Printed with permission from the authorDR. P.G. LANDSBERG MDOriginally published in „Trauma & Emergency Medicine Vol 17 No 2 July 2000in South Africa. INTRODUCTION The term blast refers to the intense sound wave created by a detonated explosive. The detonation energy of an explosion is distributed between(1) the initial shock wave(2) the velocity imparted to...

Even if you have chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, cystic fibrosis, asthma, or heart disease and need an oxygen supply, you should be able to travel so long as you consult closely with your physician and then follow the advice received.For COPD patients, whose main problem is moving air in and out...

You’ve just gotten home from a dive and you’re feeling rotten. You ache all over, are so tired you can hardly hold your head up and you have a low grade fever, nausea, headache or shivering. You might even have some shortness of breath and a productive cough. You wonder if you might not have...

PULMONARY FUNCTION Most divers tend towards an increase in vital capacity with age but the general conclusion, that divers tend to have larger vital capacities than nondivers, was not confirmed by a study of 126 saturation divers by Thorsem et al (1989). They suggest that the increase is transient and that there is a greater...

COPD and Mucous plugs Most of the risks of smoking and diving are related to long term usage–the chronic obstructive pulmonary disease that smoking produces over many years. This obstruction is in the terminal airways and the emphysema that’s caused can (and does) produce air-filled dilations that can markedly increase your chances of pulmonary barotrauma...

Sarcoidosis is a disease that causes inflammation of the body’s tissues. Inflammation is a basic response of the body to injury and usually causes reddened skin, warmth, swelling, and pain. Inflammation from sarcoidosis is different. In sarcoidosis, the inflammation produces small lumps (also called nodules or granulomas) in the tissues. Unfortunately, sarcoidosis of the lungs...

Historic Contra-indication to diving Traditionally, asthma has been thought to be an absolute contraindication to diving. The classical thought is that the asthmatic has air-trapping associated with the constrictive airway disease, bronchospasm and mucous plugging. Because of these factors -the vast majority of diving physicians felt that the risk for developing arterial gas embolisms to...

Clinical: Pulmonary involvement with langerhans cell histiocytosis is characterized by a granulomatous infiltration of the alveolar septae and bronchial walls by foamy histiocytes. The disorder is uncommon, accounting for only 3.4% of cases of chronic diffuse interstitial lung disease. Patients with isolated pulmonary involvement are usually older (30-40y), Caucasian, and there is an equalfrequency in...

History The same conditions that cause spontaneous pneumothorax can be deadly in the increased ambient pressures of diving – and even in the pressure changes that take place in pressurized aircraft. Awareness of these conditions that can lead to spontaneous pneumothorax might aid in the reduction of the risk of 'burst lung’ and cerebral arterial...

Pathophysiology Arterial gas embolism is a major cause of death in diving and the initiating cause (pulmonary barotrauma) usually goes undetected. Caused most often by the expansion of respiratory gases during ascent, it also occurs when the breath is held during ascent from a dive, when there is local pulmonary pathology, when there is dynamic...

What is Cystic Fibrosis? Cystic fibrosis or 'mucoviscidosis’ is an inherited condition where there is considerable thickening of the mucous production of the body in several places but with effects occurring mainly in the lungs, nose, sinuses and ears. Why is it dangerous to divers? There is the production of inspissated (dried, thickened) plugs in...

What is Marfan’s Syndrome? It seems inevitable that someone will want to scuba dive with every disease known to man and wonder if there is some reason not to. Marfan’s Syndrome is one of these conditions. It has clinical features that are uniformly fatal unless corrected surgically and include aortic aneurysmal formation and dissection due...

There are three obvious reasons for not diving: Disorders that may lead to altered consciousnessDisorders that inhibit the „natural evolution of Boyle’s Law”.Disorders that may lead to erratic and irresponsible behavior. Pneumothorax Any lung disease, procedure, or event that can result in air trapping is thought to be a contraindication to diving. That having been...

Scenario A 25 year old divemaster made one dive to 40 feet for 38 minutes and then spent 3 hours and 45 minutes on the surface. His second dive was to 55 feet for 27 minutes, at the end of which he struggled with a heavy anchor, swimming with it to the surface. At the...

What is pulmonary edema? Pulmonary edema is the sudden filling of the lungs with fluid, generally thought of as being caused by a failure of the left side of the heart to pump properly. What is the cause? Pulmonary edema, characterized by cough, shortness of breath, and hemoptysis, has been observed in both divers and...

Like having asthmatic attack all the time! The issue of whether a patient with COPD (chronic obstructive pulmonary disease) should dive is very similar to the individual who has asthma. The same theoretical arguments apply to the individual with COPD concerning the increased risk of AGE (arterial gas embolism), except that in the person with...

Pulmonary decompression sickness is the result of sudden, massive blocking the pulmonary arterial circulation by bubbles. Ordinarily, the lungs act as a filter and protect the arterial circulation from circulating bubbles (except when there is a PFO). The chokes is a rare condition in diving, usually occurring with very rapid ascents from deep dives, often...

Why does oxygen cause damage to the lung? Animal studies have shown that when the lungs are exposed to high levels of oxygen that deterioration occurs progressively by steps that overlap. The first step is an acute outpouring of fluid into the tissues of the lung, filling the spaces usually full of air. Following this...