#EMconf: Diving Emergencies

Thu, 07/13/2017 - 6:21am
Author: 
Michael Tom, MD
  • Dive injuries occur during descent, ascent, and from staying at depth too long  

  • 2 broad categories of dive injuries: 
    -Air Gas Embolism 
          -Usually abruptly upon ascent, can be fatal
          -Alveolar rupture ~ air embolus to right heart ~ PFO ~ to left heart ~ to brain
          -Symptoms may include cardiac, pulmonary or neurologic symptoms 
    -Decompression Sickness (aka the Bends)
          -Usually more delayed presentation following ascent; minutes to 24 hours
          -Factors include dive depth, duration, rate of ascent
          -Nitrogen dissolved in the blood comes out of solution, inert gas bubbles to tissues and joints
          -Type 1 symptoms: pain in joints/extremities, skin mottling with pruritis (cutis marmorata)
          -Type 2 symptoms: cough, hemoptysis, dyspnea, chest pain, vertigo, hearing loss, tinnitus
          -Hyperbaric oxygen is treatment for type 1&2 symptoms
                 -Only absolute contraindication to HBO is an untreated pneumothorax

  • Seizures at depth are invariably fatal; any hx of seizures absolutely cannot dive

  • Important history for discussing cases with HBO specialists:
          -Water Temperature
          -Depth and total time time at depth
          -Gas mixture of air
          -Diver plan or computer
          -Experience/certification symptoms