Page 193 - ATP-P 11th Ed

BAROTRAUMA PROTOCOL

SPECIAL CONSIDERATIONS
1. Pulmonary Over-Inflation Syndrome (POIS) may occur from ascent from depth
if compressed air was used or exposure to blast overpressure.
2. The most commonly affected site is the middle ear and tympanic membrane, but
paranasal sinuses and teeth may be affected.
3. Pulmonary barotrauma occurs when compressed air is breathed at depth fol-
lowed by ascending with a closed airway (i.e. breath-holding), and can cause SECTION 2
pneumothorax or arterial gas embolism.

Signs and Symptoms
1. Pain in the ear(s), sinuses, and/or teeth
2. Pulmonary over-inflation syndrome (POIS) may present with chest pain, dyspnea, me-
diastinal emphysema, subcutaneous emphysema, pneumothorax or AGE.
a. Arterial gas embolism (AGE) – unconsciousness, paralysis, weakness, fatigue, large
areas of abnormal sensations, convulsions. Symptoms usually occur within 10 min-
utes of surfacing after a dive or shortly after overpressure exposure (blast injury).
b. In all cases of AGE associated pneumothorax it is possible and should not be
overlooked.
Management
1. If flying, descend to altitude until relief is felt (if feasible).
2. Middle ear
a. If a tympanic membrane rupture is present or suspected, protect the ear from water
or further trauma.
b. Moxifloxacin (Avelox ) 400mg PO daily if contamination is suspected
®
®
c. Pseudoephedrine (Sudafed ) 60mg PO q4–6hr prn
d. DO NOT use ear drops. If TM is not ruptured, use oxymetazoline (Afrin ) nasal
®
spray.
e. Refer to higher level of care when feasible.
3. Paranasal Sinus barotraumas
®
a. Pseudoephedrine (Sudafed ) 60mg PO q4–6hr prn

182 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 183