Scuba diving emergencies: Difference between revisions

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==Barotrauma of Descent==
==Types==
===Otic Barotrauma ("ear squeeze")===
{{Scuba diving DDX}}
====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==
==Differential Diagnosis==
===Pulmonary Barotrauma===
{{Water related injuries DDX}}
*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
===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


==Depth injuries==
==See Also==
#Oxygen Toxicity
#Nitrogen narcosis
#Hypothermia
#Contaminated gas mixture (e.g. CO toxicity)


==Source==
[[Category:Environmental]]
Tintinalli
 
 
[[Category:Environ]]

Revision as of 14:47, 22 March 2016

Types

Diving Emergencies

Differential Diagnosis

Water-related injuries

See Also