Reducing the Risks of Pulmonary Barotrauma

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 gas embolism.

Some of these conditions and diseases include:

Asthma, COPD, mucoviscidosis (cystic fibrosis), Pneumocystis carinii, tb, bronchiolitis (smokers), viral lower airway disease, HIV infection, bronchial atresia, sports blunt trauma, weight lifting, metastatic tumors, catamenia (perimenstrual), empyema, bullous emphysema (juvenile, apical, generalized), Marfan’s syndrome, Schistosome infestation, Pregnancy, cryptogenic fibrosing alveolitis, and pulmonary histiocytosis X, Congenital bronchopulmonary cystic disease, vibroacoustic disease, alveolar proteinosis, bronchiectasis

Symptoms of emphysema include:
Cough
Wheezing
Shortness of breath
Blue or pink discoloration of the nail beds or lips (blue bloater or pink puffer)
Smoking
Exposure to chemical or commercial agents

Examination

Prolonged expiratory phase in breathing
Audible wheezing and rhonchi (rattles)
Auscultatory rales (stethoscope findings by the physician)
Increased AP diameter chest
Clubbing (fingernails rounded and tips of fingers widened)
Nail bed and lip color changes
Percussive changes in the lung fields (tonal reverberations)

Studies

Spiral (helical) CT (probably the best to rule out pulmonary blisters)
Chest x-ray
Pulmonary functions
Lung scan
Xe-CT ventilation studies
Forced Expiratory Volume
Computer-Assisted MT
Maximal Midexpiratory Flow Rate
Tomography, X-Ray Computed
Vital Ca pacity
Body plethysmography
spirometry
metacholine airway provocation.

Diver Factors

Awareness of cause of problem (ascending from depth with a closed air-containing chamber)
Gear failure
Breath holding on ascent
‘Sipping’ from a regulator by a free diver
Weight lifting from depth
Boat exits in heavy wave action
-ascend anchor line for stability
-continue to breathe via regulator until you are out of the water
Straining while removal of gear (fins, weight belt) in the water
Poor air management, avoid running out of air
Panic ascents
Faulty buddy breathing practices

AUTHOR

Ernest S. Campbell, M.D., FACS

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