6-21
Objective: Signs
Using Basic Tools: Rapid respiratory rate; choking and gagging; red, irritated and burned mucosa; pharynx
may swell, compromising airway; lungs may develop rales.
Assessment:
Differential Diagnosis - laryngospasms secondary to inhalation of saltwater. There will not be any burning
or redness with this event.
Plan:
Treatment
- Place patient in an upright position in the water and remove mouth from caustic source.
- Repeatedly rinse mouth with fresh water. When foul or sour taste is gone, have the diver swallow
several mouthfuls. If only seawater is available, only rinse mouth. Do not have the patient swallow
any of the seawater. - If the injury is severe and extends down to the lungs, secure the airway and apply 100% O 2. Patient
may require intubation and mechanical ventilation, as well as immediate evacuation.
Patient Education
General: Remain calm and do not hyperventilate, which may worsen symptoms.
Activity: Rest until symptoms are gone and medic ensures there is no pulmonary or airway involvement.
Diet: Avoid eating until foul or sour taste is gone and pulmonary involvement is ruled out.
Prevention and Hygiene: Avoid getting water into CO 2 scrubber canister.
Wound Care: Rinse burned areas with water.
Follow-up Actions
Return Evaluation: If no hospitalization is needed, follow-up daily until symptoms are completely resolved.
Evacuation/Consultation Criteria: If respiration becomes labored or airway starts to swell, secure airway
immediately and apply 100% O 2. Evacuate immediately and consult a Diving Medical Officer or pulmonologist.
Dive Medicine: Disqualifying Conditions for Military Diving
CPT Jeffrey Morgan, MC, USAIntroduction: All the conditions that make diving dangerous cannot be adequately discussed in this short
section. Consequently, diving medical personnel must evaluate each disease/injury process and the limita-
tions it may produce in the context of diving physiology. Each branch of service has different standards for
disqualifying individuals from diving duty, but much authority rests in the hands of the Diving Medical Officer
(DMO). Standards for qualified divers are different from those who are entering training. The following list
includes medical conditions that are generally considered disqualifying (temporary or permanent) for diving
duty in all branches of the U.S. military.
Ocular: Visual acuity that does not correct to 20/20. Each service has different regulations for uncorrected
acuity. The main consideration is that poor visual acuity must be correctable to 20/20. All services prohibit
radial keratotomy surgery, but photo radial keratotomy is acceptable as a surgical correction for acuity. Color
and night vision must be normal.
Pulmonary: Spontaneous pneumothorax, traumatic pneumothorax (6 month disqualification), history of
sarcoidosis; isoniazid (INH) treatment for positive PPD, recurrent pulmonary barotrauma, any exercise-limiting
pulmonary diseases (including pnuemonia), respiratory airway diseases or asthma after the age of 12; COPD.
Psychiatric: Any diseases with potential to hinder performance, judgment or reliability; any psychotic
disorder; any depressive or anxiety disorder that required hospitalization, involved work loss, involved suicidal
gestures or required medication; alcohol dependence w/o 1 year of sobriety and aftercare; panic prone