Scuba diving emergencies: Difference between revisions
Silas Chiu (talk | contribs) (Added type of DCS) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Barotrauma of Descent== | ==Barotrauma of Descent== | ||
===Otic | ===[[Otic barotrauma]] ("ear squeeze")=== | ||
====Middle Ear==== | ====Middle Ear==== | ||
*Results from inability to equalize middle ear pressure | *Results from inability to equalize middle ear pressure | ||
| Line 16: | Line 16: | ||
#antivertigo medications | #antivertigo medications | ||
#ENT consult | #ENT consult | ||
===Sinus barotrauma ("sinus squeeze")=== | ===[[Sinus barotrauma]] ("sinus squeeze")=== | ||
*Pain over affected sinus, possible bleeding from nare | *Pain over affected sinus, possible bleeding from nare | ||
:;Treatment | :;Treatment | ||
#Decongestants | #Decongestants | ||
#consider antibiotics | #consider antibiotics | ||
===Face | ===[[Face squeeze]]=== | ||
*Occurs when air is not added to facemask during descent resulting in: | *Occurs when air is not added to facemask during descent resulting in: | ||
**Facial bruising | **Facial bruising | ||
| Line 28: | Line 28: | ||
==Barotrauma of Ascent== | ==Barotrauma of Ascent== | ||
===Pulmonary | ===[[Pulmonary barotrauma]]=== | ||
*Occurs when diver breathing compressed air ascends too rapidly | *Occurs when diver breathing compressed air ascends too rapidly | ||
*Symptoms occur minutes to hours after surfacing | *Symptoms occur minutes to hours after surfacing | ||
| Line 34: | Line 34: | ||
*Lung rupture can lead to pneumomediastinum, pneumothorax, or air embolism | *Lung rupture can lead to pneumomediastinum, pneumothorax, or air embolism | ||
**Pneumomediastinum and pneumothorax do not require recompression | **Pneumomediastinum and pneumothorax do not require recompression | ||
===Decompression | ===[[Decompression sickness]] (DCS)=== | ||
*Dissolved inert gases come out of solution and form bubbles in blood and tissue | *Dissolved inert gases come out of solution and form bubbles in blood and tissue | ||
====Types==== | ====Types==== | ||
| Line 53: | Line 53: | ||
**May spontaneously resolve | **May spontaneously resolve | ||
===Arterial | ===[[Arterial gas embolism=== | ||
*Results from pulmonary barotrauma (most common) and decompression sickness | *Results from pulmonary barotrauma (most common) and decompression sickness | ||
*Symptoms develop during ascent or immediately upon surfacing | *Symptoms develop during ascent or immediately upon surfacing | ||
| Line 64: | Line 64: | ||
#Rapid recompression | #Rapid recompression | ||
==Depth injuries== | ==At Depth injuries== | ||
*[[Oxygen toxicity]] | |||
*[[Nitrogen narcosis]] | |||
*[[Hypothermia]] | |||
*Contaminated gas mixture (e.g. [[CO toxicity]]) | |||
==Source== | ==Source== | ||
Revision as of 23:09, 10 February 2015
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
- decongestants
- 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
- Head of bed up
- no nose blowing
- antivertigo medications
- ENT consult
Sinus barotrauma ("sinus squeeze")
- Pain over affected sinus, possible bleeding from nare
- Treatment
- Decongestants
- 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
- Vertigo, hearing loss, tinnitus
- 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
- Place in supine position
- 100% O2
- IVF (increases tissue perfusion)
- Rapid recompression
At Depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
Source
Tintinalli