eMedicine Specialties > Emergency Medicine > Environmental

Dysbarism: Differential Diagnoses & Workup

Author: Stephen A Pulley, MS, DO, FACOEP,, Assistant Professor, Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine; Attending Faculty, Emergency Medicine Residency, Albert Einstein Medical Center; Attending Physician, Montgomery Hospital Medical Center
Contributor Information and Disclosures

Updated: Sep 17, 2009

Differential Diagnoses

Acute Coronary Syndrome
Hyperventilation Syndrome
Anaphylaxis
Labyrinthitis
Asthma
Mediastinitis
Benign Positional Vertigo
Meniere Disease
Chronic Obstructive Pulmonary Disease and Emphysema
Myocardial Infarction
Congestive Heart Failure and Pulmonary Edema
Otitis Externa
Costochondritis
Otitis Media
Decompression Sickness
Pneumothorax, Iatrogenic, Spontaneous and Pneumomediastinum
Dental, Infections
Pneumothorax, Tension and Traumatic
Dermatitis, Contact
Pulmonary Embolism
Epistaxis
Esophagitis
Fractures, Rib

Workup

Laboratory Studies

  • No specific tests are required for the diagnosis of dysbarism. When diving is involved, the primary consideration should be a pressure-related injury. Baseline laboratory studies usually have no bearing on initial management. They could be useful in excluding other entities on the differential diagnosis list while HBO therapy is pursued. Transfer should not be delayed. For a patient with a mental status change, routine evaluation of reversible causes is mandated. If the individual is in extremis (eg, shock), appropriate resuscitation studies should be obtained.
  • Change in mental status or medically unstable
    • Serum glucose level, CBC
    • Electrolytes, magnesium, calcium, phosphorous, BUN, and creatinine levels
    • Oxygen saturation
    • Ethanol level, drug screen
    • Carboxyhemoglobin level
    • Type and screen, cross-match
    • Prothrombin time (PT), activated partial thromboplastin time (aPTT)

Imaging Studies

  • Chest radiography
    • Chest radiography is the primary diagnostic imaging study for overpressurization injuries.
    • Chest radiography can identify evidence of pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium, and alveolar hemorrhage.
  • Sinus radiography
    • Opacification of the sinuses confirms the presence of pathology in that area.
    • It does not confirm that the pathology is related to diving.
  • CT scanning
    • CT differentiates pathology in areas of concern better than radiography.
    • Chest CT, especially spiral CT, is recommended for evaluation of the lungs after a pulmonary barotrauma event. It can show preexisting pathology, such as small lung cysts.47
    • Although this information is not helpful for treatment of a dysbaric injury, it can help determine future fitness for diving. CT scanning has also been advocated for detection of arterial gas embolism in postmortem examinations (see Decompression Sickness).48

Other Tests

  • Diagnostic repressurization: When a question exists as to whether the patient's problem is dysbarism or DCS, repressurization in a hyperbaric chamber can be pursued for diagnostic and therapeutic reasons. (This may require patient transfer.)
  • Electrocardiography

More on Dysbarism

Overview: Dysbarism
Differential Diagnoses & Workup: Dysbarism
Treatment & Medication: Dysbarism
Follow-up: Dysbarism
Multimedia: Dysbarism
References
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Further Reading

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Keywords

decompression sickness, DCS, the bends, ear squeeze, sinus squeeze, tooth squeeze, mask squeeze, barotrauma, Boyle law, Dalton law, Henry law, Charles law, scuba diving, diving, self-contained underwater breathing apparatus, SCUBA, air embolism, hyperbaric chamber, pressure during descent, high altitude, dysbaric injury

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Contributor Information and Disclosures

Author

Stephen A Pulley, MS, DO, FACOEP,, Assistant Professor, Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine; Attending Faculty, Emergency Medicine Residency, Albert Einstein Medical Center; Attending Physician, Montgomery Hospital Medical Center
Stephen A Pulley, MS, DO, FACOEP, is a member of the following medical societies: American College of Osteopathic Emergency Physicians and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
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

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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