Wilderness and Rescue Medicine 8th Edition

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Section V: Environmental Medicine

Chapter 21 Review: Water-Related Injury

• A submersion event with self-rescue, no loss of consciousness, and no persistent respiratory symp- toms is not likely to result in critical system problems. • The primary assessment problem with submersion injury is respiratory failure or arrest, and the immediate treatment is positive pressure ventilation (PPV). • People who are submerged for more than a few minutes will go into cardiac arrest. At that point, successful field resuscitation is highly unlikely. • Because SCUBA has become popular as a tool for both recreation and rescue, it is important for all medical personnel working in water rescue and marine environments to be able to recognize and treat diving injuries. • Pulmonary overpressure is the most dramatic and most serious hyperbaric injury. The usual cause is a panicked rush for the surface while forgetting to breathe, preventing rapidly expanding air in the lungs from escaping without causing injury. • Decompression sickness (the bends) is caused by the release of air previously dissolved under pressure in the blood and body tissues while using SCUBA or other compressed air systems. The accumula- tion of small bubbles in the circulatory system causes widespread problems with ischemia. • Basic and advanced life support, including the administration of high-flow oxygen during rapid evacuation to a hyperbaric chamber, is the ideal treatment for both pulmonary overpressure and decompression sickness. • Middle ear barotrauma is usually not an emergency, but it carries the anticipated problem of middle ear infection.