diving

1. DIVING RELATED
ILLNESS

2. 1. Conditions unique to underwater diving
2. Those that also occur during other activities
Further divided into
2a. conditions caused by exposure to ambient pressures significantly different from
surface atmospheric pressure
2b. range of conditions caused by general environment and equipment associated with
diving activities

3.  Variations in ambient pressure
 Barotraumas of descent and ascent
 Decompression sickness

4. BAROTRAUMAS OF DESCENT
(QUEEZES)
 Ear squeeze (alternobaric vertigo)
 Sinus squeeze (aerosinusitis)
 Tooth squeeze (dental barotrauma, barodontalgia)
 Mask squeeze
 Helmet squeeze
 Suit squeeze

5. BAROTRAUMAS OF ASCENT
(OVEREXPANSION INJURIES)
 Lung overexpansion injury (pulmonary barotrauma)
 Pneumothorax
 Interstitial emphysema
 Mediastinal emphysema
 Subcutaneous emphysema

6. BAROTRAUMAS OF ASCENT
(OVEREXPANSION INJURIES)
 Arterial gas embolism
 Intestinal gas overexpansion
 Middle ear overpressure (reversed ear / alternobaric vertigo )
 Sinus overpressure (aerosinusitis)
 Tooth overpressure (dental barotrauma, barodontalgia)

7. NON-DYSBARIC DISORDERS
 effects of the aquatic environment
 drowning
 disorders caused by the equipment
 associated factors, such as carbon dioxide and carbon monoxide
poisoning

8. GENERAL ENVIRONMENTAL
CONDITIONS
 Hypothermia
 Motion sickness
 Injuries by marine and aquatic organisms
 Contaminated waters
 Man-made hazards
 Pre-existing medical and psychological conditions
 Adverse side effects of medications and other drug use

9. DECOMPRESSION SICKNESS
 Decompression sickness (DCS) or diver’s disease
 The bends or caisson disease
 Describes a condition arising from dissolved gases coming out of solution
into bubbles inside the body on depressurisation
 DCS most commonly refers to a specific type of underwater diving hazard
but may be experienced in other depressurisation events such as caisson
working or flying in unpressurised aircraft

10. TYPE I
 Non- systemic
 Peripheral
 Minor
 Clinical features:
 Pain
- Joint and tendon pain
 Lymphatic
- Local lymphatic congestion
 Cutaneous symptoms
- Itching
- Rash
- Localised cyanosis
- Cutis Marmorata

11. Type I DCS
Skin DCS
 Itching and mild urticarial- no Tx needed
 Cutis Marmorata- more serious
- Deep red or purple marbling or mottling
- Blanches with pressure suggests vascular etiology
- May be associated with itching
- Tends to be associated with subsequent serious DCS
- treat as Type II DCS

12. TYPE II
 Systemic, serious
 Clinical features
 Cerebral- cerebellar
- Altered consciousness
- Visual disturbances
- Auditory, vestibular symptoms
 Spinal
- Paralysis, paresis
- Bladder or bowel dysfunction
- Sensory disturbances
 Pulmonary
- Dyspnea, cough
- Desaturation
- Circulatory collapse

13. GENERAL ASSESSMENT
 Early assessment and treatment
 Develop the diving history
 Time at which the signs and symptoms occurred
 Type of breathing apparatus utilized
 Type of hypothermia protective garment worn

14. ASSESSMENT APPROACH
 Airway Assess, secure
Not a problem unless obtunded
 Breathing Assess, assist
Not a problem unless obtunded
 Circulation IV line with crystalloid to restore volume

15. ASSESSMENT APPROACH
 Drugs No drugs until diagnosed
or required to stabilize circulation
 Evaluation Rapid neurological assessment
 Investigations as necessary

16. TREATMENT
 100% oxygen initially
 Hyperbaric oxygen
 IV fluids
 Recompression therapy

17. PREVENTION
 Limiting the depth and duration of deep sea dives
 Following standard diving guidelines
 Avoiding diving if obese, pregnant, heart or lung problems, or had a recent
joint or limb injury
 Avoiding excessive alcohol consumption for 24 hours before diving

18. PREVENTION
 Avoiding flying for 24 hours after deep sea diving
 Avoiding repeated dives within a 12 hour period
 Taking ibuprofen to help prevent altitude sickness when hiking
 Avoiding flights in non-pressurized aircraft