Scuba divers can face a variety of medical challenges and are at risk of injuries that are typically caused by the change in pressure. Therefore, Matthew Kelly, M.D., co-medical director of the University of Alabama at Birmingham Wound Care and Hyperbaric Medicine program, says it is important to assess potential risks before scuba diving and to know the symptoms of diving injuries in order to be able to seek care promptly when needed.
Common scuba diving injuries
One of the most common diving disorders UAB Emergency Medicine experts see is middle-ear barotrauma, which involves damage to the tympanic membrane in the ear due to a difference in the pressure levels inside the ear and the outside environment. This condition can lead to a ruptured eardrum, pain or bleeding inside the ear, and in severe cases, hearing loss. Other symptoms include pressure in the ear, dizziness or ringing.
Some of the more severe diving complications include pulmonary barotrauma and decompression sickness. Pulmonary barotrauma occurs when a diver is rapidly returning to the surface without exhaling or when air is trapped in the lungs. This often occurs when a diver is scared or panicked or if they are running out of air.
“If you’re breathing compressed air underwater, your lungs are fully expanded,” Kelly said. “If you do not exhale and rapidly rise to the surface, the volume of gas in your lungs doubles every 33 feet. The volume of gas expands rapidly if not exhaled and can lead to significant complications.”
The expanding volume of gas can lead to air expanding into the pleural space called pulmonary barotrauma (pneumothorax), to the tissues lining the heart (pneumomediastinum), to the skin (subcutaneous emphysema) or to the blood supply (arterial gas embolism). In rare but serious cases, bubbles entering the blood supply can disseminate to the brain leading to stroke-like symptoms, or the heart causing heart attacks.
Decompression sickness occurs when a diver has been at depth for a prolonged period, and the diver is performing multiple dives per day. When scuba divers are breathing compressed air at depth for a prolonged period, nitrogen builds up in every tissue of the body. As divers ascend to the surface, the water pressure decreases, and the nitrogen comes out of solution forming bubbles. The number of bubbles produced depends upon the depth of the dive, and time spent at depth. If divers ascend too quickly, the rapid decrease in pressure causes excess nitrogen to form bubbles in the blood that can block blood flow and damage tissues leading to decompression sickness. Bubbles in the joints can lead to the bends, meaning pain in the joints, low back or skin. If the bubbles lodge in the brain or spinal cord, this leads to symptoms such as dizziness, headache, brain fog, fatigue, tingling or numbness, weakness in arms or legs, trouble walking, and issues with motor coordination.
UAB is home to four hyperbaric chambers. Primary diagnoses for hyperbaric therapy include compromised grafts and flaps, radiation tissue damage, problem wounds, osteomyelitis, gas gangrene, necrotizing soft tissue infection, crush injuries, carbon monoxide poisoning, air embolism, and thermal burns.
Prevention
“Diving is a safe activity if you follow some simple, safe diving practices” Kelly said. “If you are going scuba diving, you need to make sure you are healthy. This means that you are feeling well, you are hydrated and you have had a good night’s sleep.”
Kelly recommends divers ensure their gear is working properly and that they are monitoring time at depth throughout the dive and avoid having to ascend quickly. He says divers need to follow United States Navy dive tables, which inform how long someone can stay under water and the maximum depths they can go to minimize the chance of decompression sickness. Dive computers can also be used to compute individual guidance based on real-time depth and time inputs.
Treatment
While prevention is key, accidents may still happen. Conditions such as middle-ear barotrauma symptoms may go away on their own; but if they persist or get worse, talk to a health care provider. If someone develops pulmonary complications from diving, they should call 911 or go to the nearest emergency department.
For less severe diving injuries, nasal decongestants, bed rest and fluids may be treatment options. Diving injuries, such as decompression illness, are treated through IV fluids and recompression with hyperbaric medicine. Hyperbaric chambers can be used to recompress the patient by decreasing the number of bubbles in the bloodstream and filling the tissues with oxygen. Hyperbaric medicine and its four chambers are housed within the UAB Department of Emergency Medicine. In therapy, pressure administered to patients is typically two to three times greater than normal atmospheric pressure, causing the blood, tissue and muscles to carry larger amounts of oxygen which can help oxygenate ischemic tissues and expediting the removal of any residual nitrogen bubbles. UAB is home to two of the few board-certified physicians trained in undersea and hyperbaric medicine in the state.
To learn more about UAB hyperbaric oxygen treatment options, visit uabmedicine.org.