Diving Injuries 

Assessment

Pediatric Pearls:	Signs & Symptoms:	Differential:
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes.	□ Joint pain □ Mental status change □ New paralysis □ Confusion, appearing intoxicated □ Coughing up blood □ Hypoxia	□ Hypothermia □ Marine envenomation □ Spinal cord injury from diving

Clinical Management Options

EMT-B

• Oxygen, target SpO2 92 – 96%  • Place in left lateral decubitus position of air embolism suspected • If concerned for decompression sickness, place on full oxygen

Paramedic

• Vascular access as appropriate for patient condition  • Consider CPAP early for pulmonary barotrauma

Pearls

• Decompression illness occurs up to 48 hours after diving (so consider travelers)
• Be alert for signs of barotrauma (pulmonary barotrauma, arterial gas embolism, pneumothorax, ear/sinus/dental barotrauma etc.) and/or decompression sickness (joint pain, mental status change, other neurologic symptoms including paralysis) or nitrogen narcosis (confusion, intoxication).
• You can consider Trendelenburg position as it is sometimes recommended to help trap the air in the dependent right ventricle, and may be useful if a central venous catheter is being used to withdraw the air, but this position may increase cerebral edema (so caution in the confused patient)