Common dive injuries
Let’s start with a scenario.
SOMEONE saw a gas cylinder marketed as a “SCUBA Oxygen tank for snorkeling” online, and he decided to get one because it’s 20% off on the day.
A few days later, his “SCUBA Oxygen tank for snorkeling” arrived, and he tried out this new toy in the evening with fins, which was working well as advertised. This adventurous young man had some difficulties equalizing his ears on descend, he pushed on despite the pain in his ears, eyes, and face as he vaguely remembered what an ex-Navy PTI said, “Pain is weakness leaving the body”.
At a certain depth, he thought he saw the moving silhouette of two sharks, he ascended from depth in panic.
This scenario is based on a real case, while this is not the best place to discuss the details of the injuries and treatment required, it is not hard to figure out that he suffered from barotrauma to his ears and sinuses, along with other gas bubbles-related injuries.
Before we dive into barotrauma, we’ll go through one important concept that you may remember from your Science class called Boyle’s law. In essence, if you inflate a balloon at the bottom of the swimming pool and seal it, the balloon will increase in size when it comes up to the surface, because the pressure close to the surface is lower than that at the bottom of the pool, which allows more room for the balloon to expand. The reverse is also true, if you drag an inflated balloon down to the bottom of the pool, the balloon will shrink. In mathematical terms, it’s P1V1=P2V2.
Barotrauma is a physical injury due to pressure changes in a closed or air-tight compartment, similar to the balloon above, rapid changes in pressure, either by sucking in or expanding, can result in damage to delicate parts of the body such as the eardrum or surface of the maxillary sinus.
It is beyond the scope of this article to discuss decompression injuries- which effectively means the gas (mostly Nitrogen) dissolved in blood/ tissue expands when the diver ascends to the surface rapidly (panic ascend), which can be provoked by the dive profile, physical activities or flying post diving. Decompression injuries should be assessed promptly +/-referred to the nearest Hyperbaric Medicine Unit for treatment if required. Initial and periodic Dive medicals are essential as there are medical conditions that would put divers at a significantly higher risk of Decompression Injuries.
Statistically, barotrauma to the ear and sinus is the commonest type of dive-related injury, seconded by musculoskeletal trauma– somewhat between a splinter lodged under the nail and to dislocated shoulder while at depth. Back pain can be exacerbated by repetitive lifting and carrying heavy dive equipment. Once I asked a patient. “What’s the safe way to lift something heavy?”, he replied, “Get my son-in-law to do it.”
The last category is self-explanatory: threat from marine creatures. It is not uncommon to come in contact with sharks while snorkeling/ diving along the East Coast in NSW, and there are plenty of stingrays and jellyfish both in the shallow and deep end of the coastline.
Stay safe until next time.
About the author
Dr. Armand Edison graduated from Melbourne University Medical School in 2008 and completed an internship and residency at Westmead Hospital, since then he worked at various locations ranging from Regional Trauma Facilities to solo Emergency Units both locally and overseas for 5 years. He has extensive experience in treating minor trauma and performing emergency procedures as required.
Dr. Edison is also a qualified Underwater Medicine Medical Officer and Aviation Medical Officer in the Royal Australian Navy, his job role involves treating various acute and chronic injuries in the elite athlete population on a daily basis.
Special interests: Dive Medicine, Aviation Medicine