Synopsis
Recognise lung over-expansion injury and arterial gas embolism after diving, stabilise immediately, and obtain urgent UK diving-medicine and hyperbaric advice.
- Compressed gas expands during ascent, with the greatest proportional volume change near the surface; breath-holding or regional airway trapping can rupture alveoli even after a shallow dive.
- Escaped gas may cause pneumothorax, tension pneumothorax, pneumomediastinum, subcutaneous emphysema or entry into pulmonary veins with arterial gas embolism.
- A stroke-like deficit, seizure, visual change, confusion or loss of consciousness within minutes of surfacing is arterial gas embolism until urgently assessed, even if symptoms improve spontaneously.
Key red flags
A rapid or uncontrolled ascent, breath-holding, out-of-air emergency or obstructive lung disease followed immediately by chest symptoms strongly supports barotrauma. It can occur despite apparently compliant computer profiles.
Investigation priorities
Reconstruct pressure exposure and mechanism without delaying treatment.
Management branches
Any serious chest, neurological or cardiorespiratory symptom during ascent or after surfacing.
- Call 999 or Coastguard at sea, give 100% oxygen by tight-fitting mask, keep the casualty lying horizontally, warm and monitored, and use the live BHA emergency contact.
- Perform ABCDE assessment with glucose and a documented neurological examination, treating arrest, hypoxaemia, seizure, trauma and shock in parallel.
Key medicines
Normobaric 100% oxygenDeliver continuously through a tight-fitting non-rebreather or secured airway at the highest feasible inspired concentration during transfer and consultation.
Isotonic crystalloidGive cautious boluses or maintenance guided by perfusion, oral tolerance, urine output and the diving or critical-care specialist plan.