Diving Emergencies

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Quick Chart

Introduction

Diving injuries include but are not limited to:
- Arterial Gas Embolism
- Decompression Sickness
- Pulmonary barotrauma

Clinical Presentation

Decompression illness (DCS and AGE):

Decompression Sickness (DCS): Where the nitrogen absorbed into the body’s tissues during a dive as a result of pressure changes does not have time to diffuse from the tissue back into the bloodstream and be eliminated by the lungs. That nitrogen stays as bubbles in the tissue, blood or lymphatic system. Any organ in the body may be affected.
Arterial Gas Embolism (AGE): A bolus of gas or air within the blood vessels, which may be caused by over-inflation of the lungs following traumatic chest injury, secondary to distension or barotraumatic rupture of alveoli due to trapped gases in scuba divers. Can also occur during mechanical ventilation.
Clinical Presentation:
- Extreme fatigue
- Numbness/tingling
- Headache or other body pain (joint)
- Poor balance/coordination
- Irritability, confusion, decreased GCS
- Weakness, paralysis
- Rash
- Speech, visual/hearing disturbances

Pulmonary Barotrauma

Pulmonary Barotrauma: Injury produced as the result of volume increases in air-filled cavities expanding on ascent.
Clinical Presentation:
- Chest pain
- SOB
- Coughing
- Cyanosis
- Dysphagia
- Surgical emphysema around neck
- Decreased GCS

Exclusion Criteria

Risk Assessment

Note circumstances surrounding the event including dive history — depth, duration, repetitive dives, ascent, time of onset of problem.
Definitive treatment for decompression illness is recompression and should be sought as soon as possible. Fiona Stanley Hospital provides hyperbaric treatment for Western Australia.
A supine posture without leg elevation is recommended in injured divers suspected of DCI as it has been shown to increase the rate of inert gas elimination. It may also reduce the likelihood of arterial bubbles migrating to the brain.
However, if a conscious diver is having increased SOB when supine, they can be placed in a position of comfort.
Administration of 100% oxygen reduces the size and number of gas bubbles in the bloodstream and tissue by helping to eliminate the inert gas in the bubbles and blood.
Symptoms of arterial gas embolism almost always begin within 10 minutes of surfacing and are primarily neurological in nature.
Joint pain can occur at depths less than 10 m, and any joint pain within 24-48 hours of a dive should be treated as decompression sickness.
Obesity lengthens the time during which the diver is at risk of DCI, as nitrogen is slowly absorbed and slowly released.
Coronary artery emboli may present as an acute myocardial infarction or dysrhythmia.

Management

Primary Care

Intermediate Care (EMT / Level 2)

Apply cardiac monitor if trained and authorised
Consider pain relief as required
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if patient time critical, pre-notifying receiving facility

Advanced Care (AP)

Apply cardiac monitoring
Establish vascular access
Consider fluid therapy as per CPG
Consider pain relief as required
Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
Transport Priority 1 if patient time critical, pre-notifying receiving facility;
- As per Clinical Services Matrix, Fiona Stanley Hospital is the suitable destination for hyperbaric treatment

Critical & Extended Care (CCP, PSO)

Additional Information

References

Key Terms & Links

Colour assist:

Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Published Date

Review Date