Scuba diving emergencies

Barotrauma of Descent

Face Squeeze

1. Occurs when air is not added to the facemask during descent
   1. Facial bruising, conjunctival injection or hemorrhage, retrobulbar hemorrhage (rare)

Otic Barotrauma ("ear squeeze")

Middle Ear

• Results from inability to equalize middle ear pressure
• Pain, fullness, vertigo, conductive hearing loss, TM rupture

Treatment

1. decongestants
2. consider abx if TM ruptured

Inner Ear

• Results from forceful Valsalva against an occluded eustachian tube
  • Pressure difference between middle ear and inner ear can rupture oval or round window
• Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo

Treatment

1. Head of bed up
2. no nose blowing
3. antivertigo medications
4. ENT consult

Sinus barotrauma ("sinus squeeze")

• Pain over affected sinus, possible bleeding from nare

Treatment

1. Decongestants
2. consider antibiotics

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

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

Depth injuries

1. Oxygen Toxicity
2. Nitrogen narcosis
3. Hypothermia
4. Contaminated gas mixture (e.g. CO toxicity)

Source

Tintinalli