Scuba diving emergencies

Barotrauma of Descent

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

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

Depth injuries

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

Source

Tintinalli