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THE DIVER
The diver was a 26-year-old woman with approximately
200 lifetime dives.
THE DIVE
She did a single, morning dive to a maximum depth of
88 feet. She reported no troubles equalizing or other
complications during her descent. Approaching her safety
stop near the end of the ascent, however, she was struck
by a sudden massive headache, nausea and vomiting.
She skipped the safety stop and ascended directly to
the surface. The headache and vomiting continued on
the boat, and she also experienced an onset of what she
called dizziness. The crew helped her remove her gear
and administered oxygen. After a few minutes with no
improvement, the crew recalled the rest of the divers and
called emergency medical services (EMS) and the DAN®
Emergency Hotline.
ANALYSIS
Further discussion revealed that the dizziness the diver
reported was likely true vertigo. Vertigo is characterized
by a spinning sensation and is usually accompanied by
nausea and vomiting, while dizziness is a sensation of loss
of balance.
In a diving context, a sudden onset of vertigo during
ascent or descent is suggestive of ear barotrauma, with
inner-ear barotrauma (IEBT) being most concerning. Ear
pain may or may not be present. Vertigo is also common
in cases of inner-ear decompression sickness (IEDCS).
Symptom onset for IEDCS is usually not so sudden and
dramatic, and the dive profile did not seem to be aggressive
enough to immediately suggest IEDCS.Nevertheless, such a
diagnosis could not be completely ruled out.
Distinguishing between IEDCS and IEBT can
pose a significant diagnostic challenge, but doing so
is critical because the two conditions require very
RESEARCH, EDUCATION & MEDICINE
INCIDENT INSIGHT
60
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SPRING 2016
If You Can’t Equalize, Abort
SINUS BAROTRAUMA CAN BE VERY UNPLEASANT.
By Matías Nochetto, M.D.
We should not forget one of the first lessons
we were taught as new divers: Don’t force it
— if it’s hard to equalize, end the dive.
STEPHEN FRINK