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Scuba Related Injuries and Decompression SicknessThere are close to 4 million recreational scuba divers in this country today. Over 300,000 new sport divers are certified each year. Diving is also an important associated activity of industrial, scientific, and military professions. There are a wide variety of conditions that can occur as a result of the pressure changes when one submerges. BAROTRAUMA (injury that results from a change in pressure) and DECOMPRESSION ILLNESS (the bends) will be discussed in this section. NO ONE SHOULD SCUBA DIVE WITHOUT TRAINING AND CERTIFICATION. FOUR LEADING CAUSES OF DEATH IN SCUBA DIVERS1. Exhaustion and panic. 2. Air embolism (see below). 3. Cave diving accidents. 4. Running out of air at depth. BAROTRAUMAPROBLEMS ASSOCIATED WITH THE PRESSURE OF DESCENT1. BAROTITIS EXTERNA: This refers to the pressure exerted on, and inside, the ear canal when a diver descends. If the ear canal is plugged (wax, ear plugs, etc.), normal equalization of pressure cannot occur. The result, generally is a painful eardrum rupture. Bleeding usually occurs from the canal. Examination by a physician will be necessary. TREATMENT involves keeping the canal dry (no swimming) and close follow-up to make sure bacterial infection does not occur. Ear drops should not be used (unless instructed by your physician). No diving will be allowed under any circumstances. 2. BAROTITIS MEDIA: In this case, pressure is exerted during descent on the middle ear (on the inside aspect of the eardrum). This occurs as the result of eustachian tube becoming plugged. The eustachian tube connects the middle ear to the back of the throat (pharynx). It is through this tube that equalization of pressure is possible (yawning, chewing gum, or blowing air through closed nose and mouth). If the tube becomes blocked (a frequent accompaniment of colds, allergies, or smoking), ear pain from the inability to equalize pressure will occur. Eventual rupture of the eardrum is possible. This is a particularly dangerous situation, frequently accompanied by nausea, vomiting, and vertigo. Pain should signal the diver to resurface IMMEDIATELY. SAFETY TIPSPrior to diving, always have your ears examined in any cases of suspected canal blockage. Stop your dive with the occurrence of any ear pain or discharge. Do not dive or swim with a ruptured eardrum. Avoid diving when you have a cold, sinus infection, or allergy problems. If decongestant nasal sprays are used, they should be long-acting (12 hour sprays). PROBLEMS ASSOCIATED WITH THE PRESSURE OF ASCENT1. BAROTITIS MEDIA (reverse squeeze): In this case, the problem is the same as that described above, but occurs during ascent. This is more rare, as most divers have less trouble equalizing during ascent. See the above for treatment details. 2. TOOTH SQUEEZE: Fillings, decay, periodontal infections, or recent extractions all can lead to a pressure disequilibrium in or around a tooth. The result is dental pain. People with this problem need a dental evaluation. 3. AEROGASTRALGIA (gas in the gut): This is caused by the expansion of gas in the intestine when the surrounding pressure is decreased during ascent. Rarely serious, it is more common in novice divers. Avoid chewing gum, carbonated beverages, and heavy meals prior to diving. 4. PNEUMOTHORAX (burst lung): This serious problem occurs in the inexperienced diver who fails to freely exhale during ascent. The expansion of gas in the lungs that occurs as the surrounding pressure decreases will "over inflate" the lung, thus causing the problem. Any surfacing, unconscious, unresponsive diver is likely to have this problem. This is an absolute EMERGENCY requiring IMMEDIATE medical attention. Information on pneumothorax. 5. AIR EMBOLISM: Probably the most feared complication, and one of the major causes of death among scuba divers. There are estimated to be between 80-100 cases of air embolism per year in the United States, with 12-15% of these cases resulting in deaths. This problem results from the entry of gas bubbles into the blood stream (arterial) via ruptured veins in the overexpanded lung. The bubbles can cause an interruption in blood flow by occluding small blood vessels. Results are variable and dramatic; cardiac arrest or stroke can occur. AIR EMBOLISM results commonly in the diver who "runs out of air" and rapidly ascends, not expelling the expanding gas that is contained in the lungs. Air embolization can occur in as little as 5-6 feet of water in the diver who FAILS TO EXHALE AIR during ascent to the surface. Loss of consciousness on surfacing usually occurs and IMMEDIATE medical care is IMPERATIVE. DECOMPRESSION ILLNESSCommonly referred to among divers as the "bends", this multi-system disorder results from the liberation of inert gas (nitrogen) from solution (in the blood) to form gas bubbles in the bloodstream. On resurfacing, the ambient pressure is decreased. If the reduction in pressure occurs too rapidly, nitrogen bubbles will form in the blood stream. There are several complex factors (depth of dive and total time at that depth) which influence this gas/tissue/blood equilibrium. It is the formation of nitrogen bubbles that is responsible for the multitude of symptoms that characterize decompression sickness. Decompression illness is categorized into two types:TYPE 1 (mild): There is pain involving only one joint. It may appear as a rash with itching (skin bends) or blotchy discoloration. Medical care will be required and prognosis is generally good. Treatment in a hyperbaric chamber (decompression chamber) is required in most cases. TYPE 2 (serious): Here pain involves multiple joints, usually the lower extremities. There may also be brain (stroke) or spinal cord involvement (some type of paralysis). Lung involvement is known as the "chokes" (shortness of breath). Involvement of the inner ear or the brain is known as the "staggers". SYMPTOMS here include; nausea, equilibrium difficulty (can't walk), limb weakness, limb numbness, or paralysis. RISK FACTORS FOR DECOMPRESSION ILLNESS1. ADVANCED AGE (over age 40) 2. OBESITY 3. RECENT INJURY 4. MULTIPLE DIVES WITHIN 24 HOURS 5. COLD WATER 6. EXERTION UNDER WATER 7. SMOKING 8. EXERCISE AFTER A DIVE 9. BREATH HOLDING DIVES SHORTLY AFTER A SCUBA DIVE Treatment involves IMMEDIATE emergency evaluation. In some cases, recompression will be done in a decompression chamber. Oxygen (at 100%) via face mask will be administered until the patient is ready for the chamber. Transport to a properly equipped facility will be necessary and will be arranged by your local EMERGENCY ROOM. Hope this article will provide you information about scuba related Injuries and decompression sickness.
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