Diving Emergencies

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Diving Emergencies
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Pressure Laws

• Boyles law PVK
• As pressure ?, volume ?
• As pressure ?, volume ?
• Daltons law Pt P02 PN2 Px
• Total pressure of gas mixture is sum of partial
  pressures of its components
  
• Henrys law
• Pressure of a gas in liquid is proportional to
  its pressure in the atmosphere

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Barotrauma

• Injury caused by compression or expansion of gas
  in body spaces

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Barotrauma

• Ear squeeze
• Sinus squeeze
• Lung trauma (pulmonary overpressure)
• Arterial air embolism

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Ear Squeeze

• Pressure does not equalize in middle ear through
  Eustachian tube
  
• Common when diving with URI
• Severe pain
• Potential for ear drum rupture
• Water enters middle ear vertigo/incapacitation

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Sinus Squeeze

• Pressure does not equalize in frontal or
  maxillary sinus
  
• Common when diving with URI
• Severe pain

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Lung Trauma

• Pulmonary Overpressure Syndrome (POPS)
• Breath-holding during ascent
• Compressed air in lungs expands
• Lung tissue ruptures, resulting in
• Pneumothorax/tension pneumothorax
• Pneumomediastinum
• Subcutaneous emphysema
• Arterial air embolism

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Lung Trauma

• May occur in shallow depths
• Signs/Symptoms
• Respiratory distress
• Substernal chest pain
• Diminished breath sounds
• Treatment
• Rest
• Oxygen
• Treat pneumothorax

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Arterial Air Embolism

• Caused by breath-holding during ascent
• Lung tissue tears/air enters pulmonary
  circulation
  
• Air enters left heart, is pumped to systemic
  circulation
  
• Air bubbles enter, clog cerebral circulation

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Arterial Air Embolism

• Rapid onset of
• Alterations in consciousnessusually within 10
  minutes
  
• Hemiplegia
• Unequal pupils
• Cardiopulmonary failure
• Vertigo
• Visual disturbances

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Arterial Air Embolism

• Management
• ABCs
• 100 oxygen, assist ventilations as needed
• Supine (Left side 300 head down)
• IV with NS, LR
• Transport to decompression chamber
• Steroids on medical control orders

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Decompression Sickness
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Decompression Sickness

• Diver breathes compressed air
• Nitrogen dissolves in blood
• Diver does not surface at correct rate to allow
  nitrogen to escape from blood
  
• Nitrogen bubbles form in tissue, small blood
  vessels
  
• Occludes circulation in small vessels

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Decompression Sickness

• Cutaneous bends
• Itching
• Mottled rash

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Decompression Sickness

• Musculoskeletal DCS (Bends)
• Dull ache in muscles/joints
• Movement worsens pain
• Fatigue
• Inflating BP cuff over area relieves pain

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Decompression Sickness

• Central nervous system DCS
• Brain involvement
• CVA like symptoms
• Paresthesias
• Staggers
• Spinal cord involvement
• Paralysis

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Decompression Sickness

• Pulmonary DCS --Chokes
• Chest pain
• Cough
• Dyspnea
• Pulmonary edema

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DCS Management

• ABCs
• 100 Oxygen
• IV with LR
• Lateral recumbent position if air embolism
  suspected
  
• Transport to recompression chamber
• Steroids on Medical Control orders

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Nitrogen Narcosis

• Rapture of the Deep
• Pressurized nitrogen toxic effects on CNS
• Anesthetic effect due to lipid solubility of N2
• Result is intoxication
• Other injury may result from impaired judgment
• Affects most divers to some degree
• Usually on dives 70-100 feet

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Nitrogen Narcosis

• Signs and Symptoms
• Euphoria
• Confusion
• Disorientation
• Slowed motor response
• Treatment
• Surfacing corrects problem
• Consider possibility of CO toxicity

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Diving Incident Assessment

• When was last dive?
• How many dives that day?
• What depths?
• Did diver ascend quickly? Why?
• Did diver make decompression stops during
  ascent?
  
• Symptoms? Onset of symptoms?
• Divers appearance immediately after dive?

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Divers Alert Network

• [phone] (emergency)
• www.diversalertnetwork.org
• [phone] (non-emergency)