Scuba diving emergencies

Diving Emergencies

• Barotrauma of descent
  • Otic barotrauma
  • Pulmonary barotrauma
  • Sinus barotrauma
  • Mask squeeze
  • Barodentalgia (trapped dental air causing squeeze)
• Barotrauma of ascent
  • Pulmonary barotrauma (pulmonary overpressurization syndrome)
  • Decompression sickness (DCS)
  • Arterial gas embolism
  • Alternobaric vertigo
  • Facial baroparesis (Bells Palsy)
• At depth injuries
  • Oxygen toxicity
  • Nitrogen narcosis
  • Hypothermia
  • Contaminated gas mixture (e.g. CO toxicity)
  • Caustic cocktail from rebreathing circuit

Barotrauma of Descent

Face squeeze

• Occurs when air is not added to facemask during descent resulting in:
  • Facial bruising
  • Conjunctival Injection/hemorrhage
  • Retrobulbar hemorrhage if severe

Barotrauma of Ascent

Pulmonary barotrauma

• Occurs when diver breathing compressed air ascends too rapidly
• Symptoms occur minutes to hours after surfacing
  • Can occur without rapid ascent in pts w/ obstructive lung disease
• Lung rupture can lead to pneumomediastinum, pneumothorax, or air embolism
  • Pneumomediastinum and pneumothorax do not require recompression

Decompression sickness (DCS)

• Dissolved inert gases come out of solution and form bubbles in blood and tissue

Types

Type I (Pain only DCS)

• Involves the joints, extremities, and skin ("cutis marmorata")
• Usually only single joint is involved

Type II (Serious DCS)

• Spinal cord involvement
  • Ascending paralysis
  • Signs often cannot be traced to single location in the cord (may have skip lesions)
• Vestibular ("staggers") involvment
  • Vertigo, hearing loss, tinnitus
    • Differentiated from inner ear barotrauma which usually occurs on descent
• Pulmonary "chokes"
  • Cough, hemoptysis, dyspnea, substernal chest pain

Type III (Type II + gas embolism)

• Variety of stroke symptoms/signs
  • May spontaneously resolve

[[Arterial gas embolism

• Results from pulmonary barotrauma (most common) and decompression sickness
• Symptoms develop during ascent or immediately upon surfacing
• Causes variety of stroke syndromes depending on part of brain affected
  • Immediate death, loss of consciousness, seizure, blindness, hemiplegia

Treatment

1. Place in supine position
2. 100% O2
3. IVF (increases tissue perfusion)
4. Rapid recompression

At Depth injuries

• Oxygen toxicity
• Nitrogen narcosis
• Hypothermia
• Contaminated gas mixture (e.g. CO toxicity)

Source

Tintinalli