Presentation
Pulmonary barotrauma was not contemplated because of the relatively mild presentation. Later, a very significant pneumothorax was discovered and successfully treated without sequelae. [ncbi.nlm.nih.gov]
Having briefly discussed some relevant pulmonary mechanics, possible mechanisms whereby lung rupture in divers appears to differ from other circumstances are presented. [archive.rubicon-foundation.org]
Respiratoric
- Tracheal Deviation
Tension pneumothorax, although rare with barotrauma, can cause hypotension, distended neck veins, hyperresonance to percussion, and, as a late finding, tracheal deviation. [merckmanuals.com]
- Hyperresonance
Tension pneumothorax, although rare with barotrauma, can cause hypotension, distended neck veins, hyperresonance to percussion, and, as a late finding, tracheal deviation. [merckmanuals.com]
Eyes
- Diplopia
Following the appearance of diplopia and exotropia, orbital emphysema was demonstrated radiologically. [ncbi.nlm.nih.gov]
[…] emesis, nystagmus, tinnitus, sensorineural hearing loss Within 30 to 60 minutes of surfacing (> 50 percent), 90 percent by six hours; significant time-depth exposure required Same as above Cerebral DCS Confusion, focal weakness, fatigue, visual loss, diplopia [aafp.org]
Musculoskeletal
- Neck Pain
The result can be pneumothorax (causing dyspnea, chest pain, and unilateral decrease in breath sounds) or pneumomediastinum (causing sensation of fullness in the chest, neck pain, pleuritic chest pain that may radiate to the shoulders, dyspnea, coughing [merckmanuals.com]
Neurologic
- Forgetful
Once the button is released, flow through the valve is automatically re-established, minimizing the risk for forgetting to reopen the original pop-off valve, as it will always be left open. [cliniciansbrief.com]
This may be due to failure to read "Diving Medicine for Scuba Divers", panic, ignorance, forgetfulness or spasm of the larynx after inhalation of water. [cfua.org]
- Dysmetria
Signs and symptoms: Dizziness, headache Nausea, vomiting Nystagmus Chest pain Shortness of breath, hemoptysis, crepitus Stroke symptoms such as bilateral or unilateral motor or sensory changes, aphasia vertigo, ataxia, dysmetria, cortical blindness Seizures [clinicaladvisor.com]
- Aphasia
Signs and symptoms: Dizziness, headache Nausea, vomiting Nystagmus Chest pain Shortness of breath, hemoptysis, crepitus Stroke symptoms such as bilateral or unilateral motor or sensory changes, aphasia vertigo, ataxia, dysmetria, cortical blindness Seizures [clinicaladvisor.com]
- Altered Mental Status
A head CT scan should be strongly considered in any patient who has altered mental status in order to evaluate alternative diagnoses, such as subdural or epidural hematoma. [clinicaladvisor.com]
- Generalized Tonic-Clonic Seizure
tonic-clonic seizures occur with an incidence of approximately 1-4 per 10,000 patient treatments. [clinicaladvisor.com]
Workup
Besides reduced emergency medical costs and shorter hospital stays (diagnostic workups would be greatly shortened), insurers would find reduced health care costs in their capitated population because of the added efficiency and increased mortality with [scubamed.com]
X-Ray
- Pneumoperitoneum
Massive pneumoperitoneum developing immediately following initiation of artificial ventilation is an unusual sign of pulmonary barotrauma, and must be distinguished from pneumoperitoneum following rupture of a hollow abdominal viscus. [ncbi.nlm.nih.gov]
There is also pneumoperitoneum. There is right pleural effusion and areas of higher density in the lung parenchyma corresponding to pneumonic foci. Endotracheal tube well located. [radiopaedia.org]
In the lung it is caused by excessive airway pressures, resulting in extra-alveolar air, as in pneumothorax, pneumomediastinum, or pneumoperitoneum. bar·o·trau·ma ( băr'ō-traw'mă ), A term previously used to describe injury to the middle ear or paranasal [medical-dictionary.thefreedictionary.com]
P(total) = P(1) + P(2) +.....P(n) Pulmonary barotrauma (POIS = Pulmonary Over Inflation Syndrome) Results in: Arterial Gas Embolism Pneumothorax Mediastinal or surgical emphysema Pneumoperitoneum History Get as detailed dive history as possible - particularly [emed.ie]
Microbiology
- Streptococcus Pneumoniae
Regarding the patients with pneumonia, no microorganism was isolated in 11 subjects, while in the remaining 39 patients the causal microorganisms were influenza virus A (H1N1) in 12 cases, Legionella pneumophila in 5, Pneumocystis jiroveci in 5, Streptococcus [medintensiva.org]
Treatment
Increasing the time to treatment reduced the likelihood of cure. [ncbi.nlm.nih.gov]
The rate of successful treatment increased with the team’s experience. [omicsonline.org]
Prognosis
[…] for recovery from barotrauma is anticipated to be excellent; however, its effects at the time of the event and the patient’s underlying comorbidities and lung disease affect the prognosis. [emedicine.medscape.com]
Outlook (Prognosis) Barotrauma is usually noncancerous ( benign ) and responds to self-care. Hearing loss is almost always temporary. When to Contact a Medical Professional Try home care measures first. [mountsinai.org]
Prognosis Mortality rates vary widely. [patient.info]
Confinement anxiety – managed with anxiolytics Fire (due to elevated FiO2) What is the prognosis for patients managed in the recommended ways? Outcome data for SCUBA divers who suffer from DCS is compiled and published by the Diver’s Alert Network. [clinicaladvisor.com]
Etiology
Initial evaluations considered decompression sickness and musculoskeletal etiologies. Pulmonary barotrauma was not contemplated because of the relatively mild presentation. [ncbi.nlm.nih.gov]
They suggest that the etiology of the decompression disorders is impossible to define, the two illnesses are difficult to separate from one another, and both require the same therapy. [scubamed.com]
Etiology Barotrauma is one of the manifestations of VILI. [emedicine.medscape.com]
Epidemiology
Having identified some caveats with respect to the diagnosis of the condition and discussed the routes which air may take having left the intra-pulmonary air spaces, the epidemiology of the condition in the contexts of diving and submarine escape is discussed [archive.rubicon-foundation.org]
Epidemiology Frequency depends on both the political stability of the region, eg terrorism, and local factors such as occupational health and safety priorities. Presentation Lungs may show evidence of pulmonary trauma and pneumothorax. [patient.info]
Epidemiologic data pertinent to divers have traditionally not been recorded in sufficient detail to allow a more specific classification. [scubamed.com]
Epidemiology United States statistics The incidence of barotrauma in mechanically ventilated patients varies widely and is reported to be as low as 0.5% in postoperative patients and as high as 87% in patients with ARDS. [emedicine.medscape.com]
Pathophysiology
This report cites four cases demonstrating different mechanisms by which pulmonary barotrauma can be caused during CPR, and reviews their pathophysiologic consequences. [ncbi.nlm.nih.gov]
These terms are unambiguous and perfectly appropriate for denoting the pathophysiologic concepts for which they were defined. [scubamed.com]
Here we describe the causative agents (shock) and the consequences (sepsis, organ failure) in two main sections, divided on the basis of their pathophysiology. [books.google.es]
DCS pathophysiology: Under normal conditions, we breathe air at 1 atmospheres absolute (ATA), which is the average atmospheric pressure at sea level. [clinicaladvisor.com]
Prevention
It is concluded that the Royal Navy policy of preventing all divers who suffer PBT from further diving is justified, regardless of the cause or mild nature of the injury. [ncbi.nlm.nih.gov]
Get the skills you need now with new information on global humanitarian relief and expedition medicine, plus expanded coverage of injury prevention and environmental preservation. [books.google.com]
A thoracostomy tube should then be placed to allow air to be continuously removed until the ruptured alveoli can seal to prevent the reoccurrence of a tension pneumothorax. [cliniciansbrief.com]
Prevention of pulmonary barotrauma is usually the top priority. Proper ascent timing and techniques are essential. [merckmanuals.com]
Rescue procedure in the case of an occurrence of pulmonary barotrauma, methods of prevention. [degruyter.com]