Page 198 - PJ MED OPS Handbook 8th Ed

Open Circuit Diving Emergencies
Pulmonary Overinflation Syndromes (including A.G.E.)

Characterized by a sudden onset occurring during or immediately after ascent (unconsciousness
or other neurological symptoms usually developing within 10 minutes of coming to the surface).
Injuries include subcutaneous emphysema, mediastinal emphysema, pneumothorax, arterial gas
embolism (AGE) or respiratory arrest.
Signs and Symptoms:
• Altered mental status
• Crepitus and swelling of the neck
• Voice change
• Dyspnea
• Difficulty swallowing
• Syncope
• Shock
• Shortness of breath
• Dizziness
• Blurred vision
• Vertigo
• Paralysis or weakness of extremities
• Loss of sensation
• Chest pain
NOTE: Some patients with AGE may exhibit a ‘lucid interval’, where the symptoms will im-
prove for a short time after initial onset. Do not delay evacuation in such cases.

Treatment:
1. ABCs/High flow O2/IV NS/LR KVO/Hypothermia prevention.
2. Begin resuscitation if required.
3. 100% O2 (or highest % avail) via tight fitting aviator’s mask with a demand valve.
4. If symptomatic pneumothorax identified, treat accordingly.
5. Arrange for immediate evacuation and recompression.

Decompression Sickness (DCS)
DCS is usually seen after surfacing, with the majority of cases occurring within 3 hours after comple-
tion of dive. Signs and symptoms can occur immediately or after a sustained period; however, onset
of symptoms after 24 hours is highly unusual.
NOTE: Previously DCS was divided into Type 1 and Type II. This is still in use by divers. The
medical community classifies DCS by the organ system affected.

196 n Pararescue Medical Operations Handbook / 8th Edition