Diving Emergencies :Diving Emergencies


Pressure Laws :Pressure Laws Boyle’s law: PV=K As pressure , volume  As pressure , volume  Dalton’s law: Pt = P02 + PN2 + Px Total pressure of gas mixture is sum of partial pressures of its components Henry’s law: Pressure of a gas in liquid is proportional to its pressure in the atmosphere


Barotrauma :Barotrauma Injury caused by compression or expansion of gas in body spaces


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


Ear Squeeze :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


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


Lung Trauma :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


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


Arterial Air Embolism :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


Arterial Air Embolism :Arterial Air Embolism Rapid onset of: Alterations in consciousness—usually within 10 minutes Hemiplegia Unequal pupils Cardiopulmonary failure Vertigo Visual disturbances


Arterial Air Embolism :Arterial Air Embolism Management ABC’s 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


Decompression Sickness :Decompression Sickness


Decompression Sickness :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


Decompression Sickness :Decompression Sickness Cutaneous bends Itching Mottled rash


Decompression Sickness :Decompression Sickness Musculoskeletal DCS (“Bends”) “Dull ache” in muscles/joints Movement worsens pain Fatigue Inflating BP cuff over area relieves pain


Decompression Sickness :Decompression Sickness Central nervous system DCS Brain involvement CVA like symptoms Paresthesias “Staggers” Spinal cord involvement Paralysis


Decompression Sickness :Decompression Sickness Pulmonary DCS --“Chokes” Chest pain Cough Dyspnea Pulmonary edema


DCS Management :DCS Management ABC’s 100% Oxygen IV with LR Lateral recumbent position if air embolism suspected Transport to recompression chamber Steroids on Medical Control orders


Nitrogen Narcosis :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


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


Diving Incident Assessment :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? Diver’s appearance immediately after dive?


Diver’s Alert Network :Diver’s Alert Network (919) 684-8111 (emergency) www.diversalertnetwork.org (919) 684-2948 (non-emergency)