Barotrauma in Emergency Medicine Workup

  • Author: Joseph Kaplan, MD, MS, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 9, 2011
 

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.

Next

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

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.

Previous
Next

Other Tests

  • ECG is useful for determining potential cardiac causes of the altered mental status or shock.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph Kaplan, MD, MS, FACEP  Attending Physician, Department of Emergency Medicine, Martin Army Community Hospital, Fort Benning

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.

Specialty Editor Board

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 College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David Eitel, MD, MBA  Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Khan RM, Sharma PK, Kaul N. Barotrauma: a life-threatening complication of fiberoptic endotracheal intubation in a neonate. Paediatr Anaesth. Aug 2010;20(8):782-4. [Medline].

  2. Blatteau JE, Gempp E, Galland FM, et al. Aerobic exercise 2 hours before a dive to 30 msw decreases bubble formation after decompression. Aviat Space Environ Med. Jul 2005;76(7):666-9. [Medline].

  3. Dujic Z, Palada I, Obad A. Exercise during a 3-min decompression stop reduces postdive venous gas bubbles. Med Sci Sports Exerc. Aug 2005;37(8):1319-23. [Medline].

  4. Hickey MJ, Zanetti CL. Delayed-onset cerebral arterial gas embolism in a commercial airline mechanic. Aviat Space Environ Med. Sep 2003;74(9):977-80. [Medline].

  5. Tschopp S, Keel M, Schmutz J, Maggiorini M. Abdominal compartment syndrome after scuba diving. Intensive Care Med. Nov 2005;31(11):1595. [Medline].

  6. [Best Evidence] Eckmann DM, Zhang J, Lampe J, Ayyaswamy PS. Gas embolism and surfactant-based intervention: implications for long-duration space-based activity. Ann N Y Acad Sci. Sep 2006;1077:256-69. [Medline].

  7. Ball R, Auker CR, Ford GC, Lawrence D. Decompression sickness presenting as forearm swelling and peripheral neuropathy: a case report. Aviat Space Environ Med. Jul 1998;69(7):690-2. [Medline].

  8. Bond JP, Kirschner DA. Spinal cord myelin is vulnerable to decompression. Mol Chem Neuropathol. Apr 1997;30(3):273-88. [Medline].

  9. Boussuges A, Blanc P, Molenat F, et al. Haemoconcentration in neurological decompression illness. Int J Sports Med. Jul 1996;17(5):351-5. [Medline].

  10. Bove AA. Risk of decompression sickness with patent foramen ovale. Undersea Hyperb Med. 1998;25(3):175-8. [Medline].

  11. Butler WP, Topper SM, Dart TS. USAF treatment table 8: treatment for altitude decompression sickness. Aviat Space Environ Med. Jan 2002;73(1):46-9. [Medline].

  12. Camporesi EM. Diving and pregnancy. Semin Perinatol. Aug 1996;20(4):292-302. [Medline].

  13. Cogar WB. Intravenous lidocaine as adjunctive therapy in the treatment of decompression illness. Ann Emerg Med. Feb 1997;29(2):284-6. [Medline].

  14. Colebatch HJ, Ng CK. Decreased pulmonary distensibility and pulmonary barotrauma in divers. Respir Physiol. Dec 1991;86(3):293-303. [Medline].

  15. Colebatch HJ, Smith MM, Ng CK. Increased elastic recoil as a determinant of pulmonary barotrauma in divers. Respir Physiol. Feb 1976;26(1):55-64. [Medline].

  16. Evans DE, Kobrine AI, LeGrys DC, Bradley ME. Protective effect of lidocaine in acute cerebral ischemia induced by air embolism. J Neurosurg. Feb 1984;60(2):257-63. [Medline].

  17. Files DS, Webb JT, Pilmanis AA. Depressurization in military aircraft: rates, rapidity, and health effects for 1055 incidents. Aviat Space Environ Med. Jun 2005;76(6):523-9. [Medline].

  18. Germonpre P, Dendale P, Unger P, Balestra C. Patent foramen ovale and decompression sickness in sports divers. J Appl Physiol. May 1998;84(5):1622-6. [Medline].

  19. Goldenberg I, Shupak A, Shoshani O. Oxy-helium treatment for refractory neurological decompression sickness: a case report. Aviat Space Environ Med. Jan 1996;67(1):57-60. [Medline].

  20. Gustavsson LL, Hultcrantz E. [Medical aspects of diving--a sport for both women and men]. Lakartidningen. Feb 17 1999;96(7):749-53. [Medline].

  21. Hyldegaard O, Madsen J. Influence of heliox, oxygen, and N2O-O2 breathing on N2 bubbles in adipose tissue. Undersea Biomed Res. May 1989;16(3):185-93. [Medline].

  22. Kieser J, Holborow D. The prevention and management of oral barotrauma. N Z Dent J. Dec 1997;93(414):114-6. [Medline].

  23. Kimbro T, Tom T, Neuman T. A case of spinal cord decompression sickness presenting as partial Brown-Sequard syndrome. Neurology. May 1997;48(5):1454-6. [Medline].

  24. Melamed Y, Shupak A, Bitterman H. Medical problems associated with underwater diving. N Engl J Med. Jan 2 1992;326(1):30-5. [Medline].

  25. Moon RE, de Lisle Dear G, Stolp BW. Treatment of decompression illness and latrogenic gas embolism. Respir Care Clin N Am. Mar 1999;5(1):93-135. [Medline].

  26. Moon RE, Sheffield PJ. Guidelines for treatment of decompression illness. Aviat Space Environ Med. Mar 1997;68(3):234-43. [Medline].

  27. Morgenstern K, Talucci R, Kaufman MS, et al. Bilateral pneumothorax following air bag deployment. Chest. Aug 1998;114(2):624-6. [Medline].

  28. Muehlberger PM, Pilmanis AA, Webb JT, Olson JE. Altitude decompression sickness symptom resolution during descent to ground level. Aviat Space Environ Med. Jun 2004;75(6):496-9. [Medline].

  29. Parell GJ, Becker GD. Inner ear barotrauma in scuba divers. A long-term follow-up after continued diving. Arch Otolaryngol Head Neck Surg. Apr 1993;119(4):455-7. [Medline].

  30. Payne SJ, Chappell MA. Automated determination of bubble grades from Doppler ultrasound recordings. Aviat Space Environ Med. Aug 2005;76(8):771-7. [Medline].

  31. Petri NM, Andric D. Differential diagnostic problems of decompression sickness--examples from specialist physicians' practices in diving medicine. Arch Med Res. Jan-Feb 2003;34(1):26-30. [Medline].

  32. Raymond LW. Pulmonary barotrauma and related events in divers. Chest. Jun 1995;107(6):1648-52. [Medline].

  33. Reuter M, Tetzlaff K, Warninghoff V, et al. Computed tomography of the chest in diving-related pulmonary barotrauma. Br J Radiol. May 1997;70(833):440-5. [Medline].

  34. Russi EW. Diving and the risk of barotrauma. Thorax. Aug 1998;53 Suppl 2:S20-4. [Medline].

  35. Segev Y, Landsberg R, Fliss DM. MR imaging appearance of frontal sinus barotrauma. AJNR Am J Neuroradiol. Mar 2003;24(3):346-7. [Medline].

  36. Sheffield PJ. Flying after diving guidelines: a review. Aviat Space Environ Med. Dec 1990;61(12):1130-8. [Medline].

  37. Sheridan MF, Hetherington HH, Hull JJ. Inner ear barotrauma from scuba diving. Ear Nose Throat J. Mar 1999;78(3):181, 184, 186-7 passim. [Medline].

  38. Shupak A, Melamed Y, Ramon Y, et al. Helium and oxygen treatment of severe air-diving-induced neurologic decompression sickness. Arch Neurol. Mar 1997;54(3):305-11. [Medline].

  39. Smerz RW. Age associated risks of recreational scuba diving. Hawaii Med J. May 2006;65(5):140-1, 153. [Medline].

  40. US Navy. US Navy Diving Manual. Rev 4. Vol 1-5. Claitor's Publishing Division; 1999: 1:1-5, 2:13-21, 3:19-31, 8:1-68, H:1-27.

  41. Webb JT, Pilmanis AA, Balldin UI, Fischer JR. Altitude decompression sickness susceptibility: influence of anthropometric and physiologic variables. Aviat Space Environ Med. Jun 2005;76(6):547-51. [Medline].

  42. Wherrett CG, Mehran RJ, Beaulieu MA. Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen. Can J Anaesth. Jan 2002;49(1):96-9. [Medline].

 
Previous
Next
 
Basic US Navy dive table used to compare the patient's dive profile to the standard dive profile. Reprinted with permission of the US Navy.
US Navy dive table for altitude diving used to compare the patient's dive profile with the standard dive profile at altitude. Reprinted with permission of the US Navy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.