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Decompression Sickness

Intro

Most problems that arise from barotrauma will require medical diagnosis or treatment. The most important thing the patient can do if they experience barotrauma is to seek medical attention and avoid future dives until cleared by a doctor.

Some injuries from barotrauma require immediate medical attention, while others can wait for treatment. In all cases, stop further diving until the patient has been seen by a doctor.

Air embolism is life threatening and requires immediate attention. Planning ahead is important.

Know the location of the nearest emergency facility and recompression (hyperbaric) chamber before you dive.

Bring emergency phone numbers with you on the dive. A phone can be the best immediate life saving tool.

If a diver collapses within 10 minutes of diving, suspect air embolism and seek help immediately. Find out in advance if such a number is available and how to activate emergency medical services when diving in a foreign country. A diver who has collapsed requires oxygen and emergency life support. Lay the person flat and keep the diver warm until help arrives.

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Decompression sickness also requires immediate attention, but its symptoms may not appear as quickly as those of air embolism.

Information on recompression chambers is important and generally can be obtained through the emergency medical system (911 in the U.S.).

Divers with complaints consistent with decompression sickness should seek attention through their doctor or a hospital's emergency department.

Pulmonary barotrauma and lung squeeze will require attention in an emergency department in most instances because the studies required to evaluate the symptoms and determine the possible treatment must be performed in the hospital environment.

A doctor can evaluate and treat ear squeezes and sinus squeezes initially and refer the patient to a specialist if required.

Evaluation may require a dive history.
Ear squeezes require an examination to ensure the eardrum has not ruptured.

The diver needs immediate medical attention if they lose consciousness, show paralysis, or exhibit stroke symptoms within 10 minutes of surfacing.

You or your diving buddy should contact an ambulance through 911 or the local emergency phone numbers.

Symptoms of chest pain  and Shortness of breath may occur minutes to hours after a dive. These require emergency department evaluation.

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If the symptoms are severe enough, contact an ambulance. Otherwise, have someone drive the patient to the hospital, but do not drive yourself.

These symptoms can be dive-related or could be caused by another condition, such as a heart attack. This will be sorted out in the hospital.

Decompression sickness, or "the bends,” may require an emergency department to control pain and arrange for recompression services using specialized equipment that is available only at regional centers that specialize in barotrauma. 

Dizziness  or pain from a squeeze may require emergency attention as well. When in doubt, contact a doctor or a local emergency department for advice.

Self-Care at Home

There is no special treatment for face mask and suit squeezes. They usually go away in a few days.

Aerogastralgia symptoms usually clear up on their own and do not require attention unless the abdominal  discomfort continues to worsen and does not go away in a few hours.

Pain from ear or sinus squeezes can be treated with over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen. The patient should visit a doctor to exclude possible serious ear injuries.

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Follow-up

Doctors will recommend follow-up based on the diagnosis.
Make sure everything has healed and the patient has received clearance before diving again.

Prevention

The best prevention against barotrauma is to plan and prepare for your dive properly.
Make sure you are in good health with no upper respiratory or sinus problems.
Obtain the proper training and always use the buddy system (never dive alone).
Check that your equipment is in good working order.
Know the local emergency phone numbers in advance and have a means of contacting help, for instance, with a cellular phone. (The location of the nearest recompression facility could be very important in a problem such as air embolism.)
Newer "dive computers" designed to maximize safety can be used and may allow longer diving times and fewer or shorter decompression stops. They provide information similar to the original diving tables but are more precise. Be certain you are familiar with their use before depending on them.
Avoid flying in a plane within 24 hours of diving to reduce the risk of "the bends" occurring unexpectedly in the lower air pressure of an airplane cabin.

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