape.com. Retrieved 15 January 2017.
Jump up ^ Kaplan, Joseph. Alcock, Joe, ed. "Barotrauma Medication". emedicine.medscape.com. Retrieved 15 January 2017.
Jump up ^ Bentz, Brandon G.; Hughes, C. Anthony (October 2012). "Barotrauma". Hearing and balance disorders. American Hearing Research Foundation. Retrieved 16 January 2017.
Jump up ^ Danil, K; St.Leger, J.A. (2011). "Seabird and Dolphin Mortality Associated with Underwater Detonation Exercises" (PDF). Marine Technology Society Journal. 45 (6): 89–95.
Jump up ^ "Wind farms cause thousands of bats to die from trauma". The Times. 26 August 2008. |access-date= requires |url= (help)
Jump up ^ staff (26 August 2008). "Why Wind Turbines Can Mean Death For Bats". Science news. Science Daily. Retrieved 13 January 2017.
Jump up ^ Tripp, Emily. "Saving Rockfish Stocks One Recompression at a Time". Marine Science Today. Retrieved 29 August 2015.
[show]
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Sussex Inlet, New South Wales
From Wikipedia, the free encyclopedia
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Sussex Inlet
New South Wales
Sussex Inlet
Coordinates
35°09′S 150°34′E / 35.150°S 150.567°E / -35.150; 150.567Coordinates: 35°09′S 150°34′E / 35.150°S 150.567°E / -35.150; 150.567
Population
3,575 (2016 census)[1]
LGA(s)
City of Shoalhaven
State electorate(s)
South Coast
Federal Division(s)
Gilmore
Sussex Inlet is a town in the South Coast region of New South Wales, Australia. The town lies on the west bank of the waterway called Sussex Inlet, which divides New South Wales from the Jervis Bay Territory. The town lies within the City of Shoalhaven.
As at the 2016 census, the population of Sussex Inlet was 3,575.[1]
Contents
[hide]
1 Geography
2 Gallery
3 References
4 External links
Geography[edit]
The town of Sussex Inlet is located on the west bank of Sussex Inlet, a narrow inlet connecting Wreck Bay to the waterbody of St Georges Basin. The east bank of Sussex Inlet is the Booderee National Park.
Jervis Bay Airport is located about 10 kilometres (6.2 mi) east of Sussex Inlet.
Gallery[edit]
Jervis Bay Territory map showing Sussex Inlet.
References[edit]
^ Jump up to: a b Australian Bureau of Statistics (27 June 2017). "Sussex Inlet (State Suburb)". 2016 Census QuickStats. Retrieved 10 July 2017.
External links[edit]
SussexInlet.com
Sussex Inlet website
Sussex Inlet Info. Website
VISITNSW.com - Sussex-Inlet
[hide]
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City of Shoalhaven, New South Wales, Australia
Nowra suburbs
Nowra
Bangalee
Bomaderry
Cambewarra
Cambewarra Village
Mundamia
North Nowra
Nowra Hill
South Nowra
Tapitallee
Terara
West Nowra
Worrigee
Suburbs near Jervis Bay
Basin View
Bream Beach
Callala Bay
Callala Beach
Comberton
Erowal Bay
Huskisson
Hyams Beach
Myola
Old Erowal Bay
Sanctuary Point
St Georges Basin
Vincentia
Woollamia
Worrowing Heights
Wrights Beach
Sussex Inlet
Sussex Inlet
Berrara
Cudmirrah
Swanhaven
Ulladulla
Ulladulla
Berringer Lake
Burrill Lake
Dolphin Point
Kings Point
Little Forest
Milton
Mollymook
Mollymook Beach
Narrawallee
Woodburn
North of Shoalhaven River
Back Forest
Barrengarry
Beaumont
Bellawongarah
Berry
Berry Mountain
Bolong
Brogers Creek (part)
Broughton
Broughton Vale
Broughton Village (part)
Browns Mountain
Budgong
Bundewallah
Coolangatta
Far Meadow
Illaroo
Jaspers Brush
Kangaroo Valley
Meroo Meadow
Shoalhaven Heads
Upper Kangaroo River
Watersleigh
Wattamolla
Woodhill
South of Shoalhaven River
Bamarang
Barringella
Beecroft Peninsula
Bewong
Brundee
Burrier
Comerong Island
Culburra Beach
Currarong
Falls Creek
Greenwell Point
Jerrawangala
Kinghorne
Longreach
Mayfield
Numbaa
Orient Point
Parma
Pyree
Sassafras
Tolwong
Tomerong
Tullarwalla
Wandandian
Wollumboola
Yerriyong
Far South
Bawley Point
Bendalong
Brooman
Cockwhy
Conjola
Conjola Park
Croobyar
Cunjurong Point
Currowan (part)
Depot Beach
Durras North
East Lynne
Fishermans Paradise
Kioloa
Lake Conjola
Manyana
Mogood
Mount Kingiman
Pebbly Beach
Pointer Mountain
Pretty Beach
Tabourie Lake
Termeil
Woodstock
Yatte Yattah
Main Article: Local government areas of New South Wales

This Shoalhaven geography article is a stub. You can help Wikipedia by expanding it.
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Retrieved from "https://en.wikipedia.org/w/index.php?title=Sussex_Inlet,_New_South_Wales&oldid=795163021"
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