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Overview of Diving Injuries

By

Richard E. Moon

, MD, Duke University Medical Center

Last full review/revision Jun 2021| Content last modified Jun 2021
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More than 1000 diving-related injuries occur annually in the US; > 10% are fatal. Similar injuries can befall workers in tunnels or caissons (watertight retaining structures used for construction), in which pressurized air is used to exclude water from work sites.

Many injuries are related to high pressure, which, at depth or in a caisson, results from the water weight above plus the atmospheric pressure at the surface. At a depth of 10 m (33 ft), seawater exerts a pressure equivalent to standard sea level atmospheric pressure, which is 1.03 kg/sq cm (14.7 lb/sq in), 760 mm Hg, or 1 atmosphere absolute (atm abs); thus, the total pressure at that depth is 2 atm abs. Every additional 10 m of descent adds 1 atm.

The volume of gases in body compartments is inversely related to external pressure; an increase or a decrease in gas volume due to pressure change exerts direct physical forces that can disrupt various body tissues (barotrauma Overview of Barotrauma Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume in air-containing areas. During ascent, gas expansion affects the lungs and gastrointestinal (GI)... read more ). The amount of gas dissolved in the bloodstream increases as ambient pressure increases. Increased gas content can cause injury directly (eg, nitrogen narcosis Nitrogen narcosis Various physiologic (eg, oxygen, nitrogen, carbon dioxide) and nonphysiologic (eg, carbon monoxide) gases can cause symptoms during diving. (See also Overview of Diving Injuries.) Oxygen toxicity... read more , oxygen toxicity Oxygen toxicity Various physiologic (eg, oxygen, nitrogen, carbon dioxide) and nonphysiologic (eg, carbon monoxide) gases can cause symptoms during diving. (See also Overview of Diving Injuries.) Oxygen toxicity... read more ) or indirectly during ascent when decompression of the supersaturated blood or tissues releases nitrogen bubbles (decompression sickness Decompression Sickness Decompression sickness occurs when rapid pressure reduction (eg, during ascent from a dive, exit from a caisson or hyperbaric chamber, or ascent to altitude) causes gas previously dissolved... read more ). Arterial gas embolism Arterial Gas Embolism Arterial gas embolism is a potentially catastrophic event that occurs when gas bubbles enter or form in the arterial vasculature and occlude blood flow, causing organ ischemia. Arterial gas... read more can result from barotrauma or decompression.

Physicians caring for patients with diving or compressed air injuries may contact the Divers Alert Network: 919-684-9111 for emergencies and 919-684-2948 for other information. Physician-to-physician consultation can be obtained through Duke Dive Medicine: 919-684-8111.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

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