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SCUBA - self contained underwater breathing apparatus
5 million sport scuba divers in U.S.
250,000-400,000 new certifications annually in U.S.
Diving occurs in oceans, freshwater lakes, rivers and quarries
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Pre-dive exams for new certifications
Diving related injuries and emergency care
Even if don’t practice near dive site, many
patients may return home with dive related
problems
Certification to continue diving
FP, IM, ED, Anesthesia, Psychiatry, ENT,
Pulmonary, Cardiology, Neurology, Dermatology
all care for divers
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RSTC - Recreational Scuba Training Council has uniform medical assessment form for diving fitness
Principles for disqualification:
Diving would cause a deterioration in the medical condition
Medical condition represents and increased risk for diving injury for both the diver and dive buddy
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Relative contraindications:
Hx of CABG/PCTA/stent for CAD
MI
HTN
Dysrhythmiarequiring medication
Valvular regurgitation
Asymptomatic MVP
Pacemakers
Absolute contraindications:
Intracardiac shunts
Asymmetric septal hypertrophy
Valvular stenosis
CHF
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PFO allows venous gas emboli to bypass the lungs and move right to left
VGE can pass directly to brain/other organs and cause symptoms of DCS
65% of divers with serious DCS had PFO vs. 5 in controls
Workup if undeserved AGE/DCS and want to continue diving
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Relative contraindications:
Hx of RAD
Hx of EIB
Hx of solid tumor
Cystic or cavitating lung lesion
Hx of pneumothorax
Hx of restrictive disease
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Absolute contraindications:
Active RAD
EIB, COPD, or hx of same with abnormal PFTs or positive challenge
Restrictive diseases with exercise impairment
History of spontaneous pneumothorax
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Asthma historically thought to be absolute contraindication to diving
Air trapping associated with constrictive airway disease, bronchospasm and mucous plugging
Increased risk for AGE
More recently, may not be absolute contraindication
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Mild to moderate asthmatics with normal screening spirometry can be considered candidates for diving (FEV1/FVC 85%)
If diver has attack, use screening spirometry to monitor and no diving until airway function returns to normal
There is always an increased level of risk with asthma - potential diver needs to be aware of risk
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Exercise, cold-induced, emotional asthma should NOT dive
Asthmatics requiring “rescue inhaler” should not dive-unknown when attack may occur
Asthmatics on chronic bronchodilator and inhaled steroids are thought to be able to dive. BSAC recommends no diving if needed rescue inhaler in last 48 hours or if any asthma symptoms
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Relative contraindications:
Migraines
Hx of head injury
Herniated nucleus pulposus
Peripheral neuropathy
Trigeminal neuralgia
Hx of spinal cord or brain injury without deficit
Hx of cerebral gas embolism without residual pulmonary air trapping
Cerebral palsy without seizure activity
Absolute contraindications:
Hx of seizures, except childhood febrile
Intracranial tumor or aneurysm
Hx of CVA or TIA
Hx of spinal cord injury with deficits
Hx of type II DCS with neurological deficit
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Relative contraindications:
Recurrent OM or sinusitis
EAC obstruction
Hx of significant cold injury to pinna
ETD
Hx of TM perforation
Hx of tympanoplasty or mastoidectomy
Significant hearing impairment
Facial nerve paralysis, not due to barotrauma
Full prosthedontic devices
Hx of mid face fracture
Unhealed oral surgery sites
Hx of head or neck therapeutic radiation
Hx of TMJ
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Absolute contraindications:
Monomeric TM
Open TM perforation
PE tubes
Hx of stapedectomy
Hx of ossicular chain surgery
Hx of inner ear surgery
Hx of round window rupture
Facial nerve paralysis from barotrauma
Inner ear disease other than presbycusis
Uncorrected upper airway obstruction
Laryngectomy full or partial
Tracheostomy
Uncorrected laryngocele
Hx of vestibular decompression sickness
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Relative contraindications:
PUD
IBD
Malabsorption states
Functional bowel disorders
Post gastrectomy dumping syndrome
Paraesophageal or hiatal hernia
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Absolute contraindications:
High grade gastric outlet
obstruction
Chronic or recurrent small
bowel obstruction
Enterocutaneous fistulae
that do not drain freely
Esophageal fistula
Severe GERD
Achalasia
Unrepaired abdominal wall
hernias that may contain
bowel
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Relative contraindications:
Hormonal excess or deficiency
Obesity
Renal insufficiency
Absolute contraindications:
Diabetics on insulin therapy or oral anti-hypoglycemic medication secondary to potential loss of consciousness due to hypoglycemia
Some diabetics may dive under carefully specified conditions
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Diving is ABSOLUTELY
contraindicated in any stage of
pregnancy
Venous gas emboli formed during
decompression may result in fetal
malformations
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Relative contraindications:
Developmental
delay
Hx of drug or alcohol
abuse
Hx of previous
psychotic episodes
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Absolute contraindications:
Inappropriate motivation to dive -to please partner or spouse
To prove oneself in the face of personal fears
Claustrophobia and agoraphobia
Active psychosis or while on psychotropic medications
Hx of panic disorder
Drug or alcohol abuse
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Relative contraindications:
Sickle cell trait
Acute anemia
Absolute contraindications:
Sickle cell disease
Polycythemia
Leukemia
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Relative contraindications:
Amputation
Chronic back pain
Scoliosis-assess impact on pulmonary function
Aseptic necrosis - may cause risk of progression
due to inadequate decompression
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Absolute contraindications:
Impairment of mobility
that would affect diver safety
Acute or chronic orthopedic injury
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What is the most common reason for
diving accidents and fatalities?
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PANIC BEHAVIOR
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Diver’s Alert Network - DAN www.diversalertnetwork.org
1-919-684-4326
Diving Medicine Online www.scuba-doc.com
Undersea and Hyperbaric Medicine Society UHMS www.uhms.org
Scubamed www.scubamed.com
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