Pulmonary barotrauma
Background
- Occurs when diver breathing compressed air ascends too rapidly
Clinical Features
- Symptoms occur minutes to hours after surfacing
- Can occur without rapid ascent in patients with obstructive lung disease
- Lung rupture can lead to:
- Pneumomediastinum
- Pneumothorax
- Air embolism
Differential Diagnosis
Diving Emergencies
- Barotrauma of descent
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
- Barotrauma of ascent
- Pulmonary barotrauma (pulmonary overpressurization syndrome)
- Decompression sickness (DCS)
- Arterial gas embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- At depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
- Caustic cocktail from rebreathing circuit
Barotrauma Types
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
Evaluation
- Clinical diagnosis; do not delay intervention for studies
- CXR
- Assess for alternate etiologies
Management
- Pneumomediastinum and pneumothorax do not require recompression; see management section on those pages
- Air embolism
- IVF (increases tissue perfusion)
- Rapid recompression
References
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