Management of Diving Injuries

Diving Injuries and Illnesses Due to the pressure changes and the aquatic environment, diving may cause diseases which are unique and different than non-divers. Examples of these: Decompression Sickness Arterial Gas Embolism Barotrauma Dysbaric Osteonecrosis Nitrogen Narcosis Oxygen Toxicity Hypoxia, Carbon Dioxide Toxicity and Breathing Gas Contamination Drowning Stings, Bites and Poisoning from Dangerous Marine Animal Decompression Illness During a dive, nitrogen from the compressed air that the diver breathes is dissolved into the blood and body tissues in accordance to Henry’s law. When the diver returns to the surface, nitrogen may come out of solution in the form of bubbles, due to the high gradient between the partial pressures of the nitrogen in the tissues and the environment. The manifestations of DCS depend on the organs or tissues affected by bubble formation. The commonest presentations of DCS are generalized symptoms of weakness, tiredness, apathy and malaise. Musculoskeletal symptoms presents with pain, and limitation of movement of the affected joint. Neurological DCS presentations are varied with involvement of the cerebral, cerebellar, inner ear, vision and peripheral nerves. DCS may also present with cardiorespiratory and cutaneous involvement. More recently, an umbrella term ‘acute decompression illness’ (DCI) is used for both DCS and Cerebral Arterial Gas Embolism (CAGE), as their presentation and treatment is similar. Recompression treatment is the definitive treatment of both DCS and CAGE. Delay increases both morbidity and mortality. The increase in pressure during treatment reduces the bubble size (Boyle’s law), while oxygen hastens bubble resolution by enhancing the diffusion gradient between the bubble and its surroundings.