Barotrauma Workup

Updated: Jun 16, 2017
  • Author: Joseph Kaplan, MD, MS, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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Workup

Laboratory Studies

Do not delay treatment while waiting for laboratory studies. Laboratory studies helpful in treating patients with DCS include a complete blood cell  (CBC) count and arterial blood gas (ABG) determination.

Complete blood cell 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 barotrauma. Rising CPK levels indicate increasing tissue damage due to microemboli.

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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, subcutaneous emphysema, change in level of consciousness, difficulty breathing, or unexplained chest pain is a potential candidate for these imaging studies. [26]

Spiral CT is the most sensitive method to evaluate for pneumothorax. [27] It should be performed in all patients suspected of having a barotrauma-related pneumothorax when chest radiograph findings are negative for pneumothorax. One study, using the porcine model, indicates that CT done within 6 hours can show a significant amounts of gas in both the arterial and venous systems. This information could be used for prognostic or pathologic evaluation. [28]

Echocardiography and ultrasonography

Echocardiography and ultrasonography can be used to detect the number and size of gas bubbles in the right side of the heart, gas in the subcutaneous tissues, the presence of abscess in swelling of the face and neck, and air in the peritoneum. [29] This can be used both for diagnosis and prognosis.

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Other Tests

ECG is useful for determining potential cardiac causes of the altered mental status, chest pain, dyspnea, or shock.

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