6-4
Dental barotrauma: Analgesics. Re-fill the tooth ensuring no air remains in chamber.
Sinus barotrauma: Stop dive and surface slowly, topical and systemic pain relief as necessary. If bleeding
does not stop, pack turbinates with gauze coated in antibiotic ointment in the opening of the affected sinus.
If packing material is left in more than one hour, patient must be prescribed a prophylactic antibiotic (i.e.,
Augmentin) to prevent toxic shock syndrome.
GI barotrauma: Ascend slowly from dive
Skin barotrauma: Analgesics as necessary
Facemask squeeze: Analgesics as necessary.
Patient Education
General: Educate patient on the cause of injury. Prevention is possible with all of these injuries.
Dental barotrauma: Practice good oral hygiene. Ensure fillings have no trapped gas pocket.
Sinus barotrauma: Explain how sinuses can become blocked and force blood vessels to leak while under
increasing pressure. Avoid diving with URIs, mucosal polyps or allergic symptoms.
GI barotrauma: Encourage flatulence prn on ascent.
Skin barotrauma: Ensure dry suit fits properly.
Facemask squeeze: Equalize mask.
Diet: Normal
Medications: Over-the-counter analgesics prn. Tylenol is usually enough for pain relief (avoid aspirin and
first generation NSAIDS if persistent bleeding is present), topical and systemic decongestants prn.
Prevention and hygiene: Do not dive until all symptoms have resolved.
No Improvement/Deterioration: Consult Diving Medical Officer.
Follow-up Actions
Return evaluation: As needed.
Consultation Criteria: Dental barotrauma requires dental consult prior to returning to diving.
Decompression Injuries
Dive Medicine: Decompression Sickness
(the Bends, Caisson Disease)
CPT Jeffrey Morgan, MC, USAIntroduction: While breathing air under pressure (i.e., underwater), nitrogen is dissolved into body tissues.
Increased pressure and prolonged exposure saturates these tissues with nitrogen. When the body is
decompressed, the nitrogen comes out of solution to form bubbles in the vasculature or tissues. When
the body is decompressed too fast in relation to the nitrogen load (based on time and depth of dive; listed
extensively in the Navy Dive Tables), too many bubbles can form. These bubbles may precipitate out into the
vascular system, skin, lungs, ears and other tissues causing a variety of symptoms that are categorized into
Type I (mild) and Type II (severe) Decompression Sickness (DCS). Any neurological symptom is classified as
Type II DCS. Spinal symptoms (neurological) are common in DCS associated with diving. Cerebral symptoms
are common from rapid decompression at high altitudes (i.e., pilot ejecting at altitude). Some authors estimate
that 30% of people with typical Type I pains can have accompanying Type II symptoms. Most symptoms
of DCS occur within the first 24 hours of surfacing. When the caregiver is not sure if the DCS is Type I
or II, treat as Type II DCS.
Subjective: Symptoms
DCS (Type I): Skin itching and rashes; skin marbling; red/purple patches; limb swelling; peau d’orange (skin is
dimpled like an orange); most joint and/or muscle pain (classically a deep dull ache)
DCS (Type II): Any Type I symptom can be present plus: various neurological symptoms: numbness,
tingling, tremors, paralysis, paresthesia, mental status changes, fatigue, amnesia or bizarre behavior, light-
headedness, poor coordination or incontinence; inner ear symptoms (staggers): ringing in ears, vertigo,
hearing loss, dizziness, nausea, or vomiting; cardiopulmonary symptoms (chokes): chest pain (worse with