Scuba Diving

Aka: Scuba Diving, Scuba, Underwater Diving

1. 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
2. Contraindications
   1. Pregnancy
   2. Seizure disorder
   3. Prior Pneumothorax
   4. Diabetes Mellitus
3. 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
4. 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)
5. Injuries: Other Conditions
   1. Oxygen Toxicity (associated with Nitrox use)
6. 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
7. 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
8. 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
9. 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]