Primary prevention
The prevalence of dysbarism can be reduced by addressing diver-modifiable risk factors. Many diving-related accidents can be avoided by adherence to basic principles of safe diving.[21][22] Education on this topic should therefore always be given. This includes:
Avoidance of any patient-modifiable risk factors (e.g., immediate post-dive exercise, altitude exposure, missed decompression stops, or rapid ascent)
Use of and adherence to an appropriate dive computer or set of dive tables, with recognition of their limitations in individual circumstances
Diving within one’s own technical and physical abilities
Minimisation of the inert gas burden:
Use of breathing mixes with a lower inert gas percentage (e.g., nitrox)
Shorter, shallower, and less numerous dives
Longer surface intervals and rest days after each 2-3 days of diving
Safety stops for 3-5 minutes at 3-5 m (10-16 feet) on every dive.
However, in numerous cases there is no identifiable cause, reflecting poor understanding of the pathophysiological mechanisms involved. According to one report, up to 50% of cases of arterial gas embolism secondary to pulmonary barotrauma occur spontaneously during dives within conventional limits.[23] It is also important to emphasise the value of early reporting of any post-dive symptom that cannot be attributed, with clinical certainty, to another cause.
Secondary prevention
Following an episode of decompression sickness or barotrauma, further exposure to pressure changes (both external and internal) should be minimised.[3] Patients are advised to avoid diving, flying, auto-inflation manoeuvres, and strenuous physical exertion, ideally until full resolution has occurred.[3] As coughing or sneezing can significantly worsen inner-ear barotrauma, patients should be advised to avoid coughing, sneezing, equalising, and any physical exertion. In such patients the use of anti-tussives, antihistamines, and stool softeners is recommended.
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