CASE 1
• 42 year old male• First dive in 6 years• Own equipment• 40 mins at 15 metres in rough seas• NO rapid ascent• Developed cough and SOB 1 hour post diving• Gradually worsened• Associated fever/chills
CASE 1- DIAGNOSIS?
• On examination• Hypoxic with sats 92%• Patchy opacities on CXR• No pneumothorax• Temp 37.8 degrees
Case 1 – Salt water aspiration syndrome
• First described in Royal Navy divers in the 1960s
• Aspiration of a fine mist of seawater from faulty equipment/ flooded demand valve
• Often a delay to presentation• Similar presentation to a LRTI• Self limiting, supportive treatment with
oxygen• Differential diagnosis
CASE 2
• 54 year old female• Experienced diver• Diving on Swan Wreck (30m dive)• NO problems during the dive• At 5m deco stop developed SOB• LOC, bought to surface by buddy• Controlled ascent• PMH – HTN on B Blocker (variable compliance)
CASE 2 - DIAGNOSIS?
• Regained consciousness on boat• Transferred to ED• Alert, normal neuro exam• Clinical signs of APO• ECG – ST depression in V5, V6• Troponin mildly elevated• CXR –consistent with APO
Case 2 – Immersion pulmonary oedema
• Usually rapid onset, can occur during any part of the dive
• Likely due to increase in preload• Patients often have hypertension• Increased risk with B Blockers• ? likelihood of recurrence• Normal coronary arteries
CASE 3• 26 year old male• Experienced diver• Recent URTI• Difficulty equalising throughout dive• Diving to 20 metres for 35 mins• Developed acute onset dizziness whilst lifting tanks
back on the boat• No history of rapid ascent• Nausea and vomiting• Tinnitus and fullness in right ear
CASE 3 – DIAGNOSIS?
• On examination• Vomiting, unable to stand• Horizontal nystagmus• Hearing loss in right ear (high frequency)• Sensorineural hearing loss
Case 3 – Inner ear barotrauma
• Excessive force with difficulty equalizing• Damage to round window (most often), oval
window or membrane rupture within labyrinth (Reissner’s membrane)
• Perilymph fistula
• Differential diagnosis – inner ear DCI
Case 4
• Free diver• Multiple free dives to max 10 metres over
course of morning• Developed painful red rash on forearm• Abdominal pain, tachycardic, sweaty
• ?DCS
Taravana
Shallow Water Black Out
• Severe hyperventilation prior to breath-hold diving is the single most dangerous practice in open water, causing blackout during the ascent phase.
Questions?
Recommended
