Common HazardsOf Sports Diving ANDREW M. STEINBACH, MDSUMMARY The rapidly increasing diver population may result in any physicianbeing involved in the evaluation and treatment of injuries anddisease from skin and scuba diving. The majority of treatments aresymptomatic, but pulmonary embolism and decompression sicknessare specific emergencies that require immediate recompression.Physicians should know the site of the nearest recompressionchamber.Dr Steinbach, a family physician, practices in Toronto. He has aspecific interest in diving medicine, and is an Association ofCanadian Underwater Councils certified scuba and skin divinginstructor.SKIN AND SCUBA DIVING are fast growing watersports. The exact number of participants is unknown,but has been estimated to be about 15 x 106 in NorthAmerica and adding thousands of new converts every year.Diving is popularly described in ecstatic or poetic terms, yetany diver may be subject to poisoning by oxygen and othergases, affected by venomous fish and marine animals,2 sufferfrom barotrauma, asphyxia,2 decompression sickness andvarious other infections. Successful treatment of an injureddiver depends on the awareness of problems unique to theunderwater environment. Furthermore, diver trainingorganizations are increasingly insisting that prospectivedivers be evaluated both mentally and physically by theirphysicians; this can be somewhat difficult if no exposure tothe requirements in this field of medicine has occurred.Skin diving requires little equipment (mask, fins,snorkel) and is easily mastered. This is ideal for beginnerssince diving duration, depth and air supply are limited.SCUBA (self-contained-underwater-breathing-apparatus)increases both the vistas and the risks by adding an airsupply to the skin diver's equipment. Table 1 showsdiseases as they apply to each situation.Barotrauma refers to the various injuries that the bodycan sustain during diving operations or other exposure tohigh pressure.On DescentThe following problems are most common though fairlyinnocuous and easily treatable:1. Ear squeeze results when the diver is unable toequalize the middle ear with the ambient pressure due toURI, inexperience, or too rapid descent. The symptoms arepain in the ear with increasing depth; if rupture of thetympanic membrane occurs, vertigo may result, especiallyin cold water diving. The treatment consists of administer-ing decongestants (Neosynephrine spray) and antihistamines(Actifed Tabs tid) and the patient should not dive for sevento 10 days. If rupture has occurred, antibiotics should beadded to the above regime and diving should be prohibiteduntil the ear drum heals. This will take two to three weeks.2. Lung squeeze is a phenomenon reserved for skindivers. The average vital capacity of a diver is 6 L with aresidual volume of 1.5 L. If, on a breath-hold dive, the lungvolume is compressed to less than the residual volume (inaccordance with Boyle's Law), the symptoms of chestcompression, pain and respiratory distress can result.Usually a bloody, frothy sputum is produced at the surface.The treatment required is minimal; observation alone isusually sufficient, but occasionally hospitalization may berequired.3. Sinus squeeze is problably the most painful of divecomplications and has been typically described as 'havingyour head in a vice'. Fortunately the pain can be alleviatedby ascent. The cause is blockage of the ostia by edema,polyps or infection and results in a bloody nasal dischargeinto the face mask. Treatment usually requires anti-histamines or decongestants (Actifed tabs plus Nafrinespray), but if secondary bacterial infection results, systemicantibiotics are necessary. Diving need not be restricted.TABLE 1Diseases Applicable to Skin and Scuba Diving3Problem: Skin ScubaDrowning yes yesSqueeze-ears, sinuses yes yesLung squeeze yes noDecompression sickness unlikely yesAir embolism no yesNitrogen narcosis unlikelyyesOxygen poisoning unlikelyyesCarbon monoxide noyesCANADIAN FAMILY PHYSICIAN/JULY, 197254
