Dive Injuries and Treatments

Dive Injuries

• Objectives:
  • Recognize dive injuries.
  • Treat various dive injuries/incidents.
  • Prevent dive injuries.

Drowning and Near-Drowning

• Causes:
  • Inhaling water.
  • Suffocation (water leaking into lungs after unconsciousness).
  • Water in lungs lowers blood oxygen (diffusion cannot occur), causing hypoxia.
  • Lack of oxygen to the brain leads to loss of consciousness.
• Treatment:
  • CPR.
  • Rescue breaths.
  • AED (Automated External Defibrillator).
  • Oxygen.
  • Transport to medical care.
  • Secondary drowning: Possible hours later due to water damage in lungs; necessitates immediate medical check-up even if the patient feels fine.

Hypercapnia

• Definition: Elevated CO2 in the bloodstream.
• Causes:
  • High breathing resistance.
  • High oxygen partial pressure.
  • Skip breathing (holding breath between inhalations/exhalations).
  • Shallow breathing during dives.
  • Rapid descents.
  • Improperly packed/functioning scrubber materials (rebreather dives).
• Symptoms:
  • Dyspnea (difficult/labored breathing).
  • Headache.
  • Nausea.
  • Unconsciousness.
  • Nitrogen narcosis, oxygen toxicity, and decompression illness potentiation.

Hypercapnia (Relationship to Physiological Effects)

• Physiological effects of carbon dioxide concentration and exposure periods are charted (see image).

CO₂ Transport Considerations

• CO₂ molecule production remains consistent regardless of depth and workload.
• CO₂ transportation from tissues to lungs may be less efficient in hyperbaric environments due to a drop in venous blood hemoglobin from high oxygen partial pressure.
• Reduced hemoglobin forms carbamino compounds with CO₂ and buffers the hydrogen ions from CO₂ hydration in red blood cells.

Pulmonary Barotrauma

• General Symptoms:
  • Cough.
  • Hemoptysis (coughing up blood).
  • Chest pain.
  • Pink frothy sputum.
  • Vocal changes.
  • Discomfort swallowing.
  • Feeling of fullness in the throat.
  • Difficulty breathing.
• Treatment:
  • 100% Oxygen.
  • Basic life support.
  • Transport to medical facility.

AGE (Arterial Gas Embolism)

• General Symptoms:
  • Loss of consciousness.
  • Confusion.
  • Headache.
  • Convulsions.
  • Bloody froth from mouth/nose.
  • Weakness/paralysis in extremities.
  • Cardiac arrest or stroke symptoms.
• Treatment:
  • Contact emergency medical services.
  • Provide immediate response (EMS).
  • Administer 100% oxygen.
  • Basic life support.

DCS (Decompression Sickness)

• Onset: 15 minutes to 12 hours after surfacing.
• General Symptoms:
  • Unusual fatigue.
  • Skin itch.
  • Pain in joints/muscles (arms, legs, torso).
  • Dizziness, vertigo, ringing in ears.
  • Numbness, tingling, paralysis.
  • Shortness of breath.
  • Denial.
• Severe Symptoms:
  • Staggering.
  • Coughing up bloody, frothy sputum.
  • Collapse/unconsciousness.
  • Skin blotchy rash.
  • Difficulty urinating.
  • Confusion, personality changes, bizarre behavior.
  • Amnesia, tremors.
• Treatment:
  • Administer 100% oxygen.
  • Transport to recompression chamber (consider altitude).

DCS Follow-Up (Week 7)

• Recompression (In Water): Oxygen preferred over air.
• Air Treatment: Follow Air Treatment Table 1A (details in image).
• Equipment: Use full-face mask/helmet if available.
• Personnel: Maintain good diver communication; sufficient topside support personnel.
• Depth: Recompress to maximum available or deep depth (if deep not available), staying at max depth for 30 minutes.

Hypothermia

• Definition: Reduction of core temperature below 95°F.
• Prevention: Proper exposure protection.
• Symptoms:
  • Uncontrollable shivering.
  • Behavioral changes.
  • Inability to speak.
  • Loss of coordination.
  • Potential loss of consciousness.
• Treatment:
  • Remove wetsuit/clothing.
  • Cover with blankets/towels.
  • Avoid aggressive rewarming (can cause issues).
  • Contact EMS.

Hyperthermia

• Definition: Core temperature above 100°F.
• Prevention:
  • Drink fluids before thirst (especially when diving).
  • Minimize sun exposure (seek shade).
  • Maintain high fitness levels (cardiovascular system).
• Symptoms:
  • Hot, red, wet/dry skin.
  • Extremely fast/slow pulse.
  • Nausea.
  • Headache.
  • Dizziness.
• Treatment:
  • Fluids, cooling methods (ice packs, cool water).
  • If severe (no sweating; skin above 105°), activate EMS and aggressively cool patient.

Marine Life Encounters/Injuries

• General Advice:
  • Do not touch marine life.
  • If collecting for scientific purposes, know the species.
  • Educate yourself before diving; take proper precautions.
  • Be aware of local conditions and potential risks.
  • Expect potential infections; seek professional care for infection signs.

Box Jellyfish, Man-O-War Jellyfish, Urchins

• Box Jellyfish (Hawaii):

  • Typically observed monthly (8-10 days after full moon).
  • Found on south-facing shores.
  • Nematocysts deliver toxin upon contact (burning sensation, red skin, welts).
  • Treatment: Rinse with salt water, remove any jelly stuck to patient, use vinegar (if available), and contact EMS for allergic reactions.

• Man-o-War Jellyfish (Hawaii):

  • Most common on windward shores and nearshore water.
  • Nematocysts deliver toxin on contact (burning sensation, red skin, welts common).
  • Treatment: Rinse with salt water, ensure jelly not stuck to patient, use vinegar (use with caution; debated), and contact EMS for allergic reactions (no epinephrine).

• Urchins:

  • Found in nearshore waters.
  • Treatment of Spine puncture wounds includes using tweezers or pliers to remove the spine(s) and applying hot water with a mixture of iodine (if not allergic to penicillin) or antibiotic ointment/vinegar soak, avoiding scabbing. Seek medical treatment if showing signs of infection.

Moray Eels

• Habitat: Holes along reefs or free-swimming.
• Danger: Problems occur when sticking hands in holes (inspect first).
• Defense Mechanism: Teeth point slightly backwards in the throat; will bite and not release.
• Treatment: Use other hand to grab eel at the eyes to release it; do not shake it. Seek medical care; antibiotic likely needed.

Fish Bites

• Occurrence: Occasionally happens to divers with Ulua, Barracuda, or Groupers when attracted by shiny gear.
• Type of Injury: Punctures.
• Treatment: Irrigate and clean wound thoroughly, packing with antibiotic ointment. Seek medical attention.

Coral Scrapes

• Cause: Abrasive coral surface can easily scrape/cut human skin.
• Awareness: Be aware of surroundings; avoid touching coral.
• Treatment: Scrub wound aggressively with soap and water; flush with diluted hydrogen peroxide (50/50 solution); then apply antibiotic ointment, repeating the process twice per day.

Cone Snails

• Attractive: Attractive shells can attract divers to pick them up and the snails
• Danger: Proboscis contains a potent toxin; injury comparable to a bee sting, possibly fatal in some species.
• Treatment: Seek immediate medical attention.

Crown-Of-Thorns Starfish

• Spikes: Sharp spikes on the surface; spines carry toxin.
• Injury: Skin irritation (cortisone may help), or infection (antibiotics may be required).
• Serious Injury: If a spine breaks off in the skin, seek medical treatment.

Monk Seals

• Behavior: Look cute, but can be aggressive/bite if scared; avoid cornering or approaching closely.
• Bites: Bite wounds cause severe puncture wounds requiring medical care; control bleeding and transport to a medical facility.

Sharks

• Aggressive Species: Grey Reef and Tiger sharks may exhibit aggressive behavior; do not provoke/approach.
• Treatment: Activate EMS (emergency medical services), control bleeding and monitor vital signs while providing oxygen.

Diver's Alert Network (DAN)

• Resource: Comprehensive library/resource for divers for dive-related medical issues.
• Membership: Recommended; provides emergency medical hotline and transport services.
• Alert Diver: Publication read by members providing helpful information.

Summary (General)

• Emergency Action Plan: Be familiar with it.
• Necessary equipment: Be prepared with it.
• Medical assistance: Know options.
• Certifications: Have current CPR/First Aid/Oxygen administration certificates.
• Specific Injury Cases: Clean wounds aggressively; attempt to keep wounds dry; use antibiotic ointments.

This quiz covers the recognition and treatment of dive injuries, including drowning and hypercapnia. Learn about the causes and preventative measures related to various dive incidents to enhance your knowledge and response skills in emergency situations.