6-20
- Control any bleeding in sinuses (see Dive Medicine: Barotrauma, Other).
- Transport to a medical treatment facility as soon as possible.
- Monitor patient for at least 24 hours after injury. Some of the injuries listed above may present after a
latent period. Treat for AGE and DCS as needed. Any signs of acute abdomen must be evaluated by a
general surgeon.
Patient Education
General: Reassure patient.
Activity: Bed rest for at least 24 hours; immobilize until spine injury is ruled out. As tolerated after the
first 24 hours.
Diet: Keep patient NPO until surgery is ruled out. Keep patient hydrated with IV fluids (normal saline or
Ringer’s Lactate). Do not over hydrate.
Medications: Methylprednisolone side effects may include: peptic ulcers, masking of infections, increased
intracranial pressure, glaucoma, hypokalemia, hypocalcemia, and hyponatremia.
Wound Care: Keep wounds clean, dry and dressed.
Follow-up Actions
Return evaluation: Observe patient for at least 24 hours. Once discharged from constant (hospital) care,
follow-up daily or every other day until all injuries resolve. Treat for decompression.
Evacuation/Consultation Criteria: Evacuate all unstable patients, including those with CNS effects. Consult
a general surgeon for any complicated patient, as well as any ENT or orthopedic surgeon as required.
Calculating safe distance from underwater detonation
PSI (lbs/in 2 ) = 13,000 x 3(Weight of the explosive) x RE Factor
Distance in feet
RE (Relative Effectiveness) Factor: Based on the type of explosive used. Examples include:
Dynamite (M1) = 0.92
TNT = 1.0
C4 (M112) = 1.34
HBX-1, HBX-3, and H-6 = 1.68
< 50 PSI: Safe area with no expected injuries
200-300 PSI: Lung and Gastrointestinal injuries expected
500 PSI: Possible fatality
2000 PSI: Certain death.
Dive Medicine: ‘Caustic Cocktail’ Chemical Burn
CPT Jeffrey Morgan, MC, USAIntroduction: Closed-circuit (no respiratory gases escape the breathing apparatus) and semi closed-circuit
diving rigs use carbon dioxide (CO 2 ) absorbent chemicals to remove or scrub CO 2 from breathing gases. If
water mixes with this solid substance (i.e., water may leak into the chemical canister), an alkaline solution
forms. Inhaling or swallowing this solution causes chemical burns of the pharynx and trachea.
Subjective: Symptoms
Burning in mouth and throat, possible headache, choking and gagging with a foul taste in mouth; in severe
cases burning may extend all the way down into the lungs. History may include water getting into the
rebreather rig. Disassembling the rig may find water in the CO 2 canister.
Focused History: Did your mouth start burning after you inhaled water from your rebreather rig? (typical
history)