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Medical Author:

Daniel F. Noltkamper, MD, FACEP, CDR

Daniel F. Noltkamper, MD, FACEP, CDR

Dr. Daniel Noltkamper, Medical Corps, United States Navy, received his undergraduate degree from the United States Naval Academy. He attended medical school at the University of Texas Medical Branch at Galveston, graduating in 1990. He completed his internship in Family Medicine at Naval Hospital Charleston. CDR Noltkamper served as a General Medical Officer and Radiation Health Officer on board the USS Bainbridge and Squadron Medical Officer at Regional Support Group Norfolk.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The most serious diving complications - air embolism and decompression sickness - will require recompression therapy in a hyperbaric chamber. These hyperbaric chambers may be freestanding or associated with a local hospital. The chamber itself is typically made of thick metal plates with windows for observation. On the outside there are many pipes and valves. The chamber is usually large enough to accommodate more than one person. Medical personnel may come into the chamber with the patient or stay outside, watch through the window, and communicate by intercom, depending on the severity of the illness. While inside the chamber, one may experience loud noises or cold as the pressures change. Similar to diving, one will need to do Valsalva maneuvers to clear the ears while being pressurized. The patient will be closely monitored and be given specific instructions while they are in the chamber.

Other injuries can be managed at the hospital or doctor's office. All conditions will require avoidance of diving until improved.

• The patient may need to be transported to another location for hyperbaric treatments. This may include low-level flights in an aircraft to minimize further pressure changes.
• "Treatment tables" will determine the length of treatment and treatment steps. These tables take into account the depth, time of dive, decompression stops, and previous dives performed. The hyperbaric specialist will recommend which table to use.
• The hyperbaric chamber will increase the air pressure to make any gas bubbles inside the tissues smaller and to allow them to go away properly to avoid injury.

Pulmonary barotrauma may result in a collapsed lung (pneumothorax). If this occurs, the doctor must first determine how much of the lung has collapsed. If the collapse is relatively small the patient can be treated with supplemental oxygen and observation. Larger ones require that air be withdrawn from the body.

• Depending on the amount of air in the cavity, the doctor could use a needle or a hollow tube to withdraw air from the cavity.
• The needle will withdraw small amounts of air, and then the patient will be observed for at least 6 hours.
• Larger collapses require a catheter, or chest tube, to be placed in the chest wall and remain for a few days until the lung that has been damaged can heal.
• Doctors must insert this tube through the skin into the chest cavity by doing a small surgical procedure. Local anesthetics reduce and generally eliminate any pain associated with this procedure.
• The tube is attached to a flutter valve or suction to promote air escape from the inappropriate space.

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