He then noticed ‘bubbles under the skin’ at the left base of his neck associated with discomfort. He was a novice diver who smoked 20 cigarettes a day.Ībout two and a half hours after surfacing from the second dive, he started complaining of chest tightness. His second dive was at 12 msw for twenty minutes. During the day, he had done SCUBA dives and had no symptoms during the first dive which was at 6 metres’ sea water (msw) for 20 minutes. A 24-year-old male presented to the accident and emergency department in Gozo General Hospital complaining of chest pain. The patient provided written consent for his case and radiology to be reported. Unlike SCUBA diving, pulmonary barotrauma in breath-hold-diving is extremely unlikely since a ‘lungful’ of gas inhaled at the surface is compressed during descent, and simply re-expands safely to its original volume on ascent.[ The lungs are insensate when over-expanded. Thus, the scuba diver has no warning to prevent lung injury if breath-holding on ascent. As the ambient pressure decreases during ascent, the compressed gas in the lungs expands and this gas needs to be exhaled. When a diver starts ascending from a dive, the ambient pressure decreases and the volume in gas-filled spaces such as the lungs would increase. Consequently, a golden rule of SCUBA diving is to never breath-hold. According to Boyle’s Law, as the pressure decreases, the volume of a gas space increases and vice versa (P 1V 1=P 2V 2). To understand how barotrauma occurs, certain laws of physics have to be applied. Barotrauma refers to the injuries that may occur in gas-containing compartments of the body when there is a pressure change.
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