Scuba Diving

Aka: Scuba Diving, Scuba, Underwater Diving, Barotrauma, Diving Barotrauma, Dysbarism, Scuba Diving Injury

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II. Epidemiology

  1. Certified divers in United States: 9 million
  2. Distribution
    1. Coastal areas
    2. Inland water areas: lakes, streams, quarries
    3. Distant travel (e.g. island resorts)
  3. Annual injuries in United States
    1. Deaths: 90 per year
    2. Injuries requiring Recompression Therapy: 1,000/year

III. Contraindications

  1. Pregnancy
  2. Seizure Disorder
  3. Prior Pneumothorax
  4. Diabetes Mellitus

IV. Causes: Injuries - Barotrauma

  1. Middle Ear Barotrauma (Barotitis Media)
    1. Otalgia
    2. Vertigo
    3. Tympanic Membrane Rupture or Hemorrhage
    4. Facial baroparesis resulting in Bell's Palsy
  2. Inner Ear Barotrauma (Round and oval window rupture)
    1. Causes Tinnitus, Vertigo, Hearing Loss
    2. Avoid strenuous activity
  3. Alternobaric Vertigo
  4. Sinus Barotrauma (Sinus Squeeze)
    1. Causes sinus pain and Epistaxis
    2. Responds to topical and Systemic Decongestants
  5. Gastrointestinal Barotrauma (aerogastralgia)
    1. Causes Colicky Abdominal Pain and Belching
    2. Prevent by clearing in head up position
  6. Tooth squeeze (Barodontalgia)
    1. Causes Tooth Pain while diving
    2. Prevent by no diving 24 hours after dental work
  7. Mask Squeeze
    1. Causes Corneal injection and Conjunctival Hemorrhage
    2. Prevent by ventilating mask while diving
  8. Pulmonary Barotrauma
    1. Arterial Gas Embolism
    2. Mediastinal Emphysema
    3. Subcutaneous Emphysema
    4. Pneumothorax

V. Causes: Injuries - Decompression Sickness

  1. Type I Decompression Sickness (Constitutional DCS)
  2. Type II Decompression Sickness
    1. Inner Ear DCS
    2. Neurologic DCS (Cerebral DCS and Spinal Cord DCS)

VI. Causes: Injuries - Other Conditions

  1. Oxygen Toxicity (associated with Nitrox use)

VII. Symptom: Headache Approach

  1. General Causes
    1. Migraine Headache
    2. Tension Headache
    3. Sinusitis
  2. Scuba-specific Causes
    1. Cerebral Decompression Sickness
    2. Breathing Gas contamination with Carbon Monoxide
    3. Arterial Gas Embolism
    4. Oxygen Toxicity
    5. Tight Face Mask
    6. Sinus Barotrauma

VIII. Prevention

  1. Prepare for Scuba Diving
    1. Avoid Alcohol before diving
    2. Do not dive alone
    3. Plan dive in advance and follow plan
    4. Stay within no-decompression limits
  2. Avoid airplane flight immediately after Scuba Diving
    1. No decompression dive: no flight for 12 hours
    2. Decompression dive: no flight for 24 hours

IX. Resources (from Newton, 2001 - see references)

  1. Divers Alert Network (DAN)
    1. http://www.diversalertnetwork.org
  2. Scubamed (Underwater Medicine Associates)
    1. http://www.scubamed.com
  3. Undersea and Hyperbaric Medical Society
    1. http://www.uhms.org
  4. Association of Commercial Diving Educators
    1. http://www.diveweb.com/acde/
  5. National Association of Undersea Instructors (NAUI)
    1. http://www.naui.org
  6. PADI
    1. http://www.padi.com
  7. Scuba Schools International
    1. http://www.ssiusa.com

X. References

  1. Clenney (1996) Am Fam Physician 53(5):1761-6 [PubMed]
  2. Melamed (1992) N Engl J Med 326:30-5 [PubMed]
  3. Newton (2001) Am Fam Physician 63(11): 2211-2226 [PubMed]

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Related Studies

Ontology: Dysbarism (C0004760)

Definition (MEDLINEPLUS)

Barotrauma means injury to your body because of changes in barometric (air) or water pressure. One common type happens to your ear. A change in altitude may cause your ears to hurt. This can happen if you are flying in an airplane, driving in the mountains, or scuba diving. Divers can also get decompression sickness, which affects the whole body.

Common symptoms of ear barotrauma include

  • Pain
  • A feeling that your ears are stuffed
  • Hearing loss
  • Dizziness

Treatments for ear barotrauma include chewing gum and yawning to relieve the pressure. Medications such as decongestants may also help.
Definition (MSH) Injury following pressure changes; includes injury to the eustachian tube, ear drum, lung and stomach.
Definition (CSP) a general term applied to any clinical syndrome caused by difference between the surrounding atmospheric pressure and the total gas pressure in the various tissues, fluids and cavities of the body.
Concepts Injury or Poisoning (T037)
MSH D001469
ICD10 T70.29
SnomedCT 157730009, 217614008, 270549006, 44532001, 406445001
English Barotrauma, Barotraumas, Dysbarism, Acc-extreme,atmosphric press+to sud change in atmos pressure, Acc-extrm+changes,atmos presre, air pressure-related disorder, accident caused by changes in air pressure (diagnosis), accident caused by changes in air pressure, Barotrauma NOS, Barotrauma [Disease/Finding], Adverse effect;air pressure, barotrauma, barotraumas, Accident due to extremes of atmospheric pressure and to sudden changes in atmospheric pressure (finding), Accident due to extremes of atmospheric pressure and to sudden changes in atmospheric pressure, dysbarism, air pressure; adverse effect, Accident due to extremes of atmospheric pressure and to sudden changes in atmospheric pressure (event)
Spanish accidente por variaciones extremas y cambios repentinos en la presión atmosférica (evento), Barotrauma NEOM, accidente por variaciones extremas y cambios repentinos en la presión atmosférica (hallazgo), accidente debido a presión atmosférica extrema y a cambios bruscos en la presión atmosférica (hallazgo), accidente debido a presión atmosférica extrema y a cambios bruscos en la presión atmosférica, Barotraumatismos, barotrauma (trastorno), barotrauma, disbarismo, accidente por variaciones extremas y cambios repentinos en la presión atmosférica, Barotrauma
Dutch barotrauma NAO, luchtdruk; gevolg, barotrauma, Barotrauma, Trauma, baro-
French Barotraumatisme SAI, Blessures barotraumatiques, Barotraumatisme, Barotraumatismes
German Barotrauma NNB, Barotrauma
Italian Barotrauma NAS, Barotrauma
Portuguese Barotrauma NE, Barotraumatismos, Barotrauma
Japanese 気圧性外傷ＮＯＳ, 気圧性外傷, ｷｱﾂｾｲｶﾞｲｼｮｳNOS, ｷｱﾂｾｲｶﾞｲｼｮｳ
Swedish Tryckskada
Czech barotrauma, Barotrauma, Barotrauma NOS
Finnish Barotrauma
Russian BAROTRAVMA, БАРОТРАВМА
Croatian BAROTRAUMA
Polish Uraz ciśnieniowy, Barotrauma
Hungarian Barotrauma, Barotrauma k.m.n.
Norwegian Barotraume, Atmosfæretrykkskader, Trykkskader
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Scuba diving (C0240984)

Concepts Daily or Recreational Activity (T056)
ICD10 Y93.15
SnomedCT 75335000
English SCUBA diving, Scuba diving, scuba diving, diving scuba, Activity, SCUBA diving, Scuba diving (qualifier value), Scuba diving, NOS, Scuba diving, function (observable entity)
Spanish natación submarina (calificador), natación submarina
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Diving barotrauma (C0413257)

Concepts Injury or Poisoning (T037)
SnomedCT 241977008
English Diving barotrauma, Diving barotrauma (disorder)
Spanish barotrauma por inmersión (trastorno), barotrauma por inmersión
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Activity, underwater diving and snorkeling (C2712392)

Concepts Daily or Recreational Activity (T056)
ICD9 E002.4
ICD10 Y93.15
English Underwater dive/snorkel, Activity, underwater diving and snorkeling, Activities involving underwater diving and snorkeling, Underwater diving and snorkeling
Derived from the NIH UMLS (Unified Medical Language System)

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