Safe S. C. U. B. A.

First Aid

SCUBA (Self Contained Underwater Breathing Apparatus) diving is a safe sport enjoyed by millions with a fatality rate estimated less than for alpine skiing.

This pamphlet is intended to give some suggestions towards recognizing and responding to some of the dangers. Some illnesses require recompression therapy. They can be subtle but should be acted on promptly if suspected.

.Carbon Dioxide Toxicity

This can happen under heavy exertion, by skip breathing (slow breathing), or equipment failure. Symptoms include shortness of breath, headache, nausea, dizziness, and confusion. Divers may develop rapid breathing, muscle twitches, and unconsciousness. If breathlessness occurs, divers should stop and rest until breathing returns to normal, if not, then ascend.

Lung Overpressure Syndrome

These problems independently or with an air embolism. They all represent that the lung is injured and an embolism should be suspected.

Pneumothorax- usually is felt as chest pain or shortness of breath and occurs when air enters the space between the lung and chest wall. This problem can worsen with time and treatment in a hospital to remove this is needed.

Mediastinal Emphysema- is when air becomes trapped in the space between the heart and the lungs, and is felt as chest pain, shortness of breath and faintness. This must also be followed in a hospital.

Subcutaneous Emphysema- is when escaped air from the lungs is trapped under the skin, usually at the neck. A swelling and crackling is felt at the neck, with a change of voice and difficulty swallowing. This is a simple condition and no treatment is required for it alone. Breathing 100% oxygen will help resolve all types of over-pressure problems.

Motion Sickness- should be anticipated and medication should be used with caution since they all cause some drowsiness. It is advisable to cancel a dive if sickness is severe. Some will take meclizine 25mg taken 2 hrs before dive (lasts 6-12 hrs).

Other Problems

Sinus Squeeze- occurs as acute pain in sinuses.

Mask Squeeze- painful pressure buildup around mask.

Ear Barotrauma- Otitis media barotraumas acute pain in ear. Should not dive till healed. Inner ear disturbance should be treated as a possible urgent referral to D. A. N. (it might only be a perilymph problem in the inner ear but it cannot easily be differentiated from AGE or DCI.

Marine animals and envenomations are beyond the scope of this pamphlet but should be treated by experienced people.

Decompression Illness -is the broad term to describe both air gas embolism (AGE) and decompression syndrome (caused by nitrogen bubbles forming in the body).

Signs and symptoms of AGE include-any type of neurological problem, chest pain, personality change, bloody froth, paralysis, convulsions, and death. Symptoms can occur immediately after surfacing.

Airplane travel can also precipitate nitrogen bubble formation. DAN recommends not to fly 12 hrs after the last non-stop dive. The U.S. Air Force recommends 24 hrs. Longer time is needed if the dive is a complicated one.

Decompression illness symptoms may also include fatigue, itch, pains in muscles or joints, and a blotchy rash. Even muscular symptoms are worrisome since bubbles could soon form in the nervous tissue. Once you suspect decompression illness the diver may be categorized as Emergent, Urgent, and Timely.

Emergent cases are obviously very sick. Begin CPR, and arrange evacuation. Check for foreign bodies and place patient on back (if vomiting, turn onto side) 100% oxygen should be supplied. IV fluids using isotonic fluids without glucose should be given (this corrects dehydration and reduces hemoconcentration). Give 1 litre over 30 minutes then 100-175 cc/hr.

If trained, insert urine catheter to monitor urine output. After stabilization, contact D. A. N. for nearest chamber location. Transfer even if the victim is improving. Take a detailed history, and evaluate neurological status. If flying, pressurized aircraft is recommended.

In cerebral arterial gas embolisms, having the head slightly down, theoretically reduces further emboli towards the brain. Some believe that this can also increase cerebral pressure. A compromise is to keep the victim level with the body and tilted to the left side.

In decompression sickness, muscular or other body movements can dislodge venous emboli so patients should rest. Near-drowning victims movements may redistribute fluid causing decreased lung compliance. Patients with hypothermia should not be jostled as this could precipitate a cardiac arrhythmia in a chilled heart.

Additional treatments that have some evidence to support them, include giving ASA (chewable baby aspirin may stop platelets accumulate around bubbles and lidocaine dose is the same as for cardiac patients). Given in 1 or 2 boluses, Lidocaine acts to increase cerebral blood flow and may prevent leukocyte activation. Corticosteroids like decadron are sometimes also given but there is less evidence of their usefulness.

Urgent

These patients are those with severe pain that has unchanged or become worse over hours. Their neurologic status appears normal. They should be placed on 100% oxygen and given oral fluids. Contact DAN and arrange a transfer.

Timely

These patients have vague complaints with abnormal sensations. Phone DAN and go to the nearest medical facility.

Dive History

This information is very helpful to D. A. N. Find out all dives (dive logs), symptoms (onset and progressive), all first aid measures, description of rashes, and any other medical information. A reasonable neurological exam can be done with some training by fellow divers so they can give a brief assessment to DAN.

Emergency Telephone Numbers

DAN Diving Emergency Numbers

DAN America +1.919.684.8111 or +1.919.684.4DAN(4326)

(-4DAN accepts collect calls)

DAN America-Mexico +52-5-629-9800 Code 9912935

DAN-Europe +41.1.1414

DAN-Japan ++81.3.3812.4999

DAN-Southern Africa

(outside South Africa) +27.11.242.0112

(inside South Africa) 0800.020.111

DAN Southwestern Asia-Pacific region

Diving Emergency Services (DES):

DES Australia (within Australia)   1.800.088.200

DES Australia (from overseas)   +61.8.8212.9242

DES New Zealand     +64.9.445.8454

Singapore Neval Medicine-Hyperbaric Centre +65.750.5546

DAN S. E. A. P.-Philippines   +36.2.815.9911

Neurologic history of injured divers should include:

•  Orientation (to name, place, and time).

•  Check movement of eye following a finger, check pupil size and vision.

•  Look for symmetry of facial muscles, facial sensation.

•  Hearing (check ability to hear rustled hair at each ear).

•  Watch the swallowing reflex.

•  Check if tongue is straight when stuck out.

•  Check muscle strength-ask patient to shrug shoulders, add resistance, check the strength of both arms and legs by asking the patient to bend and extend while you resist movement.

•  Check sensory perception to light touch along left and right side of body.

•  Balance and coordinate. Have divers walk heel to toe in a straight line if able, forward and backward. Then stand with feet together, eyes closed and palms held straight out. Check for ability to maintain balance and be prepared to catch the person. Check the divers ability to touch your finger and their own nose while you move your hand.

By doing these tests early and regularly at 30-60 min. intervals, valuable information about a neurologic injury is obtained while awaiting evacuation. (Tests 1, 7, and 9 are the most important).

Suggested Divers First Aid Kit (Basic)

•  Vial of rubbing alcohol (to neutralize jelly fish stings).

•  Decadron 8mg or Prednisone 50mg (for anaphylaxis).

•  Package of baking soda.

•  Motion sickness tablets (meclizine, phenergan, gravol, ginger).

•  Epipen

•  Mechanical suction device.

•  Resusitube (combi-tube) with training.

•  Waterproof bandages.

•  Rubber cement (to pull out spines, envenomations).

•  Oxygen and training.

•  First aid training.

•  Pressure bandage to slow venom from sea snakes and blue octopus bites.

References

•  Dive and Marine Medicine (3 Conference). March 2000 , Sponsored by The Undersea and Hyperbaric Medical Society.

•  Dive and Travel Medical Guide Ed Thalmann, Editor, Revised 1999, published by D. A. N.

•  Divers Alert Network (D. A. N.) is a non-profit organization that gives information and advice to the general public. They support diving research and have a 24-hour emergency phone number (1-919-684-2948) for dive accidents. Members are eligible for very good travel insurance packages while on dive-related vacations.

•  Diving Medicine Bore, Alfred A and Davis,

Jefferson C. (1990) Pub W.B. Saunders.

•  Edmonts (1978) Diving and Sub Aquatic Medicine 2 nd Edition.

•  Divers Alert Network. Report on Decompression Illness and Diving Fatalities 2000 Edition.

•  Undersea and Hyperbaric Medical Society Inc. (July 21, 1995).

•  Divers Alert Magazine Published by D. A. N.

•  D. A. N. Website ww.diversalertnetwork.com

  Manitoba Underwater Council - A community for SCUBA divers.

About Us…

The Skylark Medical Clinic specializes in sports and travel medicine. The clinic's director is Dr. Gary Podolsky who has worked on Carnival Cruise Lines as a Chief Medical Officer, and has been a past Director of the Grand Beach Medical Clinic. He also does Diver Physicals for the Dept of Fisheries and Oceans, Health Canada, and as well as Recreational Divers.

He is a member of the American College of Sports Medicine, Divers Alert Network, Wilderness Medical Society, and the International Society of Travel Medicine.

Skylark Medical Clinic

264 Tache Avenue

Winnipeg, MB R2H 1Z9

Tel: 453-9107 Fax: 453-9115