Scuba divers breathe compressed gas, and rising too fast can cause nitrogen bubbles in tissues (decompression sickness) or air to enter the arteries from damaged lungs (arterial gas embolism). Both need 100 percent oxygen and fast transfer to a center with a hyperbaric chamber.
Key symptoms
- Joint pain, mostly in shoulders and elbows
- Numbness, tingling or weakness
- Itching or a mottled rash
- Confusion, stroke-like signs or collapse right after surfacing
- Chest pain or shortness of breath
What you find on exam
- Dive history: depth, time, ascent rate, symptom onset
- Neurological exam: strength, sensation, coordination, mental status
- Breath sounds for pneumothorax
- Skin for marbling and ears for barotrauma
Tests
- Pulse oximetry and blood glucose
- Chest X-ray for pneumothorax
- ECG
- Contact a diving medicine hotline
Treatment basics
- 100 percent oxygen by non-rebreather mask
- Keep the patient lying flat
- IV or oral fluids
- Transport for hyperbaric recompression; avoid high-altitude flights
- Decompress a tension pneumothorax before hyperbaric treatment
Red flags
- Loss of consciousness right after surfacing
- Weakness, paralysis or confusion
- Chest pain or breathlessness
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.