time to wait before diving after subcutaneous emphysema

[Agamemnon]

Do people continue diving after an accident resulting in less severe subcutaneous emphysema? If the cause of such an incident was bad diving practice rather than an underlying condition, how long do people wait before resuming diving or is it even considered to be safe to dive after such an incident? (assuming the bad diving practice issue was corrected). Of course, DAN and personal physicians provide great information but just curious about general opinion in this forum. I'm guessing this kind of question has been asked before but there were a ton of search results so no previous threads jumped out. thanks!

 

[Duke Dive Medicine]

Without knowing the history it's impossible to give a case-specific answer here. Subcutaneous emphysema as a result of pulmonary overinflation is usually benign and resolves on its own, so it's not the subcutaneous emphysema that's the concern but rather the pulmonary overinflation. The U.S. Navy Diving Manual specifies a 30-day recovery period after an uncomplicated arterial gas embolism that resolves completely with treatment. If there's a definable etiology e.g. breathholding on ascent, the diver in question is evaluated as otherwise healthy and has no residual symptoms, then IN GENERAL it's probably reasonable to follow that guideline. Again, this isn't case-specific advice. Any diver who suffers such an injury should be evaluated by a diving physician prior to returning to diving.

 

[Agamemnon]

thanks!

---------- Post Merged on November 13th, 2012 at 06:21 PM ---------- Previous Post was on November 12th, 2012 at 12:21 PM ----------

Without knowing the history it's impossible to give a case-specific answer here. Subcutaneous emphysema as a result of pulmonary overinflation is usually benign and resolves on its own, so it's not the subcutaneous emphysema that's the concern but rather the pulmonary overinflation. The U.S. Navy Diving Manual specifies a 30-day recovery period after an uncomplicated arterial gas embolism that resolves completely with treatment. If there's a definable etiology e.g. breathholding on ascent, the diver in question is evaluated as otherwise healthy and has no residual symptoms, then IN GENERAL it's probably reasonable to follow that guideline. Again, this isn't case-specific advice. Any diver who suffers such an injury should be evaluated by a diving physician prior to returning to diving.

Thanks again for this information! After a chest xray, everything appears normal (no blebs etc) and my Doctor found no other medical issues that would be suspected as a cause of subcutaneous emphysema. I developed a bad habit of skip-breathing when I started diving and, during the dive that resulted in subcutaneous emphysema, I remember that I found myself skip-breathing on a few occasions as well as breathing in too deeply from time to time (bad subconscious habits). The dive seemed uneventful and an average of 30' or less for 90 minutes - normally I dive deeper where, perhaps, i could get away with bad breathing habits with less issue.

Anyway, now that I'm fairly certain that the cause of the subcutanous emphyema was due to breath holding, is your response above still a good general rule for this incident of pulmonary overinflation and subcutaneous emphysema? I've read a little about pneumothorax and spontaneous pnemothorax and am a little concerned - although my doctor did check and found nothing. thanks again for your help!

 

[Duke Dive Medicine]

You're very welcome. What specific checks did your doctor perform?

 

[Agamemnon]

He had a chest xray taken - i think to see if there was a pneumothorax. We went through my history and confirmed no previous chest injury, recent surgery or history of lung issues, no smoking..and a few other questions i can't remember. I don't know if he sees a lot of divers or dive injuries, so although all sounds good so far, i'm a little hesitant to dive again without being sure that a less severe breath-hold injury gets better by itself without any concern for future reoccurrence.

 

[whaylonsmithers]

I rush to point out that I have no medical knowledge and only moderate diving experience. However:
+1 for DDM who said in his first post
Any diver who suffers such an injury should be evaluated by a diving physician prior to returning to diving.

Annecdotally I have a friend who used to do a lot of shallow water recreational diving that experienced your problem. He found that by repeatedly exposing himself to it and not getting proper treatment he significantly lowered his susceptibility and he pretty much got it all the time and until he quit diving (for unrelated reasons). It was never diagnosed and he didn't even know what it was at the time but I remember him describing it to me and the symptoms are practically identical to those described in the PADI Rescue Courses I did a few months ago. And he was a DM so he should have known better.

 

[Duke Dive Medicine]

He had a chest xray taken - i think to see if there was a pneumothorax. We went through my history and confirmed no previous chest injury, recent surgery or history of lung issues, no smoking..and a few other questions i can't remember. I don't know if he sees a lot of divers or dive injuries, so although all sounds good so far, i'm a little hesitant to dive again without being sure that a less severe breath-hold injury gets better by itself without any concern for future reoccurrence.

Vancouver General has a hyperbaric unit with physicians who can evaluate divers. From the information you've given so far I'm pretty optimistic that they'll clear you to dive, but the docs there are in the best position to make that determination. I'd recommend you go see them. Your PCP can make a referral.

Best regards,
DDM

 

[Agamemnon]

Thanks for this advice - i didn't think to ask for a referral to a Dive medicine Dr. during my visit but that makes a lot of sense!