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| {{Barotrauma}} | | {{Barotrauma}} |
| | '''For patient information, click [[Barotrauma (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}} |
| | ==[[Barotrauma overview|Overview]]== |
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| == Overview == | | ==[[Barotrauma historical perspective|Historical Perspective]]== |
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| '''Barotrauma''' is physical damage to body tissues caused by a difference in pressure between an air space inside or beside the body and the surrounding gas or liquid.
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| Barotrauma typically occurs to air spaces within a body when that body moves to or from a higher pressure environment, such as when a SCUBA diver, a free-diving diver or an airplane passenger ascends or descends. Boyle's law defines the relationship between the volume of the air space and the ambient pressure.
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| Damage occurs in the tissues around the body's air spaces because gases are compressible and the tissues are not. During increases in ambient pressure, the internal air space provides the surrounding tissues with little support to resist the higher external pressure. During decreases in ambient pressure, the higher pressure of the gas inside the air spaces causes damage to the surrounding tissues if that gas becomes trapped.
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| == Diving barotrauma ==
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| ===Types of injury===
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| Examples of organs or tissues easily damaged by barotrauma due to diving are:
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| * middle ear
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| * paranasal sinuses (causing [[Aerosinusitis]])
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| * lungs
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| * eyes (the unsupportive air space is inside the diving mask)
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| * skin (when wearing a diving suit which creates an air space)
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| ===Squeeze===
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| The term 'squeeze' describes the phenomenon of a shrinking air space as the pressure rises and the volume reduces during descent and the pain felt by the diver when this happens. It normally happens in the diving mask and the drysuit.
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| ===Lung damage===
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| Most lung pressure damage occurs on ascent where the high-pressure gas in the lung causes it to expand. As the lungs do not sense pain when over-expanded, the diver receives no warning to prevent the injury.
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| ===Causes=== | | ==[[Barotrauma classification|Classification]]== |
| When diving, the [[pressure]] differences needed to cause the barotrauma come from two sources:
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| * descending and ascending in water. 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 approximately 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.
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| * breathing gas at depth from SCUBA equipment results in the lungs containing gas at a higher pressure than atmospheric pressure. So a free-diving diver can dive to 10 metres (33 feet) and safely ascend without exhaling because the gas in the lungs was inhaled at atmospheric pressure, whereas a SCUBA diver who breathes at 10 metres and ascends without exhaling, has lungs containing gas at twice atmospheric pressure and is very likely to suffer life threatening lung damage.
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| ===Equalising=== | | ==[[Barotrauma pathophysiology|Pathophysiology]]== |
| Diving barotrauma can be avoided by eliminating any pressure differences acting on the tissue or organ by ''equalising'' the pressure. There are a variety of techniques:
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| *The air spaces in the '''[[ear]]s''', and the [[sinus]]es. The risk is '''burst eardrum'''. Here, the diver can use the [[valsalva maneuver]], to let air into the [[middle ear]]s via the [[Eustachian tube]]s. Sometimes swallowing will open the Eustachian tubes and equalise the ears. See [[ear clearing]].
| | ==[[Barotrauma causes|Causes]]== |
| *The '''[[lung]]s'''. The risk is [[pneumothorax]]. which is commonly called '''burst lung''' by divers. To equalise, always breathe normally and never hold the breath. 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.
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| *The air inside the usual eyes-and-nose '''diving mask'''. The main risk is bleeding round the eyes. Here, let air into the mask through the nose. Do not dive in eyes-only goggles as sometimes seen on land with industrial breathing sets.
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| *Air spaces inside a '''dry suit'''. The main risk is folds of skin getting pinched inside folds of the drysuit. Most modern drysuits have a tube connection to feed air in from the cylinder. Air must be injected on the descent and vented on the ascent.
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| ==Blast induced barotrauma== | | ==[[Barotrauma differential diagnosis|Differentiating Barotrauma from other Diseases]]== |
| An [[Explosion|explosive blast]] creates a pressure wave that induces 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.
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| ==Ventilator induced barotrauma== | | ==[[Barotrauma epidemiology and demographics|Epidemiology and Demographics]]== |
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| [[Mechanical ventilation]] can lead to barotrauma of the lungs. This can be due to either: | | ==[[Barotrauma risk factors|Risk Factors]]== |
| *absolute pressures used in order to ventilate [[Compliance (physiology)|non-compliant]] lungs.
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| *shearing forces, particularly associated with rapid changes in gas [[velocity]].
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| The resultant [[alveolus|alveolar]] rupture can lead to [[pneumothorax]], pulmonary interstitial emphysema (PIE) and [[pneumomediastinum]].
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| ==References == | | ==[[Barotrauma screening|Screening]]== |
| {{Reflist}}
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| == Acknowledgements == | | ==[[Barotrauma natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.
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| == Suggested Reading and Key General References == | | ==Diagnosis== |
| | [[Barotrauma history and symptoms| History and Symptoms]] | [[Barotrauma physical examination | Physical Examination]] | [[Barotrauma laboratory findings|Laboratory Findings]] | [[Barotrauma chest x ray|Chest X Ray]] | [[Barotrauma CT|CT]] | [[Barotrauma MRI|MRI]] | [[Barotrauma echocardiography or ultrasound|Ultrasound]] | [[Barotrauma other imaging findings|Other Imaging Findings]] | [[Barotrauma other diagnostic studies|Other Diagnostic Studies]] |
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| == Suggested Links and Web Resources == | | ==Treatment== |
| | [[Barotrauma medical therapy|Medical Therapy]] | [[Barotrauma surgery|Surgery]] | [[Barotrauma primary prevention|Primary Prevention]] | [[Barotrauma secondary prevention|Secondary Prevention]] | [[Barotrauma cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Barotrauma future or investigational therapies|Future or Investigational Therapies]] |
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| == For Patients == | | ==Case Studies== |
| | [[Barotrauma case study one|Case #1]] |
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