eMedicine Specialties > Emergency Medicine > Environmental

Barotrauma: Differential Diagnoses & Workup

Author: Joseph Kaplan, MD, MS, FACEP, Attending Physician, Department of Emergency Medicine, Martin Army Community Hospital, Fort Benning, Georgia
Coauthor(s): Marshall E Eidenberg, DO, Staff Emergency Physician, Via Christi Regional Medical Center
Contributor Information and Disclosures

Updated: Sep 29, 2009

Differential Diagnoses

Ankle Injury, Soft Tissue
Pneumothorax, Iatrogenic, Spontaneous and Pneumomediastinum
Asthma
Pneumothorax, Tension and Traumatic
Asystole
Shock, Cardiogenic
Brown-Sequard Syndrome
Shock, Hemorrhagic
Hypothermia
Shock, Hypovolemic
Methemoglobinemia
Shock, Septic
Otitis Externa
Sinusitis
Otitis Media
Tuberculosis
Pneumonia, Bacterial

Other Problems to Be Considered

Surgical abdominal complaint
Sprain or contusion of any joint

Workup

Laboratory Studies

  • Do not delay treatment while waiting for laboratory studies. Laboratory studies helpful in treating patients with DCS include a complete blood count (CBC) and arterial blood gas (ABG) determination.
  • Complete blood count
    • In one study, patients who had a hematocrit of 48% or higher had persistent neurologic sequelae 1 month after the injury.
    • White blood cell (WBC) count with differential may help to determine infectious causes.
  • ABG determination: Determine the alveolar-arterial gradient in patients suspected of having an embolism.
  • Serum creatine phosphokinase level: Increases in creatine phosphokinase (CPK) levels indicate tissue damage associated with DCS. Rising CPK levels indicate increasing tissue damage due to microemboli.

Imaging Studies

  • Chest radiography
    • Obtain a chest radiograph if the patient complains of chest discomfort or difficulty breathing.
    • Obtain inspiratory and expiratory views if a pneumothorax is suspected clinically.
  • Radiographs of joints or extremities: When indicated clinically, obtain these to evaluate for the presence of a fracture or dislocation.
  • Computed tomography (CT) scans and magnetic resonance imaging (MRI)
    • Patients who may benefit the most from these diagnostic modalities are often the most unstable, making their transport to the radiology suite potentially dangerous.
    • Any patient who presents with a severe headache or severe back pain after a dive is a potential candidate for these imaging studies.
    • Spiral CT is the most sensitive method to evaluate for pneumothorax. It should be performed in all patients suspected of having a barotrauma-related pneumothorax when chest radiograph findings are negative for pneumothorax.
  • Echocardiography (ultrasonography) can be used to detect the number and size of gas bubbles in the right side of the heart. This can be used both for diagnosis and prognosis.

Other Tests

  • ECG is useful for determining potential cardiac causes of the altered mental status or shock.

More on Barotrauma

Overview: Barotrauma
Differential Diagnoses & Workup: Barotrauma
Treatment & Medication: Barotrauma
Follow-up: Barotrauma
Multimedia: Barotrauma
References
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References

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Further Reading

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Keywords

barotrauma, the bends, caisson disease, dive medicine, hyperbaric medicine, squeeze, sinus squeeze, decompression sickness, DCS, decompression sickness type I, decompression sickness type II, middle ear squeeze, arterial gas embolism, AGE, decompression chamber, recompression, diving-related disease, diving barotrauma

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Contributor Information and Disclosures

Author

Joseph Kaplan, MD, MS, FACEP, Attending Physician, Department of Emergency Medicine, Martin Army Community Hospital, Fort Benning, Georgia
Joseph Kaplan, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Marshall E Eidenberg, DO, Staff Emergency Physician, Via Christi Regional Medical Center
Marshall E Eidenberg, DO is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David Eitel, MD, MBA, Associate Professor, Department of Emergency Medicine, York Hospital
David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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