Page 94 - PJ MED OPS Handbook 8th Ed

Barotrauma

SPECIAL CONSIDERATIONS:
1. Pulmonary Over-Inflation Syndrome (POIS) may occur from ascent from depth if com-
pressed air was used or exposure to blast overpressure.
2. The most commonly affected site is the middle ear and tympanic membrane, but para-
nasal sinuses and teeth may be affected.
3. Pulmonary barotrauma occurs when compressed air is breathed at depth followed by
ascending with a closed airway (i.e., breath-holding), and can cause pneumothorax or
arterial gas embolism.
Signs and Symptoms:
1. Pain in the ear(s), sinuses, teeth.
2. Pulmonary over-inflation syndrome (POIS) may present with chest pain, dyspnea, mediastinal
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 minutes of surfacing
after a dive or shortly after overpressure exposure (blast injury).
b. In all cases of AGE, associated pneumothorax is possible and should not be overlooked.
Management:
1. If flying, descend in 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 fur-
ther 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.
4. Pulmonary barotraumas (to include subcutaneous emphysema):
a. If no respiratory distress, monitor patient closely. Use pulse oximetry if available.
b. If respiratory distress occurs – Treat per Spontaneous Pneumothorax Protocol.
5. If Pulmonary Over Inflation Syndrome (POIS) is suspected, administer 100% oxygen and 1 liter
normal saline IV 150mL/hr. Urgent evacuation to recompression chamber.

NOTE: If an unpressurized airframe is used, avoid altitude exposure greater than 1,000ft.

6. Treat per Pain Management Protocol. (Avoid narcotics if recompression is anticipated.)
DISPOSITION:
1. Urgent evacuation for cerebral arterial gas embolus, POIS or pneumothorax with respira-
tory distress.
2. Routine evacuation for mild to moderate middle ear, sinus, or pulmonary barotraumas
without respiratory distress. Continue to monitor until evacuated.
3. Routine evacuation for consultation for Tympanic Membrane ruptures.

92 n Pararescue Medical Operations Handbook / 8th Edition