Jump to content

Barotrauma: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
Line 28: Line 28:
* [[teeth]] (causing [[Barodontalgia]], i.e. barometric pressure related [[toothache|dental pain]],<ref name="class"/><ref name="Rauch 1985"/><ref name="Zadik 2006"/><ref name="Zadik et al 2007"/><ref name="Zadik 2009"/> or dental fractures<ref name="Zadik 2006b"/><ref name="BDJ"/><ref name="Diving_dentistry"/>)
* [[teeth]] (causing [[Barodontalgia]], i.e. barometric pressure related [[toothache|dental pain]],<ref name="class"/><ref name="Rauch 1985"/><ref name="Zadik 2006"/><ref name="Zadik et al 2007"/><ref name="Zadik 2009"/> or dental fractures<ref name="Zadik 2006b"/><ref name="BDJ"/><ref name="Diving_dentistry"/>)
*[[genital]] (squeeze and associated complications of ''[[Dry suit#The P-valve|P-valve]]'' use) <ref name="pmid22752741"/>
*[[genital]] (squeeze and associated complications of ''[[Dry suit#The P-valve|P-valve]]'' use) <ref name="pmid22752741"/>

== Diving barotrauma ==


===Ear barotrauma===
===Ear barotrauma===

Revision as of 14:40, 15 January 2017

Barotrauma

Barotrauma is physical damage to body tissues caused by a difference in pressure between a gas space inside, or in contact with the body, and the surrounding gas or fluid.[1][2]

Barotrauma typically occurs when the organism is exposed to a significant change in ambient pressure, such as when a scuba diver, a free-diver or an airplane passenger ascends or descends, or during uncontrolled decompression of a pressure vessel, but can also be caused by a shock wave. Whales and dolphins are also vulnerable to barotrauma if exposed to rapid and excessive changes in diving pressures.[3] Bats can be killed by lung barotrauma when flying in low pressure regions close to operating wind turbine blades.[4]

Presentation

Examples of organs or tissues easily damaged by barotrauma are:

Ear barotrauma

Barotrauma can affect the external, middle, or inner ear. Middle ear barotrauma (MEBT) is the most common being experienced by between 10% and 30% of divers and is due to insufficient equilibration of the middle ear. External ear barotrauma may occur on ascent if high pressure air is trapped in the external auditory canal either by tight fitting diving equipment or ear wax. Inner ear barotrauma (IEBT), though much less common than MEBT, shares a similar mechanism. Mechanical trauma to the inner ear can lead to varying degrees of conductive and sensorineural hearing loss as well as vertigo. It is also common for conditions affecting the inner ear to result in auditory hypersensitivity.[22]

Barosinusitis

The sinuses similar to other air filled cavities are susceptible to barotrauma if their openings become obstructed. This can result in pain as well as epistaxis (nosebleed).[23]

Mask squeeze

If a diver's mask is not equalized during descent the relative negative pressure can produce petechial hemorrhages in the area covered by the mask along with subconjunctival hemorrhages.[23]

Helmet squeeze

A problem mostly of historical interest, but still relevant to surface supplied divers who dive with the helmet sealed to the dry suit. If the air supply hose is ruptured near or above the surface, the pressure difference between the water around the diver and the air in the hose can be several bar. The non-return valve at the connection to the helmet will prevent backflow if it is working correctly, but if absent, as in the early days of helmet diving, or if it fails, the pressure difference will tend to squeeze the diver into the rigid helmet, which can result in severe trauma. The same effect can result from a large and rapid increase in depth if the air supply is insufficient to keep up with the increase in ambient pressure. [24]

Pulmonary barotrauma

Lung pressure damage in scuba divers is usually caused by breath-holding on ascent. The compressed gas in the lungs expands as the ambient pressure decreases causing the lungs to over-expand and rupture unless the diver breathes out. The lungs do not sense pain when over-expanded giving the diver little warning to prevent the injury. This does not affect breath-hold skin divers as they bring a lungful of air with them from the surface, which merely re-expands safely to near its original volume on ascent.[2] The problem only arises if a breath of compressed gas is taken at depth, which will then expand on ascent to more than the lung volume. Pulmonary barotrauma may also be caused by explosive decompression of a pressurised aircraft.[25]

Causes

When diving, the pressure differences which cause the barotrauma are changes in hydrostatic pressure: There are two components to the surrounding pressure acting on the diver: the atmospheric pressure and the water pressure. A descent of 10 metres (33 feet) in water increases the ambient pressure by an amount approximately equal to the pressure of the atmosphere at sea level. So, a descent from the surface to 10 metres (33 feet) underwater results in a doubling of the pressure on the diver. This pressure change will reduce the volume of a gas filled space by half. Boyle's law describes the relationship between the volume of the gas space and the pressure in the gas.[1]

Barotraumas of descent are caused by preventing the free change of volume of the gas in a closed space in contact with the diver, resulting in a pressure difference between the tissues and the gas space, and the unbalanced force due to this pressure difference causes deformation of the tissues resulting in cell rupture.[2]

Barotraumas of ascent are also caused when the free change of volume of the gas in a closed space in contact with the diver is prevented. In this case the pressure difference causes a resultant tension in the surrounding tissues which exceeds their tensile strength. Besides tissue rupture, the overpressure may cause ingress of gases into the tissues and further afield through venous blood vessels.[2]

Breathing gas at depth from underwater breathing equipment results in the lungs containing gas at a higher pressure than atmospheric pressure. So a free-diver can dive to 10 metres (33 feet) and safely ascend without exhaling, because the gas in the lungs had been inhaled at atmospheric pressure, whereas a diver who inhales at 10 metres and ascends without exhaling has lungs containing twice the amount of gas at atmospheric pressure and is very likely to suffer life-threatening lung damage.[2]

Explosive decompression of a hyperbaric environment can produce severe barotrauma, followed by severe decompression bubble formation and other related injury. The Byford Dolphin incident is an example.

Blast induced barotrauma

An explosive blast and explosive decompression create a pressure wave that can induce barotrauma. The difference in pressure between internal organs and the outer surface of the body causes injuries to internal organs that contain gas, such as the lungs, gastrointestinal tract, and ear.[26]

Lung injuries can also occur during rapid decompression, although the risk of injury is lower than with explosive decompression.[27][28]

Ventilator induced barotrauma

Mechanical ventilation can lead to barotrauma of the lungs. This can be due to either:[29]

The resultant alveolar rupture can lead to pneumothorax, pulmonary interstitial emphysema (PIE) and pneumomediastinum.

Prevention

Diving barotrauma can be avoided by eliminating any pressure differences acting on the tissue or organ by equalizing the pressure. There are a variety of techniques:

  • The air spaces in the ears, and the sinuses. The risk is burst eardrum. Here, the diver can use a variety of methods, to let air into the middle ears via the Eustachian tubes. Sometimes swallowing will open the Eustachian tubes and equalise the ears.[30]
  • The lungs. The risk includes pneumothorax, arterial gas embolism, and mediastinal and subcutanous emphysemas. which are commonly called burst lung or lung overpressure injury by divers. To equalise, all that is necessary is not to hold the breath during ascent. This risk does not arise when snorkel diving from the surface, unless the snorkeller breathes from a high pressure gas source underwater, or from submerged air pockets. Some people have pathologies of the lung which prevent rapid flow of excess air through the passages, which can lead to lung barotrauma even if the breath is not held during rapid depressurisation. These people should not dive as the risk is unacceptably high. Most commercial or military diving medical examinations will look specifically for signs of this pathology.[31]
  • The air inside the diving mask enclosing the eyes and nose (also known as a half mask). The main risk is bleeding from the capillaries of the eyes from the negative pressure[11] or orbital emphysema from higher pressures.[32] This can be avoided by allowing air into the mask through the nose. Goggles covering only the eyes are not suitable for diving as they cannot be equalised.
  • Air spaces inside a dry suit. The main risk is skin getting pinched by folds of the dry suit. Most dry suits have a hose connection with a manually operated valve to feed intermediate pressure air in from the cylinder. Air must be manually injected on the descent and is usually automatically vented on the ascent.[33]

Treatment

Treatment of diving barotrauma depends on the symptoms. Lung over-pressure injury may require a chest drain to remove air from the pleura or mediastinum. Recompression with hyperbaric oxygen therapy is the definitive treatment for arterial gas embolism, as the raised pressure reduces bubble size, low inert gas partial pressure accelerates inert gas solution and high oxygen partial pressure helps oxygenate tissues compromised by the emboli. Care must be taken when recompressing to avoid a tension pneumothorax.[34]

Following barotrauma of the ears or lungs from diving the diver should not dive again until cleared by a diving doctor. Recovery can take weeks to months.[35]

Use of a hyperbaric chamber.

Patients undergoing hyperbaric oxygen therapy must learn to equalize in order to avoid barotrauma. High risk of otic barotrauma is associated with unconscious patients. [36]

Barotrauma in animals

Whales and dolphins suffer severely disabling barotrauma when exposed to excessive pressure changes induced by navy sonar, oil industry airguns, explosives, undersea earthquakes and volcanic eruptions.[37][unreliable source?]

Injury and mortality of fish, marine mammals, including sea otters, seals, dolphins and whales, and birds by underwater explosions has been recorded in several studies.[38]Bats can suffer fatal barotrauma in the low pressure zones behind the blades of wind turbines due to their more fragile mammalian lung structure in comparison with with the more robust Avian lungs, which are less affected by pressure change.[39][40]

Swim bladder overexpansion

Barotrauma injury to tiger angelfish - head end. note distended swim bladder and gas space in abdominal cavity
Barotrauma injury to tiger angelfish - tail end

Fish with isolated swim bladders are susceptible to barotrauma of ascent when brought to the surface by fishing. The swim bladder is an organ of buoyancy control which is filled with gas extracted from solution in the blood, and which is normally removed by the reverse process. If the fish is brought upwards in the water column faster than the gas can be resorbed, the gas will expand until the bladder is stretched to its elastic limit, and may rupture. Barotrauma can be directly fatal or disable the fish rendering it vulnerable to predation, but rockfish are able to recover if they are returned to depths similar to those they were pulled up from, shortly after surfacing. Scientists at NOAA developed the Seaqualizer to quickly return rockfish to depth.[41] The device could increase survival in caught-and-released rockfish.

See also

References

  1. ^ a b c d e f g US Navy Diving Manual, 6th revision. United States: US Naval Sea Systems Command. 2006. Retrieved 2008-05-26.
  2. ^ a b c d e f g h i j Brubakk, A. O.; Neuman, T. S. (2003). Bennett and Elliott's physiology and medicine of diving, 5th Rev ed. United States: Saunders Ltd. p. 800. ISBN 0-7020-2571-2.
  3. ^ Deafwhale Society (deafwhale.com)
  4. ^ Baerwald, Erin F.; D'Amours, Genevieve H.; Klug, Brandon J.; Barclay, Robert M. R. (2008-08-26). "Barotrauma is a significant cause of bat fatalities at wind turbines". Current Biology. 18 (16): R695–R696. doi:10.1016/j.cub.2008.06.029. OCLC 252616082. PMID 18727900. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help) Laysource includes audio podcast of interview with author.
  5. ^ Reinhart, Richard O. (1996). Basic Flight Physiology. McGraw-Hill Professional. ISBN 0-07-052223-5. Retrieved 2008-09-01.
  6. ^ a b Fitzpatrick, D. T.; Franck, B. A.; Mason, K. T.; Shannon, S. G. (1999). "Risk factors for symptomatic otic and sinus barotrauma in a multiplace hyperbaric chamber". Undersea and Hyperbaric Medicine. 26 (4): 243–7. PMID 10642071. Retrieved 2008-05-23.
  7. ^ Fiesseler, F. W.; Silverman, M. E.; Riggs, R. L.; Szucs, P. A. (2006). "Indication for hyperbaric oxygen treatment as a predictor of tympanostomy tube placement". Undersea and Hyperbaric Medicine. 33 (4): 231–5. PMID 17004409. Retrieved 2008-05-23.
  8. ^ Klokker, M.; Vesterhauge, S.; Jansen, E. C. (November 2005). "Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude". Aviation, Space and Environmental Medicine. 76 (11): 1079–82. PMID 16313146. Retrieved 2008-06-05.
  9. ^ Broome, J. R.; Smith, D. J. (November 1992). "Pneumothorax as a complication of recompression therapy for cerebral arterial gas embolism". Undersea Biomedical Research. 19 (6): 447–55. PMID 1304671. Retrieved 2008-05-23.
  10. ^ Nicol, E.; Davies, G.; Jayakumar, P.; Green, N. D. (April 2007). "Pneumopericardium and pneumomediastinum in a passenger on a commercial flight". Aviation, Space and Environmental Medicine. 78 (4): 435–9. PMID 17484349. Retrieved 2008-06-05.
  11. ^ a b Butler, F. K.; Gurney, N. (2001). "Orbital hemorrhage following face-mask barotrauma". Undersea and Hyperbaric Medicine. 28 (1): 31–4. PMID 11732882. Retrieved 2008-07-06.
  12. ^ http://www.ajnr.org/cgi/reprint/26/5/1218.pdf Barotrauma Presenting as Temporal Lobe Injury Secondary to Temporal Bone Rupture - AJNR Am J Neuroradiol 26:1218–1219, May 2005
  13. ^ Robichaud, R.; McNally, M. E. (January 2005). "Barodontalgia as a differential diagnosis: symptoms and findings". Journal of the Canadian Dental Association. 71 (1): 39–42. PMID 15649340. Retrieved 2008-07-19.
  14. ^ Rauch, J. W. (1985). "Barodontalgia--dental pain related to ambient pressure change". Gen Dent. 33 (4): 313–5. PMID 2863194.
  15. ^ Zadik, Y. (August 2006). "Barodontalgia due to odontogenic inflammation in the jawbone". Aviation, Space and Environmental Medicine. 77 (8): 864–6. PMID 16909883. Retrieved 2008-07-16.
  16. ^ Zadik, Y.; Chapnik, L.; Goldstein, L. (June 2007). "In-flight barodontalgia: analysis of 29 cases in military aircrew". Aviation, Space and Environmental Medicine. 78 (6): 593–6. PMID 17571660. Retrieved 2008-07-16.
  17. ^ Zadik, Yehuda (April 2009). "Barodontalgia". Journal of Endodontics. 35 (4): 481–5. doi:10.1016/j.joen.2008.12.004. PMID 19345791. Retrieved 2009-06-01.
  18. ^ Zadik, Y.; Einy, S.; Pokroy, R.; Bar Dayan, Y.; Goldstein, L. (June 2006). "Dental Fractures on Acute Exposure to High Altitude". Aviation, Space and Environmental Medicine. 77 (6): 654–7. PMID 16780246. Retrieved 2008-07-16.
  19. ^ Zadik, Yehuda (January 2009). "Aviation dentistry: current concepts and practice" (PDF). British Dental Journal. 206 (1): 11–6. doi:10.1038/sj.bdj.2008.1121. PMID 19132029. Retrieved 2009-01-26.
  20. ^ Zadik, Yehuda; Drucker, Scott (September 2011). "Diving dentistry: a review of the dental implications of scuba diving". Aust Dent J. 56 (3): 265–71. doi:10.1111/j.1834-7819.2011.01340.x. PMID 21884141.
  21. ^ Harris, Richard (December 2009). "Genitourinary infection and barotrauma as complications of 'P-valve' use in drysuit divers". Diving and Hyperbaric Medicine. 39 (4): 210–2. PMID 22752741. Retrieved 2013-04-04.
  22. ^ Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 1906. ISBN 978-0-323-05472-0.
  23. ^ a b Marx, John (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 1907. ISBN 978-0-323-05472-0.
  24. ^ Barsky, Steven; Neuman, Tom (2003). Investigating Recreational and Commercial Diving Accidents. Santa Barbara, California: Hammerhead Press. pp. 61, 90. ISBN 0-9674305-3-4.
  25. ^ Staff (29 March 2013). "Aircraft Operations at Altitudes Above 25,000 Feet Mean Sea Level or Mach Numbers Greater Than .75" (PDF). Advisory Circular 61-107B. U.S. Department of Transportation Federal Aviation Administration. p. 36. Retrieved 13 January 2017.
  26. ^ Torkki, Markus; Koljonen, Virve; Sillanpää1, Kirsi; Tukiainen, Erkki; Pyörälä, Sari; Kemppainen, Esko; Kalske, Juha; Arajärvi, Eero; Keränen, Ulla; Hirvensalo, Eero (August 2006). "Triage in a Bomb Disaster with 166 Casualties". European Journal of Trauma. 32 (4): 374–80. doi:10.1007/s00068-006-6039-8.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  27. ^ Williams, Kenneth Gabriel (1959). The New Frontier: Man's Survival in the Sky. Thomas. Retrieved 2008-07-28.
  28. ^ Bason, R.; Yacavone, D. W. (May 1992). "Loss of cabin pressurization in U.S. Naval aircraft: 1969-90". Aviation, Space and Environmental Medicine. 63 (5): 341–5. PMID 1599378.
  29. ^ Parker JC, Hernandez LA, Peevy KJ (1993). "Mechanisms of ventilator-induced lung injury". Crit Care Med. 21 (1): 131–43. doi:10.1097/00003246-199301000-00024. PMID 8420720.
  30. ^ Kay, E (2000). "Prevention of middle ear barotrauma". Doc's Diving Medicine. staff.washington.edu. Retrieved 13 January 2017.
  31. ^ Vorosmarti, J.; Linaweaver, P. G., eds. (1987). "Fitness to Dive. 34th Undersea and Hyperbaric Medical Society Workshop". UHMS Publication Number 70(WS-WD)5-1-87. Bethesda, Maryland: Undersea and Hyperbaric Medical Society. Retrieved 13 January 2017. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)
  32. ^ Bolognini, A.; Delehaye, E; Cau, M.; Cosso, L. (2008). "Barotraumatic orbital emphysema of rhinogenic origin in a breath-hold diver: a case report". Undersea and Hyperbaric Medicine. 35 (3): 163–7. PMID 18619111. Retrieved 2009-08-07.
  33. ^ Barsky, Steven M.; Long, Dick; Stinton, Bob (2006). Dry Suit Diving: A Guide to Diving Dry. Ventura, Calif.: Hammerhead Press. ISBN 9780967430560.
  34. ^ Stephenson, Jeffrey. "Pathophysiology, treatment and aeromedical retrieval of SCUBA – related DCI". Journal of Military and Veterans' Health. 17 (3). ISSN 1835-1271. Retrieved 13 January 2017.
  35. ^ Life effects of Barotrauma at the American Hearing Research Foundation
  36. ^ Lehm, Jan P.; Bennett, Michael H. (2003). "Predictors of middle ear barotrauma associated with hyperbaric oxygen therapy". South Pacific Underwater Medicine Society Journal. 33: 127–133. Retrieved 2009-07-15.
  37. ^ Barotrauma Causes Whales to Mass Beach Themselves!
  38. ^ Danil, K; St.Leger, J.A. (2011). "Seabird and Dolphin Mortality Associated with Underwater Detonation Exercises" (PDF). Marine Technology Society Journal. 45 (6): 89–95. {{cite journal}}: Cite has empty unknown parameter: |coauthors= (help)
  39. ^ "Wind farms cause thousands of bats to die from trauma". The Times. 26 August 2008. {{cite news}}: |access-date= requires |url= (help)
  40. ^ staff (26 August 2008). "Why Wind Turbines Can Mean Death For Bats". Science news. Science Daily. Retrieved 13 January 2017.
  41. ^ Tripp, Emily. "Saving Rockfish Stocks One Recompression at a Time". Marine Science Today. Retrieved 29 August 2015.

"

Retrieved from "https://en.wikipedia.org/w/index.php?title=Barotrauma&oldid=760192614"