UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Complications of SCUBA diving

Authors
Dipak Chandy, MD
Gerald L Weinhouse, MD
Section Editor
Daniel F Danzl, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

There are more than 9 million recreational SCUBA (Self-Contained Underwater Breathing Apparatus) divers in the United States alone, and another several hundred thousand new divers are trained annually [1]. The incidence of diving-related disorders has increased in tandem with this increasing population at risk. The Divers Alert Network (www.diversalertnetwork.org) records more than 1000 diving-related injuries annually, of which almost 10 percent are fatal [2]. Hypothermia, trauma, and submersion-related injuries are potential complications of diving. (See "Accidental hypothermia in adults" and "Drowning (submersion injuries)".)

In addition, a variety of emergencies specific to diving may occur. These include [1,3]:

Barotrauma, including arterial air embolism

Decompression sickness

Nitrogen narcosis

                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu May 19 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. DeGorordo A, Vallejo-Manzur F, Chanin K, Varon J. Diving emergencies. Resuscitation 2003; 59:171.
  2. Newton HB. Neurologic complications of scuba diving. Am Fam Physician 2001; 63:2211.
  3. Taylor DM, O'Toole KS, Ryan CM. Experienced scuba divers in Australia and the United States suffer considerable injury and morbidity. Wilderness Environ Med 2003; 14:83.
  4. Braun R, Krishel S. Environmental emergencies. Emerg Med Clin North Am 1997; 15:451.
  5. Hardy KR. Diving-related emergencies. Emerg Med Clin North Am 1997; 15:223.
  6. Balk M, Goldman JM. Alveolar hemorrhage as a manifestation of pulmonary barotrauma after scuba diving. Ann Emerg Med 1990; 19:930.
  7. Slade JB Jr, Hattori T, Ray CS, et al. Pulmonary edema associated with scuba diving : case reports and review. Chest 2001; 120:1686.
  8. Colebatch HJ, Smith MM, Ng CK. Increased elastic recoil as a determinant of pulmonary barotrauma in divers. Respir Physiol 1976; 26:55.
  9. British Thoracic Society Fitness to Dive Group, Subgroup of the British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines on respiratory aspects of fitness for diving. Thorax 2003; 58:3.
  10. Gerriets T, Tetzlaff K, Liceni T, et al. Arteriovenous bubbles following cold water sport dives: relation to right-to-left shunting. Neurology 2000; 55:1741.
  11. Schwerzmann M, Seiler C, Lipp E, et al. Relation between directly detected patent foramen ovale and ischemic brain lesions in sport divers. Ann Intern Med 2001; 134:21.
  12. Gerriets T, Tetzlaff K, Hutzelmann A, et al. Association between right-to-left shunts and brain lesions in sport divers. Aviat Space Environ Med 2003; 74:1058.
  13. Knauth M, Ries S, Pohimann S, et al. Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale. BMJ 1997; 314:701.
  14. SPENCER FC, ROSSI NP, YU SC, KOEPKE JA. THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS. J Thorac Cardiovasc Surg 1965; 49:615.
  15. Arthur DC, Margulies RA. A short course in diving medicine. Ann Emerg Med 1987; 16:689.
  16. Leitch DR, Green RD. Pulmonary barotrauma in divers and the treatment of cerebral arterial gas embolism. Aviat Space Environ Med 1986; 57:931.
  17. Murphy BP, Harford FJ, Cramer FS. Cerebral air embolism resulting from invasive medical procedures. Treatment with hyperbaric oxygen. Ann Surg 1985; 201:242.
  18. Evans DE, Catron PW, McDermott JJ, et al. Effect of lidocaine after experimental cerebral ischemia induced by air embolism. J Neurosurg 1989; 70:97.
  19. Hallenbeck JM, Leitch DR, Dutka AJ, et al. Prostaglandin I2, indomethacin, and heparin promote postischemic neuronal recovery in dogs. Ann Neurol 1982; 12:145.
  20. Neblett LM. Otolaryngology and sport scuba diving. Update and guidelines. Ann Otol Rhinol Laryngol Suppl 1985; 115:1.
  21. Uzun C, Adali MK, Koten M, et al. Relationship between mastoid pneumatization and middle ear barotrauma in divers. Laryngoscope 2002; 112:287.
  22. Melamed Y, Shupak A, Bitterman H. Medical problems associated with underwater diving. N Engl J Med 1992; 326:30.
  23. Moon RE. Treatment of diving emergencies. Crit Care Clin 1999; 15:429.
  24. Farmer, JC, Jr. Eustachian tube function and otologic barotrauma. Ann Otol Rhinol Laryngol 1985; 120:45.
  25. Klingmann C, Benton P, Schellinger P, Knauth M. A safe treatment concept for divers with acute inner ear disorders. Laryngoscope 2004; 114:2048.
  26. Shupak A, Gil A, Nachum Z, et al. Inner ear decompression sickness and inner ear barotrauma in recreational divers: a long-term follow-up. Laryngoscope 2003; 113:2141.
  27. Parell GJ, Becker GD. Conservative management of inner ear barotrauma resulting from scuba diving. Otolaryngol Head Neck Surg 1985; 93:393.
  28. Fagan P, McKenzie B, Edmonds C. Sinus barotrauma in divers. Ann Otol Rhinol Laryngol 1976; 85:61.
  29. Brodie HA. Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae. A meta-analysis. Arch Otolaryngol Head Neck Surg 1997; 123:749.
  30. Edmonds C, Thomas RL. Medical aspects of diving--3. Med J Aust 1972; 2:1300.
  31. Jagger RG, Shah CA, Weerapperuma ID, Jagger DC. The prevalence of orofacial pain and tooth fracture (odontocrexis) associated with SCUBA diving. Prim Dent Care 2009; 16:75.
  32. Moon RE, Vann RD, Bennett PB. The physiology of decompression illness. Sci Am 1995; 273:70.
  33. Barratt DM, Harch PG, Van Meter K. Decompression illness in divers: a review of the literature. Neurologist 2002; 8:186.
  34. Wilmshurst PT, Byrne JC, Webb-Peploe MM. Relation between interatrial shunts and decompression sickness in divers. Lancet 1989; 2:1302.
  35. Bove AA. Risk of decompression sickness with patent foramen ovale. Undersea Hyperb Med 1998; 25:175.
  36. Kerut EK, Norfleet WT, Plotnick GD, Giles TD. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol 2001; 38:613.
  37. Cartoni D, De Castro S, Valente G, et al. Identification of professional scuba divers with patent foramen ovale at risk for decompression illness. Am J Cardiol 2004; 94:270.
  38. Torti SR, Billinger M, Schwerzmann M, et al. Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale. Eur Heart J 2004; 25:1014.
  39. Moon RE, Camporesi EM, Kisslo JA. Patent foramen ovale and decompression sickness in divers. Lancet 1989; 1:513.
  40. Germonpre P, Hastir F, Dendale P, et al. Evidence for increasing patency of the foramen ovale in divers. Am J Cardiol 2005; 95:912.
  41. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984; 59:17.
  42. Pearman A, Bugeja L, Nelson M, et al. An audit of persistent foramen ovale closure in 105 divers. Diving Hyperb Med 2015; 45:94.
  43. Gendreau MA, DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med 2002; 346:1067.
  44. Cialoni D, Pieri M, Balestra C, Marroni A. Flying after diving: in-flight echocardiography after a scuba diving week. Aviat Space Environ Med 2014; 85:993.
  45. Sheffield PJ. Flying after diving guidelines: a review. Aviat Space Environ Med 1990; 61:1130.
  46. Freiberger JJ, Denoble PJ, Pieper CF, et al. The relative risk of decompression sickness during and after air travel following diving. Aviat Space Environ Med 2002; 73:980.
  47. St Leger Dowse M, Bryson P, Gunby A, Fife W. Comparative data from 2250 male and female sports divers: diving patterns and decompression sickness. Aviat Space Environ Med 2002; 73:743.
  48. Klingmann C, Gonnermann A, Dreyhaupt J, et al. Decompression illness reported in a survey of 429 recreational divers. Aviat Space Environ Med 2008; 79:123.
  49. Green RD, Leitch DR. Twenty years of treating decompression sickness. Aviat Space Environ Med 1987; 58:362.
  50. Rivera, JC. Decompression sickness among divers: An analysis of 935 cases. Milit Med 1964; 129:316.
  51. Edmonds C, Thomas RL. Medical aspects of diving. 4. Med J Aust 1972; 2:1367.
  52. Erde A, Edmonds C. Decompression sickness: a clinical series. J Occup Med 1975; 17:324.
  53. Dick AP, Massey EW. Neurologic presentation of decompression sickness and air embolism in sport divers. Neurology 1985; 35:667.
  54. Hallenbeck JM. Cinephotomicrography of dog spinal vessels during cord-damaging decompression sickness. Neurology 1976; 26:190.
  55. Tetzlaff K, Shank ES, Muth CM. Evaluation and management of decompression illness--an intensivist's perspective. Intensive Care Med 2003; 29:2128.
  56. Melamed Y, Sherman D, Wiler-Ravell D, Kerem D. The transportable recompression rescue chamber as an alternative to delayed treatment in serious diving accidents. Aviat Space Environ Med 1981; 52:480.
  57. Bennett MH, Lehm JP, Mitchell SJ, Wasiak J. Recompression and adjunctive therapy for decompression illness. Cochrane Database Syst Rev 2012; :CD005277.
  58. Halpern P, Greenstein A, Melamed Y, et al. Spinal decompression sickness with delayed onset, delayed treatment, and full recovery. Br Med J (Clin Res Ed) 1982; 284:1014.
  59. Myers RA, Bray P. Delayed treatment of serious decompression sickness. Ann Emerg Med 1985; 14:254.
  60. Clark JM, Lambertsen CJ. Pulmonary oxygen toxicity: a review. Pharmacol Rev 1971; 23:37.
  61. Lyne AJ. Ocular effects of hyperbaric oxygen. Trans Ophthalmol Soc U K 1978; 98:66.
  62. Farmer JC, Thomas WG, Youngblood DG, Bennett PB. Inner ear decompression sickness. Laryngoscope 1976; 86:1315.
  63. Bennett M, Mitchell S, Dominguez A. Adjunctive treatment of decompression illness with a non-steroidal anti-inflammatory drug (tenoxicam) reduces compression requirement. Undersea Hyperb Med 2003; 30:195.
  64. Eichhorn L, Leyk D. Diving medicine in clinical practice. Dtsch Arztebl Int 2015; 112:147.
  65. Camporesi EM. Diving and pregnancy. Semin Perinatol 1996; 20:292.
  66. Bolton ME. Scuba diving and fetal well-being: a survey of 208 women. Undersea Biomed Res 1980; 7:183.
  67. Turner G, Unsworth I. Intrauterine bends? Lancet 1982; 1:905.
  68. Bove AA. Pulmonary barotrauma in divers: can prospective pulmonary function testing identify those at risk? Chest 1997; 112:576.
  69. Tetzlaff K, Muth CM, Waldhauser LK. A review of asthma and scuba diving. J Asthma 2002; 39:557.
  70. Krieger BP. Diving: what to tell the patient with asthma and why? Curr Opin Pulm Med 2001; 7:32.
  71. Kanter AS, Stewart BF, Costello JA, Hampson NB. Myocardial infarction during scuba diving: a case report and review. Am Heart J 1995; 130:1292.
  72. Harrison D, Lloyd-Smith R, Khazei A, et al. Controversies in the medical clearance of recreational scuba divers: updates on asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale. Curr Sports Med Rep 2005; 4:275.
  73. Moss AJ, Robinson JL, Gessman L, et al. Comparison of clinical and genetic variables of cardiac events associated with loud noise versus swimming among subjects with the long QT syndrome. Am J Cardiol 1999; 84:876.
  74. Ackerman MJ, Tester DJ, Porter CJ. Swimming, a gene-specific arrhythmogenic trigger for inherited long QT syndrome. Mayo Clin Proc 1999; 74:1088.
  75. Batra AS, Silka MJ. Mechanism of sudden cardiac arrest while swimming in a child with the prolonged QT syndrome. J Pediatr 2002; 141:283.
  76. Dear Gde L, Pollock NW, Uguccioni DM, et al. Plasma glucose responses in recreational divers with insulin-requiring diabetes. Undersea Hyperb Med 2004; 31:291.