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| ==Barotrauma of Descent== | | ==Types== |
| ===Face Squeeze===
| | {{Scuba diving DDX}} |
| #Occurs when air is not added to the facemask during descent
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| ##Facial bruising, conjunctival injection or hemorrhage, retrobulbar hemorrhage (rare)
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| ===Otic Barotrauma ("ear squeeze")===
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| ====Middle Ear====
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| *Results from inability to equalize middle ear pressure
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| *Pain, fullness, vertigo, conductive hearing loss, TM rupture
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| :;Treatment
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| #decongestants
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| #consider abx if TM ruptured
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| ====Inner Ear====
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| *Results from forceful Valsalva against an occluded eustachian tube
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| **Pressure difference between middle ear and inner ear can rupture oval or round window
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| *Sudden onset of sensorineural hearing loss, tinnitus, severe vertigo
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| :;Treatment
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| #Head of bed up
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| #no nose blowing
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| #antivertigo medications
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| #ENT consult
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| ===Sinus barotrauma ("sinus squeeze")===
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| *Pain over affected sinus, possible bleeding from nare
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| :;Treatment
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| #Decongestants
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| #consider antibiotics
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| | ==Differential Diagnosis== |
| | {{Water related injuries DDX}} |
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| ==Barotrauma of Ascent== | | ==See Also== |
| ===Pulmonary Barotrauma===
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| *Occurs when diver breathing compressed air ascends too rapidly
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| *Symptoms occur minutes to hours after surfacing
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| **Can occur without rapid ascent in pts w/ obstructive lung disease
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| *Lung rupture can lead to pneumomediastinum, pneumothorax, or air embolism
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| **Pneumomediastinum and pneumothorax do not require recompression
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| ===Decompression Sickness (DCS)===
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| *Dissolved inert gases come out of solution and form bubbles in blood and tissue
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| ====Types====
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| =====Type I (Pain only DCS)=====
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| *Involves the joints, extremities, and skin ("cutis marmorata")
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| *Usually only single joint is involved
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| =====Type II (Serious DCS)=====
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| *Spinal cord involvement
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| **Ascending paralysis
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| **Signs often cannot be traced to single location in the cord (may have skip lesions)
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| *Vestibular ("staggers") involvment
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| **Vertigo, hearing loss, tinnitus
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| ***Differentiated from inner ear barotrauma which usually occurs on descent
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| ===Arterial Gas Embolism===
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| *Results from pulmonary barotrauma (most common) and decompression sickness
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| *Symptoms develop during ascent or immediately upon surfacing
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| *Causes variety of stroke syndromes depending on part of brain affected
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| **Immediate death, loss of consciousness, seizure, blindness, hemiplegia
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| :;Treatment
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| #Place in supine position
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| #100% O2
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| #IVF (increases tissue perfusion)
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| #Rapid recompression
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| ==Depth injuries==
| | [[Category:Environmental]] |
| #Oxygen Toxicity
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| #Nitrogen narcosis
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| #Hypothermia
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| #Contaminated gas mixture (e.g. CO toxicity)
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| ==Source==
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| Tintinalli
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| [[Category:Environ]] | |