Barotrauma
Basics
Description
Description
Injury resulting from the expansion or contraction of gases in an enclosed space
Etiology
Etiology
- Tissue damage results when a gas-filled space does not equalize its pressure with external pressure
- Boyle law: At a constant temperature, pressure (P) is inversely related to volume (V):
- PV = K (constant) or P1V1 = P2V2
- As pressure increases/decreases, volume decreases/increases
- Solid- and liquid-filled spaces distribute pressure equally
- Volume changes are greatest in the few feet nearest the surface
- Gas-filled cavities in the body are subject to expansion/contraction:
- External objects:
- Air pockets in dive suit/mask expand and contract
- Paranasal sinus:
- Barotrauma of descent
- Pressure equalization impaired through nasal ostia resulting in negative pressure in sinus cavity
- Frontal sinus most commonly affected
- External ear:
- Barotrauma of descent
- Blockage of external auditory canal results in trapped air leading to a vacuum
- Middle ear:
- Barotrauma of descent
- Most common type of barotraumas
- Seen in 30% of inexperienced divers and 10% of experienced divers
- Eustachian tube provides sole route of pressure equalization for middle ear
- Inadequate clearance via eustachian tube leads to increasingly negative pressure gradient across tympanic membrane (TM)
- Inner ear:
- Barotrauma of descent
- Results from rapid development of pressure differential across middle and inner ear (Valsalva, Frenzel maneuvers, rapid descent)
- Increased pressure in inner ear may cause round or oval window to rupture
- Frequently associated with middle-ear barotrauma
- Teeth:
- Entrapped gas within or around tooth
- GI:
- Barotrauma of ascent
- Swallowed air in GI tract expands as external pressure decreases
- Pulmonary:
- Barotrauma of ascent
- Expansion of gas trapped in lungs (closed glottis, bronchospasm) leads to distention of alveoli
- Can lead to alveolar rupture
- Most common is pneumomediastinum
- Potential arterial gas embolism (AGE) (see “Arterial Gas Embolism”)
- Divers with decreased lung compliance/increased lung volumes at increased risk (chronic obstructive pulmonary disease [COPD], asthma)
- External objects:
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Citation
Schaider, Jeffrey J., et al., editors. "Barotrauma." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307559/all/Barotrauma.
Barotrauma. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307559/all/Barotrauma. Accessed October 12, 2024.
Barotrauma. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307559/all/Barotrauma
Barotrauma [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 12]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307559/all/Barotrauma.
* Article titles in AMA citation format should be in sentence-case
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