W
hether you’re exploring Australia’s
coral reefs, drifting through warm
Caribbean waters or diving into a
crisp Canadian lake, nothing puts
a damper on a dive vacation quite
like a trip to the emergency room
(
ER). Anxiety and uncertainty accompany most illnesses
and injuries — from cuts that need stitches to more serious
problems like chest pain. Unfortunately, even the most well-
planned dives by careful and experienced divers may result
in ER visits. A little knowledge, whether about ear squeezes
or decompression sickness (DCS), can go a long way in
reducing anxiety around trips to the ER.
DAN’s medical staff is available to offer advice about
dive injuries and provide recommendations about the need
for medical care. In complex and more serious cases DAN
can work with local facilities to help coordinate care or
arrange emergency medical evacuations. If you experience
symptoms after diving, activate local emergency medical
services or safely get yourself to the nearest ER. Call the
DAN Emergency Hotline at +1-919-684-9111 if you wish to
discuss your symptoms with an expert in dive medicine.
One of the most common problems in the management
of dive accidents is delay in seeking care. If you are worried
you may be suffering from a diving-related medical problem,
don’t hesitate to make the call. Whether a DAN medic
advises you to seek care or you decide on your own to do
so, the best course of action is to go to the nearest hospital
—
not the closest hyperbaric chamber. Chambers are not
generally equipped to receive patients directly; patients must
be evaluated in an ER first. People with severe burns don’t
seek out the closest burn center — they go directly to the
hospital. Symptoms after diving warrant the same approach.
The Doctor Meets the Diver
The doctor will ask about your medical history and conduct
a physical exam. Provide as much information as you can
about your symptoms and dives. Be prepared to tell the
doctor the number of dives you made over the past few days,
the depths and times of the most recent dives, the maximum
depth of the deepest dive in the series and the gases you
breathed. Also, make sure to mention any rapid ascents,
omitted decompression or other problems.
Be honest and thorough when describing your symptoms
and the events leading up to your injury. An unanticipated
problem or error during a dive may provide clues that will
help with the diagnosis. Bring your dive computer with you; it
can provide information such as dive profiles and ascent rates
that may be of interest to the doctor.
The Physical and Neurological Exams
In the course of the physical exam, the doctor will try
to identify any abnormalities that will help in making a
diagnosis and determining the best treatment. For a patient
who was diving, the most important parts of the physical
exam are the assessments of the ears, lungs, heart, skin and
neurological function.
The doctor will check your ears for signs of barotrauma,
such as visible damage to the eardrums and blood or other
fluid in the middle ears, will listen to your lungs and heart
for abnormal sounds and will examine your skin for any
rashes that might be suggestive of DCS. The neurological
exam may seem a little unusual, but it is a critical part of the
evaluation, and subtle deficits may be significant. The exam
is a series of observations, questions and measurements
used to evaluate motor strength and sensation all over
the body, the function of the 12 cranial nerves, reflexes,
balance, coordination and cognition. Impaired balance or
coordination is relatively common in people with neurological
decompression illness (DCI). Some of the specific evaluations
used to detect impairments include the Romberg and
sharpened Romberg tests, in which you will be asked to stand
still with your eyes closed and your feet close together, the
finger-to-nose test and the heel-to-shin test. The doctor may
also carefully examine your gait for signs of unsteadiness and
evaluate your ability to perform rapid, alternating movements.
Making the Diagnosis
During the evaluation, the physician may make frequent
adjustments to a list of possible diagnoses. This list is called the
differential diagnosis. When it comes to diving-related medical
conditions, diagnosis may be especially difficult since both forms
of DCI —DCS (or “the bends”) and arterial gas embolism (AGE)
—
are clinical diagnoses. This means there are no definitive
medical tests that can prove these conditions are present. The
diagnosis is instead the result of a thorough history, identification
of abnormalities during the physical exam and data gathered
from other tests and observations.
By Katina Fosen, M.D., and Christopher Logue, M.D.
A detailed discussion of medical
history and recent diving
history is essential for
diagnosing DCI.
www.alertdiver.com
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