Deceptive bends

2. CASE 1
• 42 year old male
• First dive in 6 years
• Own equipment
• 40 mins at 15 metres in rough seas
• NO rapid ascent
• Developed cough and SOB 1 hour post diving
• Gradually worsened
• Associated fever/chills

3. CASE 1- DIAGNOSIS?
• On examination
• Hypoxic with sats 92%
• Patchy opacities on CXR
• No pneumothorax
• Temp 37.8 degrees

5. Case 1 – Salt water aspiration syndrome
• First described in Royal Navy divers in the
1960s
• Aspiration of a fine mist of seawater from
faulty equipment/ flooded demand valve
• Often a delay to presentation
• Similar presentation to a LRTI
• Self limiting, supportive treatment with
oxygen
• Differential diagnosis

6. CASE 2
• 54 year old female
• Experienced diver
• Diving on Swan Wreck (30m dive)
• NO problems during the dive
• At 5m deco stop developed SOB
• LOC, bought to surface by buddy
• Controlled ascent
• PMH – HTN on B Blocker (variable compliance)

7. CASE 2 - DIAGNOSIS?
• Regained consciousness on boat
• Transferred to ED
• Alert, normal neuro exam
• Clinical signs of APO
• ECG – ST depression in V5, V6
• Troponin mildly elevated
• CXR –consistent with APO

8. Case 2 – Immersion pulmonary oedema
• Usually rapid onset, can occur during any part
of the dive
• Likely due to increase in preload
• Patients often have hypertension
• Increased risk with B Blockers
• ? likelihood of recurrence
• Normal coronary arteries

9. CASE 3
• 26 year old male
• Experienced diver
• Recent URTI
• Difficulty equalising throughout dive
• Diving to 20 metres for 35 mins
• Developed acute onset dizziness whilst lifting tanks
back on the boat
• No history of rapid ascent
• Nausea and vomiting
• Tinnitus and fullness in right ear

10. CASE 3 – DIAGNOSIS?
• On examination
• Vomiting, unable to stand
• Horizontal nystagmus
• Hearing loss in right ear (high frequency)
• Sensorineural hearing loss

11. Case 3 – Inner ear barotrauma
• Excessive force with difficulty equalizing
• Damage to round window (most often), oval
window or membrane rupture within
labyrinth (Reissner’s membrane)
• Perilymph fistula
• Differential diagnosis – inner ear DCI

12. Case 4
• Free diver
• Multiple free dives to max 10 metres over
course of morning
• Developed painful red rash on forearm
• Abdominal pain, tachycardic, sweaty
• ?DCS

14. Taravana

16. Shallow Water Black Out
• Severe hyperventilation
prior to breath-hold
diving is the single most
dangerous practice in
open water, causing
blackout during the
ascent phase.

17. Questions?