Emergency Medicine

210 Environmental Emergencies

SPORTS-DIVING ACCIDENTS

3 Give midazolam 0.05–0.1 mg/kg i.v., diazepam 0.1–0.2 mg/kg i.v. or

lorazepam 0.07 mg/kg up to 4 mg i.v. for seizures.

(i) These drugs may also be used for severe labyrinthine disturbance

after discussion with a hyperbaric medicine unit.

4 Minimize strong ana lgesics, particularly opiates, as t hey mask sy mptoms.

5 Fill the endotracheal tube cuff with saline to avoid changes in volume on

recompression if mechanical ventilation is required.

6 Refer every patient, however strange their symptoms, to a hyperbaric

medicine unit:

(i) Provide information about any dive in the preceding 48 h,

including the depth and duration, gas mix, time and duration of

symptoms.

(ii) Advice on diagnosis and arrangements for treatment are available

by telephoning local or national hyperbaric medicine units

(a) in a dire emergency ring the police or coastguard, who will

have the relevant contact details.

(iii) Long-distance retrievals require air transport pressurized to 1

atmosphere.

Decompression illness with barotrauma

DIAGNOSIS

1 Middle ear barotrauma

(i) This is the most common medical disorder associated with

diving, almost always occurring on descent.

(ii) Symptoms include local pain, bleeding from the ear and

conductive hearing loss.

(iii) The tympanic membrane appears reddened or may rupture.

2 Inner ear barotrauma

(i) This is associated with too rapid descent.

(ii) Vertigo, tinnitus and sensorineural deafness occur secondary

to rupture of the round or oval windows and an associated

perilymph fistula.

(iii) It mimics labyrinthine CNS decompression illness.

3 Sinus barotrauma

Local pain occurs over the maxillary and frontal sinus, sometimes associated

with bleeding.

4 Dental barotrauma

Pain occurs in or around fillings or carious teeth and percussion of the

involved tooth is painful.