Barotrauma, otitic & Barotrauma, sinus Classification and external resources
ICD-10	T70.0, T70.1
ICD-9	993.0, 993.1
DiseasesDB	3491
eMedicine	emerg/53

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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings S00-T14 - Injury (S00-S09 Head ( Superficial Injury of head ( Superficial injury of S00-T14 - Injury (S00-S09 Head ( Superficial Injury of head ( Superficial injury of The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Pressure (symbol 'p' is the force per unit Area applied to an object in a direction perpendicular to the surface This page is about the physical properties of gas as a state of matter Liquid is one of the principal States of matter. A liquid is a Fluid that has the particles loose and can freely form a distinct surface at the boundaries of ^[1][2]

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. Scuba diving is swimming underwater, or taking part in another activity while using a Scuba set. Free diving is any of various aquatic activities that share the practice of breath-holding Underwater diving. Boyle's law defines the relationship between the volume of the air space and the ambient pressure. Boyle's law (sometimes referred to as the Boyle-Mariotte law) is one of several Gas laws and a special case of the Ideal gas law. The volume of any solid plasma vacuum or theoretical object is how much three- Dimensional space it occupies often quantified numerically Pressure (symbol 'p' is the force per unit Area applied to an object in a direction perpendicular to the surface

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.

Contents 1 Types of injury 2 Diving barotrauma 2.1 Squeeze 2.2 Lung damage 2.3 Causes 2.4 Equalising 2.5 Use of a recompression chamber 3 Blast induced barotrauma 4 Ventilator induced barotrauma 5 See also 6 References

Types of injury

Examples of organs or tissues easily damaged by barotrauma are:

• middle ear^{[1][2][3][4][5]}
• paranasal sinuses^[1][2][3] (causing Aerosinusitis)
• lungs^[1][2][6][7]
• eyes^[1][2] (the unsupportive air space is inside the diving mask)
• skin^[1][2] (when wearing a diving suit which creates an air space)
• bone (bone necrosis and temporal lobe injury)^[8]

Diving barotrauma

Squeeze

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. The middle ear is the portion of the ear internal to the Eardrum, and external to the Oval window of the Cochlea. Paranasal sinuses are air-filled spaces communicating with the nasal cavity within the bones of the Skull and face Aerosinusitis, also called barosinusitis, sinus squeeze or sinus Barotrauma is a painful Inflammation and sometimes bleeding of the lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain A diving mask is an item of Diving equipment that allows scuba divers, free-divers, and snorkelers to see clearly Underwater. The skin is the outer covering of living tissue of an animal (or plant A diving suit is a garment or device designed to protect a diver from the Underwater environment Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce It normally happens in the diving mask and the drysuit.

Lung damage

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.

Causes

When diving, the pressure differences needed to cause the barotrauma come from two sources:

• descending and ascending in water. Pressure (symbol 'p' is the force per unit Area applied to an object in a direction perpendicular to the surface 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.
• breathing gas at depth from SCUBA equipment results in the lungs containing gas at a higher pressure than atmospheric pressure. A scuba set is an independent breathing set that provides a scuba diver with the Breathing gas necessary to breathe underwater during Scuba diving. So a free-diving diver can dive to 10 metres (33 feet) and safely ascend without exhaling, because the gas in the lungs had been 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. Free diving is any of various aquatic activities that share the practice of breath-holding Underwater diving. Scuba diving is swimming underwater, or taking part in another activity while using a Scuba set.

Equalising

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:

• The air spaces in the ears, and the sinuses. The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations Paranasal sinuses are air-filled spaces communicating with the nasal cavity within the bones of the Skull and face The risk is burst eardrum. Here, the diver can use the valsalva manoeuvre, to let air into the middle ears via the Eustachian tubes. The Valsalva maneuver is performed by forcibly exhaling against a closed airway The middle ear is the portion of the ear internal to the Eardrum, and external to the Oval window of the Cochlea. The Eustachian tube (or auditory tube) is a tube that links the Pharynx to the Middle ear. Sometimes swallowing will open the Eustachian tubes and equalise the ears. See ear clearing. Ear clearing or clearing the ears is any of various maneuvers to equalize the pressure in the Middle ear with the outside pressure by letting air enter along the
• The lungs. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive 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.
• The air inside the usual eyes-and-nose diving mask. A diving mask is an item of Diving equipment that allows scuba divers, free-divers, and snorkelers to see clearly Underwater. The main risk is bleeding around 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. Goggles or safety glasses are forms of protective eyewear that usually enclose or protect the eye area in order to prevent particulates water or chemicals from self contained breathing apparatus, or SCBA, sometimes referred to as a Compressed Air Breathing Apparatus (CABA or simply Breathing Apparatus (BA is
• Air spaces inside a dry suit. A diving suit is a garment or device designed to protect a diver from the Underwater environment 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.

Use of a recompression chamber

Barotrauma and decompression illness are sometimes treated with a recompression chamber, which reproduces the pressure that a person had adjusted to before coming up too quickly to a lower-pressure zone; it allows slow decompression. Decompression Illness (DCI is a term generally used to describe illness after a decrease in the ambient pressure that a body is exposed to A recompression chamber is a Pressure vessel used to treat divers suffering from certain Diving disorders such as Decompression sickness. However, a chamber (if misused) can also cause barotrauma, if the occupant is taken to three or four times atmospheric pressure and quickly returned to lower pressure. This occurs in the Tom Clancy novel Without Remorse. Thomas Leo Clancy Jr (born April 12 1947) is an American author best known for his technically detailed espionage and Military science storylines Without Remorse is a thriller Novel published in 1993 by Tom Clancy and is a part of the " Ryanverse " series

Blast induced barotrauma

An explosive blast creates a pressure wave that can induce barotrauma. An explosion is a sudden increase in Volume and release of Energy in an extreme manner usually with the generation of high Temperatures and the release 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. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations ^[9]

Ventilator induced barotrauma

Mechanical ventilation can lead to barotrauma of the lungs. In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own This can be due to either:

• absolute pressures used in order to ventilate non-compliant lungs. Ventilation is the intentional movement of Air from outside a building to the inside Compliance is a measure of the tendency of a hollow organ to resist Recoil toward its original Dimensions upon removal of a distending or
• shearing forces, particularly associated with rapid changes in gas velocity. In Physics, velocity is defined as the rate of change of Position.

The resultant alveolar rupture can lead to pneumothorax, pulmonary interstitial emphysema (PIE) and pneumomediastinum. An alveolus (plural alveoli, from Latin alveolus, "little cavity" is an anatomical structure that has the form of a hollow cavity Pneumomediastinum (from Greek pneuma - "air" also known as mediastinal emphysema) is a condition in which air is present in the Mediastinum

See also

• Alternobaric vertigo
• Dysbarism
• Diving hazards and precautions

References

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