Scuba diving emergencies

Barotrauma of Descent

1. Face Squeeze
   1. Occurs when air is not added to the facemask during descent
      1. Facial bruising, conjunctival injection or hemorrhage, retrobulbar hemorrhage (rare)
2. Otic Barotrauma ("ear squeeze")
   1. Results from inability to equalize middle ear pressure
   2. Pain, fullness, vertigo, conductive hearing loss, TM rupture
   3. Tx = decongestants, consider abx if TM ruptured
3. Sinus barotrauma ("sinus squeeze")
   1. Pain over affected sinus, possible bleeding from nare
   2. Treatment = Decongestants, consider antibiotics
4. Inner ear barotrauma
   1. Results from forceful Valsalva against an occluded eustachian tube
      1. Pressure difference between middle ear and inner ear can rupture oval or round window
   2. Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo
   3. Treatment = Head of bed up, no nose blowing, antivertigo medications
   4. Urgent ENT consult as some surgeons advocate early exploration

Source

Tintinalli