Here’s a guide to the top ten diving maladies, including real-life scenarios, treatments, and prevention strategies. Each entry provides a practical scenario, immediate and definitive treatments, and actionable prevention tips to minimize risk.
Top Ten Diving Maladies: Scenarios, Treatment, and Prevention
Scuba diving exposes you to unique physiological risks due to pressure, gas, and the underwater environment. Below are the top ten maladies divers encounter, with real-world scenarios, treatments (immediate and definitive), and prevention strategies to keep you safe.
1. Decompression Sickness (DCS) – Type 2 Neurological
- Description: Nitrogen bubbles form in tissues/blood after rapid ascent, causing severe symptoms (e.g., numbness, paralysis, confusion).
- Scenario: Diving the Spiegel Grove off Key Largo at 100 ft, you ascend too fast, skipping your safety stop. Surfacing, you feel leg numbness and confusion—Type 2 DCS hits.
- Treatment:
- Immediate: 100% oxygen via demand mask (15 L/min), lie flat, hydrate, call EMS (911) and DAN (+1-919-684-9111).
- Definitive: Hyperbaric chamber (e.g., USN Table 6, 5–6 hours)—recompresses bubbles, restores circulation.
- Prevention:
- Ascend slowly (30 ft/min), mandatory safety stop (15 ft, 3–5 min), follow dive computer no-decompression limits, avoid yo-yo diving.
2. Arterial Gas Embolism (AGE)
- Description: Gas bubbles enter arteries (often lungs to brain) from overexpansion during rapid ascent, causing stroke-like symptoms.
- Scenario: In Cozumel at 60 ft, you panic and bolt to the surface, holding your breath. Minutes later, you’re unconscious with arm paralysis—AGE strikes.
- Treatment:
- Immediate: 100% oxygen, lie flat (left side, head down if tolerated), call EMS and DAN—urgent transport.
- Definitive: Hyperbaric chamber ASAP—reduces bubble size, restores blood flow.
- Prevention:
- Breathe continuously (never hold breath), ascend slowly (30 ft/min), vent BCD, practice calm buoyancy control.
3. Barotrauma – Pulmonary
- Description: Lung tissue tears from overexpansion (rapid ascent), potentially causing pneumothorax or mediastinal emphysema.
- Scenario: Diving the Red Sea at 80 ft, you ascend too fast without exhaling. Chest pain and shortness of breath hit—pulmonary barotrauma.
- Treatment:
- Immediate: 100% oxygen, stay upright if pneumothorax suspected, call EMS—avoid exertion.
- Definitive: Hospital evaluation (X-ray), possible chest tube for pneumothorax, oxygen therapy.
- Prevention:
- Exhale on ascent (“ahh” or hum), ascend slowly (30 ft/min), maintain open airway, check BCD venting.
4. Barotrauma – Middle Ear
- Description: Pressure imbalance ruptures eardrum or causes pain during descent/ascent.
- Scenario: In Key Largo at 20 ft, you descend without equalizing. Sharp ear pain and vertigo strike—middle ear barotrauma.
- Treatment:
- Immediate: Stop descent, ascend slightly, equalize gently (Valsalva or Toynbee), rest—see a doctor if pain persists.
- Definitive: ENT evaluation, possible antibiotics (infection risk), decongestants if fluid builds.
- Prevention:
- Equalize early/often (every 2–3 ft descending), pre-dive nasal spray (e.g., oxymetazoline), avoid diving with congestion.
5. Nitrogen Narcosis
- Description: High nitrogen partial pressure (deep dives) impairs brain function—euphoria, confusion, “drunkenness.”
- Scenario: At 130 ft in the Florida Keys, you feel giddy and sluggish, fumbling your regulator—narcosis clouds your mind.
- Treatment:
- Immediate: Ascend slowly to shallower depth (e.g., 60–80 ft)—symptoms fade as pressure drops.
- Definitive: None needed—resolves with ascent; rest post-dive if shaken.
- Prevention:
- Limit depth (100 ft max on air), use nitrox (e.g., 32% O₂) to reduce nitrogen, dive with a clear-headed buddy.
6. Oxygen Toxicity – CNS
- Description: Excessive oxygen partial pressure (e.g., >1.4 ATA) causes seizures, often with nitrox or deep dives.
- Scenario: Diving with 36% nitrox at 130 ft (4.9 ATA, 1.76 ATA O₂) in the Bahamas, you convulse underwater—CNS oxygen toxicity.
- Treatment:
- Immediate: Buddy assists ascent to shallower depth (<1.4 ATA O₂), protect airway, surface if safe, 100% O₂ post-seizure.
- Definitive: Medical evaluation—oxygen therapy, no chamber unless DCS co-occurs.
- Prevention:
- Calculate MOD (e.g., 1.4 ÷ 0.36 = 94 ft for 36%), set dive computer alarm (e.g., 90 ft), stick to air for deep dives.
7. Barotrauma – Sinus
- Description: Pressure imbalance in sinuses causes pain or bleeding, often from congestion.
- Scenario: In Monterey at 40 ft, descent triggers forehead pain and nosebleed—sinus barotrauma from a cold.
- Treatment:
- Immediate: Ascend slightly, stop dive, apply pressure to nosebleed, rest—see a doctor if severe.
- Definitive: Decongestants (e.g., pseudoephedrine), nasal spray, ENT check if persistent.
- Prevention:
- Avoid diving with colds/allergies, use nasal spray pre-dive, equalize sinuses gently (swallow, wiggle jaw).
8. Hypothermia
- Description: Cold water lowers body temperature (<95°F/35°C), causing shivering, confusion, or unconsciousness.
- Scenario: Diving a 50°F wreck in California for 40 minutes in a 5mm wetsuit, you shiver uncontrollably and feel dazed—hypothermia sets in.
- Treatment:
- Immediate: Surface, remove wet gear, wrap in blankets, warm drinks (no alcohol), seek shelter.
- Definitive: Hospital if severe (e.g., <90°F)—IV fluids, warming therapy.
- Prevention:
- Wear proper exposure suit (e.g., 7mm wetsuit or drysuit for 50°F), limit exposure time, warm up between dives.
9. Drowning/Near-Drowning
- Description: Water inhalation from regulator loss, panic, or exhaustion—life-threatening oxygen deprivation.
- Scenario: In Thailand at 60 ft, a wave dislodges your regulator. You panic, inhale water, and struggle to surface—near-drowning ensues.
- Treatment:
- Immediate: Buddy retrieves regulator or assists ascent, CPR if unconscious, 100% O₂, call EMS.
- Definitive: Hospital—oxygen, monitor lungs (e.g., pulmonary edema risk).
- Prevention:
- Practice regulator recovery, stay calm (slow breaths), dive with a buddy, maintain gear (e.g., octopus secure).
10. Marine Life Injuries
- Description: Bites, stings, or cuts from creatures (e.g., jellyfish, fire coral, sharks)—pain, infection, or anaphylaxis.
- Scenario: In the Bahamas, brushing fire coral at 30 ft causes burning rash and swelling—marine injury flares.
- Treatment:
- Immediate: Rinse with seawater (not freshwater), remove stingers (vinegar for jellyfish), hot water soak (104–113°F) for pain, antihistamine.
- Definitive: Doctor for antibiotics (infection), epinephrine if allergic reaction.
- Prevention:
- Wear gloves/exposure suit, avoid touching marine life, carry vinegar/first aid kit, know local hazards.
Summary Table
| Malady | Scenario Trigger | Immediate Treatment | Definitive Treatment | Prevention |
|---|---|---|---|---|
| DCS Type 2 | Rapid ascent, 100 ft | O₂, lie flat, EMS/DAN | Hyperbaric chamber | Slow ascent, safety stop |
| AGE | Panic ascent, 60 ft | O₂, left side, EMS/DAN | Hyperbaric chamber | Breathe, slow ascent |
| Pulmonary Barotrauma | Fast ascent, 80 ft | O₂, upright, EMS | Chest tube, hospital | Exhale, slow ascent |
| Ear Barotrauma | No equalizing, 20 ft | Ascend, equalize, rest | ENT, antibiotics | Equalize often, no congestion |
| Nitrogen Narcosis | Deep dive, 130 ft | Ascend to 60–80 ft | None (resolves) | Limit depth, nitrox |
| Oxygen Toxicity | Nitrox at 130 ft | Ascend, buddy assist, O₂ | Medical eval | Calculate MOD, set alarms |
| Sinus Barotrauma | Congestion, 40 ft | Ascend, stop dive, nosebleed | Decongestants, ENT | No colds, nasal spray |
| Hypothermia | Cold 50°F, 40 min | Surface, blankets, warm drinks | Hospital if severe | Proper suit, limit time |
| Drowning/Near-Drowning | Regulator loss, 60 ft | Buddy assist, CPR, O₂, EMS | Hospital, lung monitoring | Practice recovery, stay calm |
| Marine Life Injury | Fire coral, 30 ft | Rinse, vinegar, hot water | Antibiotics, epinephrine | Exposure suit, avoid contact |
General Prevention Tips
- Training: Master buoyancy, emergency skills (e.g., GUE/UTD courses).
- Gear: Check regulators, SPG, O₂ kit—carry spares.
- Planning: Dive within limits, know chamber locations (e.g., DAN list), brief buddy.
- Health: No diving sick, stay hydrated, avoid alcohol pre-dive.
Final Note
These maladies range from common (ear barotrauma) to rare but deadly (AGE). Immediate O₂ and EMS/DAN calls save lives—prevention keeps you out of trouble. Need a specific scenario expanded? Let me know!
Disclaimer: I am not a doctor; please consult one.
Motus Aquaticus 
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