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High-Yield Facts

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  • An air embolism is the most serious dysbaric injury and requires aggressive care, which includes 100% oxygen, intravenous fluids, and hyperbaric treatment.

  • Patients with suspected air embolism should be placed in the Trendelenburg or left lateral decubitus position to minimize the passage of air emboli to the brain.

  • The treatment of choice for most air emboli and decompression illnesses is hyperbaric (recompression) therapy. This is initiated as soon as possible, ideally within 6 hours of the onset of symptoms.

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Dysbaric Injuries

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Dysbaric injuries may be the result of several distinct events that expose an individual to a change in barometric pressure. The first possible etiology is an altitude-related event, which can be illustrated by the rapid ascent or descent during airplane transport or sudden cabin decompression at an altitude of 25,000 ft. The second type of dysbaric injury results from an underwater diving accident. A third dysbarism is caused by a blast injury that produces an overpressurization effect.

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Scuba (self-contained underwater breathing apparatus) diving currently allows the recreational diver to descend to depths >100 ft. There are a number of recreational diving organizations that have minimum age requirements for certifications. In general, candidates must be 15 or 16 years old for full certification. Pool-based divers may be certified at the age of 8 years, and some organizations will certify 10-year olds for ocean diving to 40 ft (12 m). However, certification is not required to dive and it is the untrained or poorly trained individual who is at greater risk for injury.

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Serious diving-related injuries and fatalities are rare and are often associated with human error, unsafe behaviors, or hazardous conditions. On the average, each year, the Divers Alert Network receives more than 2000 scuba-related emergency calls.1 From 1995 to 2006, there has been an average of 85 diving fatalities annually in the United States and Canada, but there was a noted increase in 2007 and 2008 to over 110 fatalities each year.2 The most common cause of death is from drowning. On average, there were 16 diving injuries requiring hyperbaric recompression therapy in scuba divers aged 19 years and younger in North America between 1988 and 2002.3 During this time period, the youngest diving fatality was 14 years old and the youngest injured diver was 11.3

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Several terms are often used when discussing this topic. Dysbarism represents the general topic of pressure-related injuries. Barotrauma, the most common diving injury, refers to the injuries that are a direct result of the mechanical effects of a pressure differential. The complications related to the partial pressure of gases and dissolved gases are called decompression sickness.

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Physical Gas Laws

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Dysbarisms can best be explained by the physical gas laws and through an understanding of pressure equivalents that cause these injuries. The amount of pressure exerted ...

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