![]() People with blebs are also at risk for spontaneous pneumothorax (collapsed lung). On exhalation during ascent, pressure can build, causing rupture. Blebs empty air slowly because of their thin, nonelastic wall. Although these are common in smokers, they have also been found in non-smokers. Blebs are abnormal balloon-like air sacs most often caused by inflammation, which destroys the thin walls that separate alveoli. The risk of pulmonary barotrauma is greater in people who have blebs in their lungs. Under the skin around the upper chest and neck (subcutaneous emphysema).The bloodstream (arterial gas embolism ).The pleural space between the lungs and chest wall (pneumothorax).The area around the heart (pneumomediastinum, also known as mediastinal emphysema).Gas from a ruptured lung can leak into one or more of four places: Pulmonary barotrauma generally occurs at the end of a dive when trapped gas causes alveoli (air sacs in the lungs) to expand during ascent and ultimately rupture if normal exhalation is impaired by breath-holding or a lung problem. After consulting with pulmonary specialists both locally and in the US, the treating physician cleared Rick to fly home with his group. A follow-up CT scan three days after the incident (and one day prior to his scheduled departure) showed the same blebs as before, but much less extra-alveolar air in the mediastinum. ![]() The doctor took these aggressive measures to speed Rick’s recovery and allow him to travel home with his group. He returned to the hospital daily so doctors could monitor his progress.ĭue to the risk of a pneumothorax during air travel, Rick was admitted to the hospital two days after the incident to breathe 100 percent oxygen for six hours. It also showed at least two large blebs (cystic air pockets) in the apical regions of Rick’s lungs. A CT scan the following day revealed abundant mediastinal air around the heart and lungs and in the neck. The treating physician noted no complications besides the subcutaneous emphysema in the neck, which did not affect the airway, so he administered high-flow oxygen and allowed Rick to return to his resort. The Diagnosis of Pulmonary BarotraumaĪ doctor at the local hospital on Bonaire performed a complete neurological assessment on Rick and diagnosed pulmonary barotrauma (pressure injury to the lungs) and subcutaneous emphysema (air under the skin). All symptoms had resolved by the following morning, and he completed the last two dives of the certification without any problems. That evening he took an over-the-counter pain reliever and Benadryl and went to bed early. Others in his group discounted his symptoms as bad gas, or water in the ears. ![]() After he removed his gear he noticed a change in his voice and what he describes as water under the skin around his neck. When Rick was completing the second dive of his Wreck Diver certification a year before, he surfaced completely exhausted with a burning sensation in his throat. After he surfaced from the next dive, Rick boarded the boat and immediately noticed a change in his voice, a sore throat and crackles under the skin around his neck. He took lots of photos during the dive and occasionally inverted himself to see inside the reef. ![]() The chest discomfort resolved during the boat ride to the dive site, so he proceeded with the dive, descending to a maximum depth of 13m. He discounted it as a result of eating leftover pizza for lunch and even mentioned that he needed to take an antacid. Prior to beginning his third dive of the day, Rick felt tightness in his chest.
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