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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.


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. This chapter covers dysbaric diving injuries, and to a lesser degree, aviation-related dysbarisms. Blast injuries are outside the scope of this chapter.

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.

Serious diving-related injuries and fatalities are rare and are often associated with human error, unsafe behaviors, or hazardous conditions. From 2010 to 2014, the Divers Alert Network averaged almost 13,000 scuba-related phone and email correspondences per year, with over 4000 emergency calls. In 2014 in the United States, there were 1220 emergency room admissions for scuba-related injuries—and providers were often inexperienced with the presentation and management of these injuries.1 From 2004 to 2014, there has been an average of 65 diving fatalities annually in the United States and Canada,1,2 with a steady decline from 75 in 20112 to 54 in 2014.1 The most common cause of death is from drowning.1–3 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 2002.4 During this time period, the youngest diving fatality was 14 years old and the youngest injured diver was 11.4

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 ...

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