Medical Disorders Related to Diving

Abstract

Exposure to the underwater environment is associated with several unique disorders that may require recompression in a hyperbaric chamber. Increasing pressure during descent reduces the volume of the paranasal sinuses and middle ear, which, if not properly equalized, will sustain injury due to barotrauma. Barotrauma of the inner ear results in vertigo, tinnitus, and often permanent hearing loss. During ascent, expanding gas can produce lung injury accompanied by pneumothorax, mediastinal and subcutaneous emphysema, injection of air into the pulmonary veins, and arterial air embolism to the brain. Divers with pulmonary barotrauma often present with unconsciousness, seizures, or other evidence of cerebral dysfunction. Rapid treatment with recompression often reverses the cerebral deficits. Air embolism lesions are usually diffuse, in contradistinction to a stroke which usually follows the distribution of a single cerebral artery. Decompression sickness is a disorder caused by evolution of supersaturated dissolved gas in tissues and blood following exposure to increased pressure. Protocols for avoiding excess supersaturation during ascent from depth have been available for more than 100 years, and diving is considered safe when established decompression schedules are followed. Decompression sickness causes pain in the joints of the upper and lower extremities, and can injure the spinal cord. Paralysis, paresthesias, sensory loss, and bowel and bladder paralysis accompany spinal cord injury. Treatment involves recompression and oxygen. Platelet inhibitors and other anti‐inflammatory drugs are also useful. A diving disorder must be considered in any patient with a neurologic syndrome, vertigo, hearing loss, or joint pain following diving.

Acute ischemic colitis secondary to air embolism after diving

“…The most common clinical manifestations result from gas emboli to the brain which can occur on ascent and produce syncope. [9]…”

“…[7] If a diver ascends to the surface too quickly, the partial pressure of the gases saturated in the tissue may exceed the ambient pressure, leading to formation of bubbles which can enter into circulation. [1] The most common symptoms of localized pain, numbness/paresthesia, and muscular weakness typically present within the first 24 hours, while symptoms of gas embolism from pulmonary barotrauma occur immediately upon ascent[910] [Tables 1 and 2]. Because subtle symptoms of pulmonary barotrauma may not be recognized until hours later, timing of symptoms should not become the only criterion for distinguishing barotrauma from decompression sickness.…”

“…Because subtle symptoms of pulmonary barotrauma may not be recognized until hours later, timing of symptoms should not become the only criterion for distinguishing barotrauma from decompression sickness. [9]…”

“…[17] Arterial gas embolization is the second most common cause of death to divers, with sequela dependent on the final destination of the emboli with mortality rate from 7 to 14%. [79]…”