Cape Town is a renowned recreational SCUBA diving destination. Various ship wrecks litter the coast line and the oceans are filled with an abundance of sea life and vegetation. After a recent dive a patient was admitted to the ER following a unknown incident occurring underwater resulting in a loss of consciousnesses precipitating asystole and the implementation of CPR. ER Doctors at the Christiaan Barnard Memorial Hospital admitted the patient and closely observed the patient for further injuries.
Diving accidents: Various Dive Apparatus
SCUBA Gear:
HOOKAH Equipment:
RE-BREATHER Equipment:
COMMERCIAL DIVINING Equipment:
|
Despite the type of dive and equipment utilized, one can broadly categorize dive injuries and causes of death when they occur. Common factors leading to dive injuries and fatalities include:
The terminal event in each case is drowning, and when investigated in depth may arise from:
- Medical Factors: Including pathology, psychology and physiology
- Diving Techniques: running out of air, failure to stay in visual contact with a dive buddy
- Equipment problems: faults, misuse and loss of equipment
- Environmental factors: current, depth and visibility
The terminal event in each case is drowning, and when investigated in depth may arise from:
- Inability to swim
- Panic
- Fatigue
- Decreased level of consciousness
- Natural disease - acute myocardial infarct, asthma, diabetes, epilepsy
- Trauma
- Entrapment in caves or wrecks
- Physical disability
- Equipment malfunction
Click to set custom HTML
The term "The Bends" or decompression sickness describes a condition which results in the formation bubbles in the tissue or circulation as a result of inadequate elimination of inert gas after a dive down to a depth.
As the diver descends, the total pressure of breathing air increases and therefore the partial pressures of the individual components increase proportionately (Dalton's Law). As the decent continues, increasing amounts of nitrogen dissolve in the blood.
With increasing depth, the nitrogen in compressed air equilibrates through the alveoli into the blood. As the dive continues, more nitrogen dissolves and accumulates in the lipid component of tissue (Henry's Law).
|
When a critical amount of nitrogen has dissolved into the tissue, acceding too rapidly will cause the dissolved nitrogen to return to its gaseous form while still in the blood or tissue, causing bubbles or gas pockets to form. The effects of this trapped gas may precipitate decompression sickness, which is further classified into mild, severe and arterial gas embolization and include:
1. Type 1 (Mild)
2. Type 2 (Severe)
3. Arterial gas embolization
1. Type 1 (Mild)
- Mild pains that begin to resolve with 10min
- Pruritus (an itching or burning sensation of the skin)
- Cutis marmorata (skin rash)
2. Type 2 (Severe)
- Pulmonary symptoms (burning substernal discomfort; non productive cough; severe respiratory distress)
- Hypovolemic shock (victims are often dehydrated)
- Nervous system involvement (sensory disturbances)
3. Arterial gas embolization
- Signs and symptoms depend on where the emboli travel: coronary embolization can lead to myocardial infarction or dysrhythmia; cerebral emboli may cause stroke or seizures.
What to do in an emergency:
An Injury and Prevention Awareness Project brought to you by Christiaan Barnard Memorial Hospital Trauma & Emergency Centre.