Pressure Injuries From Scuba Diving
What are pressure injuries from scuba diving?
Scuba diving can expose you to high waves and dangerous sea life. But the more likely dangers are those you can't see. You can be injured if your body isn't able to adjust to the increasing and decreasing pressure of the water as you breathe compressed air. Pressure changes can cause injuries when you drop down into the water (descend) and come back up (ascend).
Scuba injuries may be mild. But in some cases, they can cause serious problems or even death.
There are three kinds of injuries from pressure changes when diving:
- Barotrauma: Tissues near the air-filled spaces of your body—such as your ears, sinuses, dental roots, and lungs—can be damaged if your body can't equalize the pressure between it and the surrounding water. This kind of injury is called barotrauma. As you descend, water pressure increases, and the volume of air in your body decreases. This can cause problems such as sinus pain or a ruptured eardrum. As you ascend, water pressure decreases, and the air in your lungs expands. This can make the air sacs in your lungs rupture and make it hard for you to breathe. If air bubbles get into an artery, they can cause a blockage that affects your organs. The blockage is called an arterial gas embolism. Depending on where the bubbles are, you could have a heart attack or a stroke.
- Decompression sickness: Often called "the bends," decompression sickness happens when a scuba diver ascends too quickly. Divers breathe compressed air that contains nitrogen. At higher pressure under water, the nitrogen gas goes into the body's tissues. This doesn't cause a problem when a diver is down in the water. And if a diver rises to the surface (decompresses) at the right rate, the nitrogen can slowly and safely leave the body through the lungs. But if a diver rises too quickly, the nitrogen forms bubbles in the body. This can cause tissue and nerve damage. In extreme cases, it can cause paralysis or death if the bubbles are in the brain.
- Nitrogen narcosis: Deep dives can cause so much nitrogen to build up in the brain that you can become confused and act as though you've been drinking alcohol. You might make poor decisions, such as taking out your regulator because you think you can breathe underwater. Narcosis usually happens only on dives of more than 100 feet.
What are the symptoms?
Symptoms of scuba diving injuries can appear throughout your body. Some are mild, while others are more serious and need treatment right away.
Mild symptoms can include:
- Pain in your ears, sinuses, or teeth.
- Joint pain.
- Extreme fatigue.
Severe symptoms can include:
- Numbness and tingling in your arms and legs.
- Trouble breathing.
- Staggering or other trouble walking.
- Trouble seeing.
- Chest pain.
- Passing out (losing consciousness).
Symptoms can show up right after you come to the surface. Or they may not appear for several hours, especially if you fly in an airplane too soon after diving.
Get emergency help if you have any symptoms of scuba injuries, even if they seem minor. It's easy to ignore joint pain and explain it away. But it could be a sign of illness. Sometimes the symptoms go away, but they can come back and get worse.
How are scuba injuries treated?
The main treatment for decompression sickness is time in a hyperbaric chamber. In the chamber, you're exposed to increasing air pressure, which is like the high pressure underwater. The pressure is then slowly reduced, as though you're coming up from underwater. Treatment in a chamber usually works best if it's done as soon as possible.
Most divers who have decompression sickness also get pure oxygen right away after they have symptoms.
If you have a barotrauma injury, treatment depends on what part of your body has been injured. For example, if you have a broken eardrum, you may be given antibiotics while your eardrum heals. Depending on your injury, you also might get nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids to help reduce swelling in your joints and tissues.
Nitrogen narcosis gets better on its own when you reach the surface.
How can you prevent scuba injuries?
The best way to prevent scuba diving injuries is to make sure that you have proper training and are healthy enough to dive. In diving classes, you also will learn how to clear your ears to prevent pain and injury as you descend. Diving instructors can tell you how to use dive tables or computers that show how fast you should ascend and how many stops you should make while ascending.
Air travel too soon after diving can increase the risk of decompression sickness. The time you need to wait to fly depends on how much time has passed between your last dive and flying, and on how many dives you have made over a certain amount of time. Look at your dive manual to find out how long you need to wait before you fly.
You need to wait at least 18 hours or more if you made several dives a day or you dove for several days.
Current as of: February 18, 2021
Author: Healthwise Staff
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
W. David Colby IV MSc, MD, FRCPC - Infectious Disease