Scuba diving days over after punctured lung?

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DiverG

Reached My 2nd Goal!
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I posted about a motorcycle accident I had on November 6 in the basic scuba forum. The accident involved at least 1 broken rib with multiple fractures and possibly some other fractured ribs. I've heard different things about that. I was told the rib punctured the lung, and according to the linked article from DAN my diving days could be over. Is a punctured lung a definite no dive anymore type injury or one of those it depends?

The original thread
http://www.scubaboard.com/forums/basic-scuba-discussions/469587-my-scuba-diving-days-may-over.html

DAN article
DAN | Medical Frequently Asked Questions
 
Hi there,

The breaks/fractures of the ribs not too much of a problem as long as you get a proper medical check to ensure they are completely healed before diving again. Remember when you break a bone, it actually grows back stronger than before. That being said the issue with breaks and fractures is nitrogen bubbles becoming lodged in cracks and hairlines if not properly healed. As for the lung issue, that's a difficult one. More often than not its spontaneous pneumothorax that are a definite 'no', whereas with accidents etc not always the case. I'm not a medic, but from what I understand it can depend on where exactly the lung was punctured, size of puncture, treatment & follow up etc. I would definitely seek advice from DAN, but also from your local hyperbaric facility for a full consultation/dive medical/test dive. Chamber managers and technicians are probably among the most knowledgeable in this specific area that you'l have relatively easily access to, so worth getting their take on it for sure.
 
I believe I posted in your other thread that a simple pneumothorax related to rib fractures is probably not any contraindication to diving, once everything has healed. If there is extensive lung damage, lung surgery or ARDS, evaluation by a pulmonologist might be in order before deciding that. But if it was just a pneumo related to moderate chest trauma, it shouldn't have any major sequelae.
 
That being said the issue with breaks and fractures is nitrogen bubbles becoming lodged in cracks and hairlines if not properly healed.

I've never heard of this. Can you elaborate and/or provide a reference?

Best regards,
DDM
 
Do we really need a second thread to give the same answers you got from people the first time you asked this?

Recuperating from your injuries must be pretty boring, eh? :)
 
I think the reason for the second thread is that the OP is looking for a more specific answer. I believe he is wondering not about a collapsed lung in the presence of broken ribs (which I have suffered myself), but about a case in which the lung is punctured by the broken rib. If a medical authority will provide a sentence that uses those precise terms, I believe he will be happy.
 
It is not infrequent to have air escape from a lung in the setting of moderate to severe blunt chest trauma. Often (but not always) this is associated with broken ribs. Whether the rib fragments actually puncture the lung, or whether there was an acute, sudden intrathoracic pressure rise that blew OUT the lung, is something we could only know if we were actually able to see the inside of the chest. As the majority of blunt trauma patients don't undergo either thoracoscopy or thoracotomy, we really don't know why the air escaped from the lung in most cases.

What is important is not whether the lung was punctured, because lung heals quite well. What is important is the amount and type of the damage to the lung tissue. What you don't want to have as a diver is any part of the lung that is isolated behind a very narrow air passageway, because that's when expanding gas can't escape, and can lead to AGE. Extensive scarring can do this, which is why I mentioned ARDS (which results in scarred lungs). In the majority of simple, traumatic pneumothoraces, no major damage to the lung tissue was done, and the minor damage that allowed the air to escape will quickly heal. That situation should present no increased risk for diving at all.

This is in distinct contrast to SPONTANEOUS pneumothorax, which is where the lung had an area that was sufficiently weak that, under normal stresses, it ruptured. Lungs which have such lesions often have multiple weak areas, and are prone to recurrence of the problem (up to 50%, in some studies). Since recurrent pneumothorax is a potentially lethal problem if it occurs underwater, such patients are universally, as far as I know, advised not to continue to dive. But this is based on having abnormal lungs at baseline, which the trauma patient generally does not.
 
Thanks TSM. The consulting doctor did tell me that the lung was definitely punctured, but I should be ok for diving. Need to wait at least 3 months. Still should I have any thing specific checked out before I return to diving? I/E catscan chest xrays etc?
 
So we are about 5 1/2 months out since my accident. Everything seems to be fine breathing wise. I still feel twinges of light pain when I sneeze, but it is at the bottom of the rib cage. The doctor told me my broken rib was an upper rib. Is it normal to still feel a little bit of pain at this point?
 
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