2024 Thoracic and Pulmonary Issues in Diving Pre-course
Event Properties
Event Start Date | 06-12-2024 |
Event End Date | 06-12-2024 |
Location | Crowne Plaza New Orleans French Qtr - Astor |
Categories | UHMS Directly Provided Course |
Bruce Derrick
MD
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Dr. Bruce Derrick, MD is a undersea & hyperbaric medicine specialist in Durham, NC. He currently practices at Duke Hyperbaric Medicine Clinic and is affiliated with Duke University Hospital. Dr. Derrick is board certified in Emergency Medicine. He is an Assistant Professor of Surgery, Dept. of Emergency Medicine; Attending Physician - Center for Hyperbaric Medicine & Environmental Physiology, and Emergency Department, Duke University Medical Center, Durham, NC.
Dick Sadler
MD
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Dr. Sadler is an Undersea & Hyperbaric Medicine Specialist, Medical Director for Dive Rescue International, Ft. Collins, CO & works with Delta P Medical Consultants LLC in La Jolla, CA
Frauke Tillmans
PhD
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Dr. Frauke Tillmans is the Research Director at Divers Alert Network (DAN), adjunct assistant professor in the Department of Biomedical Engineering at the University of North Carolina in Chapel Hill and a visiting scientist at the University of California, San Diego. She holds a Master’s degree in Neuroscience, and a PhD in Human Biology. Dr. Tillmans now oversees DAN’s research initiatives in diving injury and fatality monitoring, population health, and diving physiology including acute diving injuries as well as long-term health effects of extreme exposures. Throughout her career she has participated in numerous projects covering a variety of medical aspects in recreational, professional, and military diving. Starting in 2019 when she left a position at the German Naval Medical Institute to relocate to the United States, she has become DAN’s point of contact for global scientific collaborations and is in charge of DAN’s research grant program and STEM-focused internship program, inspiring young scientists and prospective physicians to pursue a career in diving and hyperbaric medicine.
James Caruso
MD
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Dr. Caruso the Chief Medical Examiner and Coroner for Denver, CO, a position he has held since retiring from the Navy in 2014. During his 30-year Navy career he was both a Navy Undersea Medical Officer and a Navy Flight Surgeon. He completed his Pathology training at Duke University Medical Center and his Forensic Pathology training at the Maryland Medical Examiner’s Office in Baltimore. Additionally, he completed a formal Fellowship in Hyperbaric Medicine at Duke and passed the subsequent board examination given by the American Board of Preventive medicine, the only Forensic Pathologist to do so. He is a Fellow of the UHMS and has numerous peer-reviewed journal articles and book chapters to his credit. He has also been a part of the physician team for the Divers Alert Network since 1994, providing training and reviewing diving-related deaths.
James Mucciarone
MD
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CAPT Mucciarone qualified as an Undersea Medical Officer in 2006 and as a Submarine Medical Officer in 2009. UMO assignments include Senior Medical Officer of Naval Special Warfare Group TWO, Officer-in-Charge of the Naval Undersea Medical Institute, and Force Medical Officer for Commander, Submarine Forces in the U.S. Pacific Fleet. He was commissioned through the U.S. Naval Academy, served in Naval Special Warfare for nine years before attending medical school, is board certified in radiology, and is a fellow of the American Academy of Physician Leadership.
Jim Chimiak
MD
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John R. Clarke
PhD
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John R. Clarke, Ph.D., FUHM, is an American scientist, private pilot, author, and inventor. He served the U.S. Navy for 39 years, 27 years as Scientific Director of the Navy Experimental Diving Unit (NEDU). Before that, he conducted pulmonary research at the Navy Medical Research Institute (NMRI) in Bethesda, MD. Clarke is recognized as a leading authority on rebreather engineering. He has an extensive academic career in biological and physiological sciences and graduated from the U.S. Navy/NOAA Scientist in the Sea Program. At NMRI, he researched the effects of saturation at great depth (1000 feet and deeper) on Navy divers. He conducted pulmonary research on dives to 1500 feet of seawater at NEDU in Florida and 450 meters at GUSI in Germany. In 2020, he assisted the Covid Task Force and Wilcox Industries in designing, testing, and producing an FDA-approved ventilator. Twenty years before, he assisted in developing and testing a novel SCBA for use by Navy SEALs. In 2022, he received the Academy of Underwater Arts and Sciences NOGI Award for Science.
Joy Dierks
CDR, MD
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Joy Dierks, MD, MPH, MSTI
Commander
Medical Corps
United States Navy
CDR Joy Dierks was commissioned in 2000 and selected to attend the Uniformed Services University of the Health Sciences School of Medicine in Bethesda Maryland. She graduated in 2004 with her Doctorate of Medicine and completed a transitional internship at Portsmouth Naval Hospital in Norfolk, VA in 2005.
Following internship CDR Dierks was selected for the Diving Medical Officer program. She completed school at Naval Diving and Salvage Training Center, Panama City, FL and Undersea Medicine at the Naval Undersea Medical Institute, Groton, CT. Upon graduation she received Surgeons General’s award for the outstanding graduate.
Her first assignment was as the Diving and Undersea Medical Officer, assigned to the USS Emory S. Land (AS-39) home ported in La Maddalena, Italy. During this assignment she completed a deployment to the Gulf of Guinea and executed the base closure/change of homeport to Naval Base Kitsap in Bremerton, WA. The base closure involved one of the largest salvage operations in naval history, CDR Dierks served as Medical Support Supervisor for this operation, providing medical treatment and care coordination for visiting naval and civilian divers in addition to participating in the clean up working as a salvage diver. During this tour she earned her surface warfare device.
In April 2008, CDR Dierks reported to Explosive Ordnance Disposal (EOD) Group ONE to serve as Senior Medical Officer/ Force Surgeon. Her responsibilities included medical oversight of seven subordinate EOD Mobile Units and Mobile Diving Salvage Unit ONE with several thousand sailors scattered throughout the Pacific. During her tenure she over saw the creation of the new Expeditionary Support Unit ONE Medical department, standardized of medical training for EOD operators at Training and Evaluation Unit ONE, Hanta virus control/abatement at Darwin Wash training area on Naval Weapons Station China Lake. She jointly presented her Hanta virus work with NEPMU-5 at the Navy Marine Corps Public Health Conference.
In June 2013 CDR Dierks completed Preventive Medicine residency and earned a Master’s in Public Health from Johns Hopkins University School of Public Health in Baltimore, MD. In addition, she completed the Public Health Emergency Officer (PHEO) course and served as the resident representative on the Johns Hopkins Residency Advisory Council.
Following residency, CDR Dierks reported as the Preventive Medicine Officer to III Marine Expeditionary Force (III MEF) in Okinawa, Japan. Additionally, she served as the acting III MEF Surgeon (May 2014- August 2014). Subsequently as Deputy III MEF surgeon and 3rd Marine Expeditionary Battalion (3rd MEB) Surgeon for the remainder of her tour. She was responsible for health care and force health protection for approximately 27,000 Marines and Sailors operating throughout the Pacific. CDR Dierks served as the JTF-505 forward surgeon for Operation Sahayogi Haat, the 2015 Nepal Earthquake response. She was instrumental in the identification and repatriation of the US Marines, Nepalese civilians and army personnel involved in a helicopter crash. In addition she spearheaded several initiatives at III MEF to improve force health protection through a quality improvement project targeting increased reporting of heat casualties and quantifying contributing human factors. She facilitated new provider orientation for III MEF medical providers and collaborated with Naval Hospital Okinawa to develop monthly grand rounds for all Okinawa military medical providers. CDR Dierks led the investigation of largest leptospirosis outbreak in US military history coordinating with both military and local Japanese health officials. She was the lead author on a publication detailing this outbreak and the lessons learned. Finally, CDR Dierks earned board certification in Preventive Medicine, Occupation and Environmental Medicine, completed USMC Command and Staff (JPME-1) and earned the Fleet Marine Force (FMF) warfare device.
From August 2015 – August 2018 CDR Dierks served as the Personnel Reliability Program (PRP) Competent Medical Authority (CMA) Community Manager at the Bureau of Medicine and Surgery (BUMED). She was the first full-time person to hold this position and brought Navy Medicine support to the nuclear weapons community to the next level. In this role she oversaw medical support to the Navy Nuclear Deterrence Mission directly serving as the Surgeon General’s liaison to Strategic Systems Programs. She was only the second Navy medically trained person to serve as a Nuclear Weapons Technical Inspector/subject matter expert to Strategic Systems Program (SSP). Additionally she worked with the Head of Undersea Medicine (UM) to increase medical student recruitment and mentorship for Undersea Medicine Programs. In this roles, she oversaw the preparation of UM packages for the Graduate Medical Education Selection Board resulting in the highest undersea medical officer candidate recruitment in the past 10 years. She completed the requirements for her submarine medical officer warfare device. Finally, she graduated in July 2018 with a Masters in Science and Technology Intelligence from National Intelligence University with a concentration is Weapons of Mass Destruction.
In August of 2018 CDR Dierks reported to Naval Hospital Yokosuka Japan. She served as Director, Branch Health Clinics and Preventive Medicine/ Occupational Medicine/ Undersea Medicine Staff Physician. CDR Dierks was responsible for six branch health clinics in two countries and one territory with over 600 personnel and a budget in excess of $ 11 million dollars and travel funds in excess of $400 thousand dollars. Additionally, she served as the Public Health Emergency Officer and Preventive Medicine consultant to Seventh Fleet. For the April-May 2019 American College of Occupational Medicine Conference, CDR Dierks gave two presentations- “Bio-security and Gene editing technologies” and “The Navy’s response to climate change.” She served as the co-champion for telehealth initiatives at the command.
In March of 2020 CDR Dierks returned to BUMED and served as acting Head, Undersea Medicine and Radiation Health from April 2020 – August 2020. During this time she led the Undersea Medicine clinical community that produced return to diving guidance for U.S. Navy diving personnel. In her current position she serves as deputy, for waivers and standards, and is the senior medical reviewer for all special duty (submarine, diving, nuclear field duty, and special warfare) waivers for all Navy and Marine Corps personnel, U.S. Coast Guard, and Department of the Navy (DoN) civilians. She assists with case reviews for the radiation effects advisory board (REAB) for DoN civilians and active duty members in the radiation health program. Additionally, she current leads the effort to revise the Manual of the Medical Department chapter 15 sections on special duty. She maintains her clinical currency through regular clinic hours at Fort Belvoir Community Hospital serving as Occupational and Diving Medicine Physican.
CDR Dierks’ personnel awards include the Meritorious Service Medal with two gold stars, the Joint Commendation Medal, Humanitarian Service Medal and the Navy Commendation Medal with gold star. She holds the following warfare devices: Submarine Medical Officer device, Surface Warfare Medical Officer device, and Fleet Marine Force. She holds an active TS-SCI clearance.
Juan Valdivia-Valdivia
MD
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Dr Juan Valdivia-Valdivia (or “Juani” in the freediving community) was born in Lima Peru,completed surgery internship at UIC-MGH in Chicago and completed residency in Neurological surgery at the University of Arizona department of Neurosurgery.
Having completed a fellowship in Complex and Reconstructive Spine Surgery at the University of Michigan Department of Neurosurgery and a fellowship in Neurosurgical Oncology at Emory University, Dr Valdivia served as Assistant professor of Neurosurgery at the University of Michigan and Chief of Neurosurgery at the Ann Arbor VA healthcare System until January 2015. He moved to Tampa, after taking his first freediving lesson in Long Island,Bahamas, a lesson that would change his life.
He is a member of the AIDA (International Association for the development of Apnea) Medical & Science Committee, and the AIDA DC. He has contributed to the AIDA Black-out guidelines, lung squeeze guidelines, medical equipment for competition guidelines and is director of communications for the AIDA Medical committee, serving under Dr Oleg Melikhov. He is the current medical director for the United States freediving federation, and team doctor for the USA Women’s spearfishing team. He holds multiple Peruvian national records for depth and pool for breath-hold diving.He is the founder and Director of the UNU Freediving Foundation, a 501C3 tax exempt organization dedicated to raising funds for Freediving scientific research, risk awareness and Prevention.
Keith Van Meter
MD
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Keith Van Meter, MD completed his undergraduate education at Miami University at Oxford, Ohio in 1968 with a degree in chemistry and English. He graduated from George Washington University School of Medicine in 1973 with a degree in medicine. He trained at Tulane University School of Medicine/Charity Hospital in New Orleans, Louisiana. He is board certified in Emergency Medicine with subspecialty board certification in Pediatric Emergency Medicine and Diving and Hyperbaric Medicine. From 1989 to the present, Dr. Van Meter has served as the Chief of the Section of Emergency Medicine in the Department of Medicine at LSU Health Sciences Center in New Orleans, Louisiana. He is the Medical Director of a 140-physician Emergency Medicine group in south Louisiana and Mississippi (Keith Van Meter & Associates). He acted as the Medical Director of the Jo Ellen Smith Medical Center Multiplace Hyperbaric Medicine Unit from 1978 until the hospital closed in 1998. He has served as the Medical Director of the Baromedical Research Institute Hyperbaric Laboratory in New Orleans, Louisiana since 1980. Dr. Van Meter served on a task force under Dr. Sam Poole and Dr. Norman McSwain to develop medical support planning for NASA for astronauts aboard a space station from 2000-2002. In his private practice, he has treated over 600 hundred commercial divers in the Gulf of Mexico who suffered from acute decompression sickness or arterial gas embolism. Dr. Van Meter’s primary research interest is the application of hyperbaric oxygen in the ACLS, PALS and ATLS in cardiopulmonary arrest utilizing a swine model.
Michael Ott
MD
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Dr. Michael Ott is a Colorado native who received his undergraduate degree from Davidson College, followed by his medical degree from Wake Forest University. He then studied Internal Medicine/Pulmonary Medicine/Critical Care Medicine at Mayo Clinic. He is a Clinical Associate Professor of Medicine at the Uniformed Services University Of The Health Sciences, F. Edward Hebert School of Medicine. Ott has been an active dive instructor since 1994 and a Diving Medical Officer with NOAA since 1998, serving on the USS Monitor and Aquarius saturation missions. He continues to serve on the NOAA Diving Medical Review Board. Ott has served as a faculty member and course director for numerous diving medical programs for NOAA and the military. He is the medical director for the Ocean Corporation. He serves as the Chief of Pulmonary/CCM/UHM at Eglin Air Force Base and is also a Flight Surgeon in the USAF working as the Chief of Aerospace Medicine for the 44th Fighter Group (F35). He has logged hours on more than 30 airframes with the Air Force.
Peter Lindholm
MD
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Peter Lindholm, MD, PhD is Professor in Residence, Gurnee Endowed Chair of Hyperbaric and Diving Medicine Research, Department of Emergency Medicine, University of California San Diego. He is a radiologist (licensed in Sweden), and associate professor in physiology and radiology from the Karolinska Institutet in Sweden. He has also served as director of thoracic radiology at the Karolinska University Hospital. His research interest is in the field of diving and hyperbaric medicine with focus on the pathophysiology of breath-hold diving. He has published studies on hypoxia and loss of consciousness as well as the pulmonary effects of lungsqueeze. He has described the physiology of how glossopharyngeal breathing extends the amount of gas in the lungs beyond total lung capacity, including the first case series suggesting cerebral arterial gas embolism from glossopharyngeal insufflation (lungpacking). He published the first study suggesting “tracheal squeeze” as an alternative to pulmonary edema in divers bleeding after deep dives. He has showed that exercise and fasting prior to diving increases the risk of loss of consciousness similar to hyperventilation. He has also developed a new method to use magnetic resonance imaging to diagnose pulmonary embolism. Current focus is on immersion pulmonary edema and lungsqueeze, as well as new methods to measure hyperbaric oxygen therapy. He also enjoys exercise and his saltwater aquarium.
Richard Moon
MD
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Dr. Richard Moon earned BSc and MD degrees at McGill University. He trained in internal medicine and biomedical engineering at the University of Toronto, then in pulmonary and critical care medicine, followed by anesthesiology at Duke University. He joined the Duke University faculty in 1983. He is Professor of Anesthesiology, Professor of Medicine and Medical Director of the Duke Center for Hyperbaric Medicine & Environmental Physiology. His research has included physiology of immersion and predictors of arterial PCO2 during underwater exercise. He has been particularly interested in causes and prevention of immersion pulmonary edema, use of an experimental breathing gas (perfluoromethane) to decrease decompression requirements after heliox dives, mechanisms of death during triathlons, causes of perioperative opioid-induced respiratory depression, and improved monitoring techniques for monitoring patients to detect it. His awards include the Mentorship Award from the AMA-Women Physicians Congress Physician Mentor Recognition Program, Leonard Palumbo Jr, MD Faculty Achievement Award for compassionate patient care and excellence in the teaching and mentoring of young physicians, Duke awards for Excellence in Medical Student Education and two awards as Duke Anesthesiology Teacher of the Year.
Simon Mitchell
PhD
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Professor Simon Mitchell MB ChB, PhD, DipDHM, DipOccMed, FUHM, FANZCA
Simon is an anesthesiologist and diving physician and is the Head of the Department of Anaesthesiology at the University of Auckland. He has been a lifelong passionate diver and was a lead member of teams that were the first to locate, dive and identify 3 deep shipwrecks of high historical significance in Australia and New Zealand. At the time of one of these dives it was the deepest (600’) ever undertaken to a wreck. He is widely published, particularly in the area of diving medicine, with over 130 scientific papers or book chapters which include the chapter on hyperbaric and diving medicine in Harrison’s Principles of Internal Medicine. Simon was elected to Fellowship of the Explorers’ Club of New York in 2006. He received the Albert R Behnke Award (the highest American award for scientific contributions to the field) in 2010, the Eurotek Discovery Award in 2014, and was the DAN / Rolex Diver of the Year in 2015. Editor of Diving and Hyperbaric Medicine Journal. Active technical diver participating in cutting edge cave and wreck diving expeditions including the first ultra-deep rebreather dive (230m (755’)) using hydrogen as a breathing gas in 2023.
0730 |
COFFEE |
0755-0805 |
Introduction: Pulmonary and Thoracic Issues in DivingJim Chimiak, MD |
0805-0835 |
Imaging: Peter Lindholm, MD, PhDAbout the Lecture
An overview from the radiologist perspective on what imaging options are available to diagnose or better classify pathology related to diving related physiology and pathology
|
0835-0905 |
Surgical and Traumatic Injuries: Dick Sadler, MDAbout the Lecture |
0905-0920 |
Panel Discussion |
0920-0950 |
Pulmonary Edema: Richard Moon, MDAbout the Lecture |
0950-1020 |
Diving after Pulmonary Infection; Michael Ott, MDAbout the Lecture
To be aware of available data concerning risks and their frequency of diving with pulmonary infections.
|
1020-1050 |
Aspiration/Non-fatal Drowning: James Mucciarone, MDAbout the Lecture
This lecture will review the epidemiology, terminology, pathophysiology, and recommended treatments for drowning and non-fatal drowning, and aspiration with an emphasis on the SCUBA diver.
|
1050-1105 |
Panel Discussion |
1105-1205 |
Lunch (on own) |
1205-1300 |
Chest/Thoracic Pain: Cardiac / Non-Cardiac: Keith Van Meter, MDAbout the Lecture |
1300-1330 |
Pulmonary Fitness to Dive: Joy Dierks, MDAbout the Lecture
Discuss common disqualifying conditions and how the US Navy evaluates and makes decision on fitness for Diving
|
1330-1400 |
Exercise/Cold Induced Asthma: Richard Moon, MDAbout the Lecture |
1400-1415 |
Panel Discussion |
1415-1445 |
Pulmonary Oxygen Toxicity: Bruce Derrick, MDAbout the Lecture
Will discuss the underlying etiology, clinical presentation, and management of pulmonary oxygen toxicity.
|
1445-1505 |
Lung Squeeze (pulmonary barotrauma): Workshop 2023: Frauke Tillmans, PhDAbout the Lecture
The San Diego Center of Excellence in Diving at UC San Diego and the Divers Alert Network convened the Barotrauma and SIPE in Freediving workshop on 27-28 October 2023 in San Diego, California to provide a synthetic overview of the current knowledge of barotrauma and swimming-induced immersion pulmonary edema (SIPE). This workshop was an international, interdisciplinary effort to examine the prevalent emerging issues with freediving and different types of swimming-, immersion-, and altitude-related pulmonary edema. This volume presents 21 papers and panel discussions with particular focus on the definition, symptomatology, mechanics, prevention and treatment of SIPE and squeeze, a colloquial term amongst freedivers for lung barotrauma of descent. Immersion pulmonary edema is considered cardiogenic edema from increased transcapillary pressure. Fluid generated in the pulmonary interstitium or alveoli is dependent on inflow (arterial pressure); outflow (venous pressure); and, lymphatic drainage. Barotrauma of descent is coupled to a relative negative pressure in the airways and/or alveoli triggering anatomical distortion of lung parenchyma that presents as tears to the structures with bleeding. New data suggests that infection may be present providing permeability and inflammation as a contributing component. Mechanisms for individual sensitivity, influence of gender, and genetic predisposition are poorly known but hypertension has been identified as a factor. Workshop presentations spanned lung squeeze and DCI in freediving education, review of emergent freediving cases, current medical procedures at competitions, pathophysiology of SIPE, pulmonary capillary stress failure, infection as a risk factor, biomechanics of SIPE, sex and age difference prevalence, mechanisms of SIPE, pathophysiology and clinical course of HAPE (high-altitude pulmonary edema), patent foramen ovale in freediving, hemoptysis, diagnosis of SIPE in recreational swimmers, lung damage and long-term consequences of barotrauma. Finally, terminology, treatment, and return to freediving or swimming were addressed in a panel discussion format. A consensus was reached to introduce a new term to describe the multiple pulmonary injury types connected with freediving. Freediving-induced pulmonary syndrome (FIPS) was suggested, acknowledging that the classification of severity and recognizable symptoms of each subcategory of FIPS is not currently possible due to a lack of reliable data. Further discussion and collection of data is warranted from retrospective as well as prospective applied research. Workshop Proceedings can be downloaded at www.dan.org.
|
1505-1525 |
Lung Squeeze (pulmonary barotrauma): Management: Juan Valdivia-Valdivia, MDAbout the Lecture
Basic concepts on Freediving-related hypoxic LOC and Freediving-induced Pulmonary syndrome. Novel first of its kind , point-based grading system, to grade severity of a Freediving incidents as a Neuro-pulmonary syndrome.
|
1525-1545 |
The Work of Breathing: What it IS, and What it Isn’t: John Clarke, PhDAbout the Lecture
Building on clinical manifestations of obstructed breathing, we see how physiological Work of Breathing is defined and how it affects decision-making in divers and diving medical supervisors based on actual diving incidents. We review how basic respiratory physiology can explain bad diving outcomes and reveal how to remedy bad decision-making. Those ameliorations can also be used to remedy Work of Breathing problems in military SCBA and tactical aircraft oxygen delivery systems.
|
1545-1605 |
Work of Breathing/lung mechanics: Simon Mitchell, MBBS, PhDAbout the Lecture
This lecture will describe how an increase in the work of breathing combined with exercise can provoke CO2 retention in diving. We will briefly review why work of breathing increases with a particular focus on the role of gas density. We will review the sparse data that provide some guidance on an appropriate limit for maximum gas density during diving.
|
1605-1635 |
Autopsy Findings: Jim Caruso, MDAbout the Lecture
The physiology and pathophysiology of immersion and drowning will be discussed as will the entities of immersion pulmonary edema and gas embolism, from a pathologist’s perspective. The presentation will include numerous images of gross and microscopic findings seen with drowning and gas embolism as well as a few select cases to demonstrate autopsy findings.
|
1635-1650 |
Panel Discussion |
1650-1705 |
Conclusion |