Clinical Management of Diving and Hyperbaric Emergencies
Core concepts
Management is ABCDE first, then dive-specific. For suspected AGE or DCS: supine position (avoid Trendelenburg), 100% oxygen by tight-fitting mask, IV access, treat seizures, and urgent transport to a hyperbaric facility. Do not delay transport for imaging; recompression is definitive. Use US Navy Treatment Table 6 for most DCS/AGE; Table 6A for residual symptoms; Table 4 for mild cases in remote settings.
Near-drowning: rescue breathing and CPR, cervical spine precautions only if indicated, and do not perform abdominal thrusts to clear water. Barotrauma: pneumothorax needs needle decompression before chamber ascent; middle-ear squeeze needs cessation of diving and decongestants, not tympanostomy in the field. Hypothermia: handle gently, rewarm, and remember "not dead until warm and dead" - but do not prolong resuscitation beyond reasonable criteria.
Traps
The classic trap is the "walking wounded" diver who is sent home and later has neuro DCS. Another is giving nitrous oxide or meperidine (which lowers seizure threshold) in a chamber. Questions also test that oxygen is continued during transport and that altitude exposure after diving (flying) is avoided - typically 12–24 h after a single no-decompression dive.
Worked rule of thumb
Any diver with neurologic symptoms after surfacing is treated as AGE/DCS until proven otherwise: 100% O2, supine, and immediate hyperbaric referral. The presence of symptoms is the indication - not the dive profile.