Scuba diving emergencies

Types

Scuba Diving Emergencies

Differential Diagnosis

Management

Barotrauma of Descent
  • Gradual Ascent, avoidance of diving deeper if experiencing pain
  • Decongestants for sinus pain
  • Antibiotic ear drops for TM rupture (choose a formulation such as ofloxacin suspension that is safe in the middle ear)

Barotrauma of Ascent
  • Gradual ascent, safety stops imperative
  • Pulmonary barotrauma may manifest in many ways[1]
    • Local pulmonary injury and pneumomediastinum require supportive care only
    • Treat Pneumothorax according to severity, does not require recompression on its own
    • If any of the above conditions present with altered mental status, presume arterial gas embolism and recompress the patient
    • Arterial gas embolism is the most dreaded complication of diving. It can manifest in many ways depending on where the emboli travel (i.e. stroke, seizure, acute myocardial infarction, or arrythmia. The treatment is immediate hyperbaric oxygen therapy.
    • Decompression sickness (aka the bends) is due to the gas (usually nitrogen) coming out of solution in the blood and tissues secondary to too rapid of an ascent/depressurization. It can present with a myriad of findings, but the most common systems affected are neurologic and musculoskeletal. Those suspected to have this condition should be referred for urgent hyperbaric therapy.

At Depth Injuries
  • Oxygen Toxicity usually results from high FiO2 at several atmospheres of pressure. It can cause pulmonary injury manifesting as chest pain, pleurisy, or even pulmonary edema/hemorrhage. It can also cause CNS pathology manifesting as nausea, auditory changes, convulsions, sweating, twitching, or tunnel vision. Treatment for any of these injuries is ascent and inhalation of lower FiO2 at decreased pressure. More severe presentations of pulmonary injury may require intubation.
  • Nitrogen Narcosis results from inhaling nitrogen containing gas mixtures at high pressures (specialized gas mixtures exist for work at depth that have decreased amounts of nitrogen). It manifests as altered mental status. Treatment is gradual ascent.
  • Hypothermia: re-warm
  • Carbon Monoxide Toxicity: see main section; oxygen, consider hyperbaric therapy
  • Caustic Cocktail: supportive

References
  1. Diving Medicine, Karen B. Van Hoesen and Michael A. Lang, Auerbach's Wilderness Medicine, Chapter 71, 1583-1618.e6
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