Board Review: Debunking Dysbarism

This post was peer reviewed. Click to learn more.

Image credit: Brett Seymour

Authors: Patrick Wallace, DO PGY-2

Emergency Medicine Resident

University of Nevada Las Vegas

AAEM/RSA Education Committee

Laurie Bezjian Wallace, DO PGY-2

Family Medicine Resident

Mike O’Callaghan Military Medical Center

Intro
“Dysbarism” collectively refers to diving-related disorders. These disorders are relatively common and range in severity. This topic is high yield on board exams and is also important for emergency medicine providers to recognize so as to administer timely interventions. This article differentiates and categorizes disorders by those occurring with descent, at depth, and with ascent (Table 1).


DISORDERS OF DESCENT
Facial Barotrauma (Mask Squeeze)
Negative pressure within the mask and over the eyes must be equalized. This is often done by exhaling through the nose. Failure to equalize leads to a negative pressure effect on the periorbital and ocular vessels, resulting in edema and subconjunctival hemorrhage.[1,2] Emergent complications are rare but may include hyphema, subperiosteal orbital hemorrhage, and intraorbital hematoma. In these cases, emergent ophthalmology consultation should be obtained as surgery or needle aspiration may be required.[3,4] However, the majority of facial barotrauma cases are benign and do not require treatment.[1,3,4]
Key Phrases: Conjunctival edema, subconjunctival hemorrhage, and petechial hemorrhage after diving.

Diving Emergencies - What You Need to Know on Your Next Shift

Image Credit: U.S. Central Command

This post was peer reviewed.
Click to learn more.

Authors:
Joshua Goldstein, MSIII Medical Student
University of Miami Miller SOM

Tim Montrief, MD MPH
Jackson Memorial Health System/University of Miami
AAEM/RSA Publications and Social Media Committee Member

Introduction
SCUBA (Self Contained Underwater Breathing Apparatus) Diving is becoming increasingly popular, with an estimated 306 million dives made in the United States between 2006 and 2015.[1] During that same time there were 658 diving deaths in the United States and nearly 14,000 emergency department (ED) visits.[1] While the pathophysiology underlying many diving injuries is complex, the basic treatments for many life-threatening diving injuries are the same (Figure 1). It is important to understand the relatively simple therapies that underlie appropriate care for these injuries.[2,3]