9.17. INJURIES AS A RESULT OF DEEP DIVING

Related titles

Barotrauma.

Purpose of assistance

1. Quick examination and treatment of emergency conditions.
2. Rescue from the water environment.
3. Transport SCBA, diving trauma patients to the hospital for evaluation and consideration of reverse pressure/hyperbaric oxygen therapy.

Description of the patient

Inclusion criteria

Patients with a history of recent (within 48 hours) diving activity who exhibit potential signs and/or symptoms of diving-related illness/injury, regardless of compliance with the diving chart.

WARNING: Complications related to scuba diving can occur anywhere, especially during a flight within 24 hours of the dive.

Exclusion criteria

Patients who have not dived under water with scuba diving in the last 48 hours.

Management of patients

Status assessment

1. Act in accordance with the instruction “General rules of assistance”.
2. The history should include the circumstances leading to the complaint, details of the mechanism of injury, time underwater, depth of dive, adherence to dive charts/decompression stops, use of gas mixture and water temperature (if applicable).
3. Be alert for signs of barotrauma (pulmonary barotrauma, arterial air embolism, pneumothorax, ear/nasal sinus/dental barotrauma) and/or signs of decompression sickness (joint pain, altered level of consciousness, other neurological symptoms including paralysis) or exposure nitrogen narcosis (disorientation, intoxication).
4. Assess for other associated injuries, such as: head or spine injury (if mechanism and symptoms suggest), marine intoxication from venomous sting, hypothermia, or other injuries.

Treatment and intervention

1. If the incident during scuba diving involves drowning – see instruction “Drowning”.

2. Control the patency of the respiratory tract.

3. If air embolism is suspected, position the patient in the left lateral recumbent position with the legs brought up to the chest.
The Trendelenburg position is sometimes recommended to help capture air in the dependent right ventricle and may be helpful if central venous catheter to remove air, but this position may increase brain swelling.

4. Monitor vital signs, including oxygenation and heart rate (if applicable).

5. Give additional oxygen to achieve saturation – 94-98%.
Carefully use positive pressure ventilation (for example, PPTD) if barotrauma is suspected (see “Airway Control” guideline).

6. With symptoms that cause suspicion of decompression sickness, be sure to use oxygen therapy, regardless of the saturation readings, to enhance the flushing of inert gases.

7. Assess for hypothermia, treat according to the guideline “Hypothermia/exposure to cold environment”.

8. Contact medical management and discuss the need for hyperbaric therapy and the method of transportation to the receiving unit with equipment for this therapy. In the anamnesis, specify the following details:

a) diving time;
b) greatest depth reached during diving;
c) rate of ascent to the surface;
d) gas mixture .

9. Provide I/O access.

10. Infusion therapy if necessary.

Patient safety

1. If the patient is still in the water, find the safest and fastest way to evacuate (within your authority and skills) while minimizing further damage.
2. Call for help immediately, if special rescue/evacuation methods are needed and transport is needed.
3. Check the number of patients (possible error in compliance with diving protocol for group diving).

Useful information for training

Key points

1. All emergency services involved must coordinate efforts to ensure rapid access to and rescue of the patient.
2. If air transport is necessary, the patient must be transported in a special pressure chamber with the lowest possible pressure. In case of transportation by conventional helicopter(without a special camera) you need to fly at the lowest possible altitude.
3. With decompression sickness, various manifestations are possible, depending on the affected system (skin, joints, respiratory or nervous system).
4. Scuba diving accidents can lead to a variety of problems, including barotrauma, air embolism, and decompression sickness.

Corresponding evaluation results

1. Vital indicators.
2. Evaluation of neurological status.
3. Assessment of respiratory status (saturation, respiratory rate).
4. Presence of subcutaneous emphysema.

Key elements of documentation

1. Water temperature (if known).

2. Dive details:

a) number of dives in recent days;
b) longest dive;
c) dive profile;
d) maximum dive depth;
br />e) rate of ascent to the surface of the water;
e) stopping (if used);
e) mixture of gases in the scuba tank.

3. Time of onset of symptoms.

4. Anamnesis of subsequent exposure to altitude difference after diving (flight on an airplane).

5. Any related damage or injury.

Criteria for the effectiveness of aid provision

1. Recognition and proper treatment of breathing and respiratory system problems.
2. Transportation to the nearest institution of the appropriate level of care (with available equipment for hyperbaric therapy, if indicated).
3. Recognition of the need for hyperbaric oxygen therapy and transfer of this information to the reception department.