Diving Physiology

Sources
Joiner, J.T. (ed.). 2001. NOAA Diving
Manual - Diving for Science and
Technology, Fourth Edition. Best
Publishing Company, Flagstaff, AZ.

Objectives
After completing this training module you
will be able to:
Describe the basic systems of the human body
Describe the process, mechanics, and control
of respiration
Describe circulation, blood transport of oxygen
and carbon dioxide, tissue gas exchange, and
tissue use of oxygen

Objectives
After completing this training module you
will be able to:
List signs & symptoms and prevention /
treatment strategies of respiratory problems
associated with hypoxia, carbon dioxide
toxicity, hyperventilation, shallow water
blackout, carbon monoxide poisoning,
excessive resistance to breathing, and lipoid
pneumonia
Describe direct effects of pressure on decent
associated with the ears, sinuses, lungs, and
eyes

Objectives
After completing this training module you
will be able to:
Describe direct effects of pressure during
ascent including reverse block, pneumothorax,
mediastinal and subcutaneous emphysema,
and arterial gas embolism
List four ways to help prevent lung
overexpansion injuries

Objectives
After completing this training module you
will be able to:
Explain indirect effects of pressure during
descent including inert gas narcosis, high
pressure nervous syndrome, CNS oxygen
toxicity, and whole-body oxygen toxicity
Differentiate between hypothermia and
hyperthermia; listing signs & symptoms and
prevention/management strategies

Objectives
After completing this training module you
will be able to:
Describe indirect effects of pressure during
ascent associated with inert gas elimination,
decompression sickness, aseptic bone necrosis,
patent foramen ovale, and pregnancy
Describe concerns associated with the use of
prescription and illicit drugs, smoking and
alcohol use, and diving

General
This module provides an overview of
how the human body responds to the
varied conditions associated with
diving
A knowledge of diving physiology
contributes to diving safety and
enables a diver to describe divingrelated medical symptoms when they
occur

Systems of the Body

Musculoskeletal System
Bones provide the structure around
which the body is formed and
protection to the organs
From a diving perspective bones are
the last tissues to become saturated
with inert gas

Musculoskeletal System
Muscles also provide protection for
vital organs
The contraction of muscles causes
movement
Some muscles are controlled
consciously, while others, like the
heart, function automatically

Nervous System
The nervous system includes the
brain and spinal cord, referred to as
the central nervous system (CNS),
and a complex network of nerves

Nervous System
The basic unit of the nervous system
is the neuron, which has the ability to
transmit electrochemical signals as
quickly as 350 feet per second
There are over ten billion nerve cells
in the body, all originating in the
brain or spinal cord

Nervous System
The brain uses approximately 20% of
the bloods available oxygen supply,
at a rate ten times faster than other
tissues; its cells will begin to die
within four to six minutes if deprived
of that oxygen supply

Digestive System
Consisting of the stomach, small and
large intestine, the salivary glands,
pancreas, liver, and gall bladder; the
digestive system converts food to a
form that can be transported to and
utilized by the cells

Respiration and
Circulation

Process of Respiration
Respiration is the process of getting
oxygen (O2) into the body, and
carbon dioxide (CO2) out
Air is warmed as it passes through
the nose, mouth, and throat;
continuing down the trachea into two
bronchi at the top of each lung

Process of Respiration
These bronchi divide
and re-divide into ten
bronchopulmonary
branches which make
up the five lobes of
the lungs; three for
the right lung and two
for the left (allowing
room for the heart)

Process of Respiration
In each lobe, the
branches divide
into smaller
bronchioles

Process of Respiration
Larger bronchioles have a muscular
lining that can squeeze and relax to
regulate how much air can pass
Special cells lining the bronchioles
secrete mucus to lubricate and
moisten the lungs, and to trap dust
and other particles for removal

Process of Respiration
The bronchioles are honeycombed
with pouches, each containing a
cluster of tiny air sacs called alveoli
Each alveolus is less than 0.04
inches (1 mm) wide and is
surrounded by a network of
capillaries
There are about 300 million alveoli in
each lung

Process of Respiration
The single cell, semipermeable, wall
separating alveoli and
capillary is where the
gas exchange
between lungs and
blood flow takes place
O2 and other gases are
absorbed by the blood
and dissolved CO2 and
other gases are
released

Credit: Permission granted by Best Publishing

Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Mechanics of Respiration
Normal inhalation requires
contractions of the inspiratory rib
muscles (external intercostals) and
the diaphragm

Mechanics of Respiration
These contractions enlarge the chest
cavity, pulling on the pleura
surrounding the lungs which
decreases pressure within the lungs
by increasing lung volume allowing
air to flow in

Mechanics of Respiration
To exhale, the diaphragm and
inspiratory muscles relax, pushing on
the lungs by elastic recoil and
pushing air out
Exhalation can be increased by
contracting the abdominal and
expiratory chest muscles (internal
intercostals)

Mechanics of Respiration
Tidal volume the volume of air
breathed in and out; at rest it
averages 0.5 liters
Vital capacity the largest volume
exhaled after maximum inhalation;
larger people generally have a larger
vital capacity
Inspiratory reserve the amount you
can forcibly inhale after a normal
inhalation

Mechanics of Respiration
Expiratory reserve the amount you
can forcibly exhale after a normal
exhalation
Residual volume air left in lungs
after exhalation; keeps lungs from
collapsing

Mechanics of Respiration
In addition to gas exchange, the
lungs also work as filters for air
passing into the lungs , and for the
blood supply
This filtration extends to small
bubbles generated during diving
ascents, but too many bubbles will
overwhelm these pulmonary filters

Control of Respiration
The need to breathe is controlled by
CO2 levels in the body
Rising production of CO2 during
exercise stimulates receptors in the
respiratory center of the brain
resulting in an increase in the
ventilation rate

Control of Respiration
Hyperventilation, (an excessive
ventilation rate) can lower CO2 too
far, reducing the drive to breath to
the point that one can become
oxygen deficient (Hypoxia)

Circulation
O2 from the
atmosphere enters
the lungs and
moves from the
alveoli into
capillaries. These
capillaries join
together into
venules, which join
to become the
pulmonary vein

Credit: Permission granted by Best Publishing

Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Circulation
The pulmonary
vein brings
oxygenated blood
from the lungs to
the heart

Credit: Permission granted by Best Publishing

Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Circulation
De-oxygenated
blood enters the
heart via the
superior and
inferior vena cava,
flows into the right
atrium, right
ventricle, to the
lungs via the
pulmonary artery

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, A

Circulation
Oxygenated blood
flows from the
lungs to the left
atrium via the
pulmonary vein,
through the left
ventricle to the
body via the
ascending and
descending aorta

Circulation
Arteries branch into progressively
smaller arterioles that increase in
number and decrease in size until
they become capillaries

Circulation
The human body has nearly 60,000
miles (100,000 km) of capillaries.
They are so narrow, blood cells pass
through them in single file

Circulation
Another part of the circulatory
system is the lymph system;
As blood passes through capillary
networks, pressure inside capillaries
pushes fluid out of the capillaries
The lymph system drains this extra fluid
so it can return to the blood vessels to
maintain proper blood volume

Blood Transport of O2
and CO2
Oxygen (O2) is transported in the blood by
hemoglobin, a red protein molecule
found inside red blood cells. At sea level,
about 98% of the oxygen in the blood is
carried by hemoglobin

Blood Transport of O2
and CO2
Most carbon dioxide (CO2) reacts with
water in the blood cells and is transformed
into bicarbonate ions, many of which
diffuse into the blood plasma for transport
to the lungs

Tissue Gas Exchange

O2 and CO2 diffuse across tissues
from areas of higher concentration to
areas of lower concentration
O2 moves from oxygenated blood into
deoxygenated cells, while CO2 moves
from areas of high concentration in cells,
to blood with lower concentrations of
CO2
The process is reversed at the lungs

Tissue Use of Oxygen

The body only uses part of the
oxygen supplied to it
At rest, the body inhales
approximately 21% oxygen and
exhales about 16%

Tissue Use of Oxygen

Usually about 25% of the oxygen
used by the body is available for
muscular activity; the balance
produces heat and supports other
metabolic functions

Tissue Use of Oxygen

Unlike other areas of the body with
varying blood supply, the brain
needs a steady supply of oxygen
If circulation slows or stops,
consciousness may be lost in
seconds, and irreparable brain
damage may occur within four to six
minutes

Tissue Use of Oxygen

Aerobic fitness is the ability of lungs,
heart, and blood to deliver oxygen,
and the ability of the muscles and
other cells to extract and use it
People who are aerobically fit are
able to deliver, extract, and use more
oxygen when exercising

Tissue Use of Oxygen

Average exercise increases the
amount of oxygen needed by active
tissues by about ten times
Heavy exercise can increase the
amount needed by about twenty
times

Tissue Use of Oxygen

Merely breathing in more oxygen
does not affect how much one can
use for exercise; only improvements
in aerobic fitness through regular
exercise can do that

Tissue Use of Oxygen

Rapid-onset, short duration, intense
activities such as sprints, hauling out
of the water, or reacting to an
emergency are anaerobic in nature
and rely on the use of special stored
fuel and glucose, not O2

Tissue Use of Oxygen

Regular exercise at high speed &
intensity for short periods improves
anaerobic capacity

Summary of Respiration
and Circulation Process

The six important, continuous phases of

respiration include:
1. Breathing air into the lungs (ventilation)
2. O2 and CO2 exchange between air in the lung
alveoli and blood
3. O2 transport by blood to the body tissue
4. Releasing O2 by blood cells, and extraction by
body cells
5. Use of O2 in cells producing waste products
including CO2
6. CO2 transport by blood back to the lungs where
it diffuses out of the blood and is exhaled

Respiratory Problems

Hypoxia
Hypoxia results when tissue oxygen
pressure drops below normal from an
inadequate supply of oxygen
Situations that may result in hypoxia
include:
Breathing mixtures low in oxygen
Ascending to high elevation
Drowning, etc.

Hypoxia
Effects of Different Levels of Oxygen Partial Pressure
PO2 (atm)
<0.08
<0.08-0.10

Application and Effect

Coma to ultimate death
Unconsciousness in most people

0.09-0.10

Serious signs/symptoms of hypoxia

0.14-0.16

Initial signs/symptoms of hypoxia

0.21
0.35-0.40
0.50

Normal environmental oxygen (sea level air)

Normal saturation dive PO2 level
Threshold for whole-body effects; maximum saturation dive
exposure

1.6

NOAA limit for maximum exposure for a working diver

2.2

Commercial/military Sur-D chamber surface

decompression, 100% O2 at 40 fsw (12 msw) pressure

2.4

60% N2 / 40% O2 nitrox recompression treatment gas at six

ata (165 fsw/50 msw)

2.8

100% O2 recompression treatment gas at 2.8 ata (60 fsw/18

msw)

Credit:50/50
Permissionnitrox
granted byrecompression
Best Publishing Company treatment
(NOAA Diving Manual
4th for
Ed.) Flagstaff,
AZ the
3.0
gas
use in
chamber at six ata

Hypoxia
Signs and Symptoms:
Frequently none (the diver may simply lapse
into sudden unconsciousness)
Mental Changes similar to alcohol intoxication
Confusion, clumsiness, slowing of response
Foolish behavior
Cyanosis (bluish discoloration of lips, nail beds,
and skin)
In severe cases, cessation of breathing

Hypoxia
Prevention:
Avoid excessive hyperventilation before
a breath-hold dive
Always know the amount of oxygen in
the gas mixture being breathed

Hypoxia
Treatment:
Get the victim to the surface and into
fresh air
If victim is breathing, supplying a
breathing gas with sufficient oxygen
usually causes rapid reversal of symptoms
An unconscious victim should be treated
as if they are suffering from gas embolism
CPR should be administered if necessary

Carbon Dioxide Toxicity

Carbon dioxide excess (Hypercapnia)
occurs from too much CO2 in the breathing
gas, or because CO2 produced by the body
is not eliminated properly

Carbon Dioxide Toxicity

Full-face masks or helmets with too much
dead space, Skip-Breathing to try to
conserve cylinder air, and increased effort
of breathing at depth are examples of
conditions that can contribute to
hypercapnia

Carbon Dioxide Toxicity

Signs and Symptoms:
There may be no symptoms
If signs and symptoms are present, they
may include:

Carbon Dioxide Toxicity

Signs and Symptoms:
A feeling of air
starvation and an
overwhelming urge to
breathe
Headache
Dizziness
Weakness

Perspiration
Nausea
A slowing of response
Confusion
Clumsiness
Flushed skin
UNCONSCIOUSNESS

Carbon Dioxide Toxicity

The Relationship of Physiological Effects of
CO2 Concentration and Exposure Periods:

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Carbon Dioxide Toxicity

Treatment:
If you experience symptoms stop, rest,
breathe deeply, and ventilate yourself
and your apparatus. Fresh breathing gas
usually relieves symptoms quickly
Note: Headache form hypercapnia may
persist for some time

An unconscious diver requires rescue

Hyperventilation
Short term, rapid, deep breathing
beyond the need for the activity
Lowers the level of CO2 in blood
(hypocapnia or hypocarbia)

Hyperventilation
Breath-hold divers often intentionally
hyperventilate so they can stay
underwater longer (see Shallow
Water Blackout)
Divers may also hyperventilate
unintentionally during stressful
situations

Hyperventilation
Signs and Symptoms:
Rapid, deep breathing
Tingling fingers, lightheadedness,
weakness, faintness
It is possible to go unconscious

Hyperventilation
Treatment:
Take immediate steps to slow breathing
rate
Hyperventilation is cause for terminating
a dive and requires proper buddy skills to
aid in identifying the problem and to
assist the victim due to the possibility of
unconsciousness

Shallow Water Blackout

Hyperventilation lowers the amount of CO2
in the blood, resulting in the urge to
breathe being postponed

Shallow Water Blackout

Breath-hold divers diving too deep for too
long use up oxygen, but do not feel the
urge to breathe,
Upon ascent, reductions in ambient
pressure reduce the partial pressure of
oxygen in the body this hypoxic
condition can cause unconsciousness

Shallow Water Blackout

Shallow Water Blackout can also be a
concern in diving operations where
compressed gas divers could find
themselves breathing a hypoxic gas
in shallow water

Shallow Water Blackout

Prevention and good buddy skills are the
keys to avoiding or responding to shallow
water blackout
Do not hyperventilate prior to breath-hold
diving
Know the partial pressure of oxygen (PO2) and
the breathable limits of your diving mixtures
Adhere to the buddy system and use proper
buddy practices for the diving you are involved
in

Carbon Monoxide
Poisoning
Carbon Monoxide (CO) disrupts the
entire process of oxygen transport,
uptake, and utilization by bonding
with:
The hemoglobin in the blood;
The oxygen-transporting and storage
protein of muscle (myoglobin);
And respiratory enzymes necessary for
oxygen use in cells

Carbon Monoxide
Poisoning
Effects of CO increase with depth

Carbon Monoxide
Poisoning
CO contamination of a scuba cylinder
can come from fumes drawn into the
compressor intake
Fumes can come from the exhaust of
an internal combustion engine or
from partial combustion of
lubricating oil in a compressor not
properly operated or maintained

Carbon Monoxide
Poisoning
Signs and Symptoms:
CO poisoning usually produces no symptoms
until the victim loses consciousness
Some victims experience headache, nausea,
dizziness, weakness, a feeling of tightness in
the head, confusion, or clumsiness
Victims may be unresponsive or display poor
judgment
Rapid deep breathing may progress to
cessation of breathing

Carbon Monoxide
Poisoning
Signs and Symptoms:
The classic sign of cherry-red lips may or
may not occur and is not a reliable diagnostic
aid

Carbon Monoxide
Poisoning
Treatment:
Administer oxygen and seek medical
attention
The treatment of choice is hyperbaric
oxygen therapy in a recompression
chamber

Excessive Resistance to
Breathing
Work-of-breathing is the amount of
effort involved in inhaling
If breathing resistance is high,
breathing is more difficult

Excessive Resistance to
Breathing
Work-of-breathing increases with gas
flow resistance in poorly tuned
regulators, valves, and hoses, and
from tight equipment
Work-of-breathing also increases with
depth as gas density increases

Excessive Resistance to
Breathing
The body compensates for high
breathing resistance by reducing
ventilation which in turn increases
CO2 retention
To reduce work-of-breathing, breathe
normally and keep equipment well
tuned and maintained

Lipoid Pneumonia
Lipoid Pneumonia can result if a diver
breaths gas containing suspended
petroleum vapor
Prevent this problem by not allowing
oil vapor in the breathing gas, and by
ensuring only approved oil is used in
compressors

Direct Effects of
Pressure During
Descent

Direct Effects of Pressure

During Descent
The body can withstand great
hydrostatic pressure without
experiencing barotrauma; liquid
areas of the body are essentially
incompressible and do not change
shape or distort

Direct Effects of Pressure

During Descent
Air spaces are not affected as long as
pressure inside the airspace is the
same as pressure outside

Ears

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Ears
The closed airspace of the middle ear
is susceptible to Ear Squeeze, as
pressure increases on descent and
the volume in the airspace decreases

Ears
Obstructing the external ear canal
with ear plugs, earwax, or a hood can
produce another closed airspace
subject to pressure increase and
squeeze

Ears
Fullness or pressure in the region of
the external ear canal; a Squeaking
sound; Pain; and Blood or fluid from
the external ear are all signs and
symptoms of ear equalization
problems
If unchecked, these distortions could
result in a ruptured ear drum

Ears
Methods to equalize the pressure in
the middle ear include:
Swallowing
Yawning
Using the Valsalva Maneuver Pinch the
noise closed and exhale gently against
your fingers - avoid forceful blowing

Ears
All of equalization techniques should
be done early and often during the
decent

Ears
Removing the obstruction of the
external ear canal allows this space to
equalize
If you experience symptoms of an ear
squeeze and cannot equalize, stop
your decent, ascend to a shallower
depth and try to equalize again
If you cannot equalize, terminate the
dive

Sinuses
The term sinus can mean any hollow
space or cavity in a bone, or a dilated area
of blood vessel or soft tissue

Sinuses
Here sinus refers to
the four paired,
mucus-lined, air
cavities in the
facial bones of the
head

Sinuses
Sinuses normally equalize when you
exhale through your nose to equalize
the pressure in your mask or when
you Valsalva
Nasal inflammation, congestion,
deformities or other blockage can
prevent equalization and cause a
sinus squeeze

Sinuses
Fullness or pain in the vicinity of the
involved sinus or in the upper teeth;
numbness of the front of the face;
and bleeding from the nose are signs
and symptoms of a sinus squeeze
As with the ears, if you cannot
equalize, terminate the dive

Sinuses
Over the counter and prescription
drugs can open sinus passages, but
there is always a risk of them
wearing off during a dive, allowing
gas to be trapped on ascent
Do not dive if you have congested
sinuses

Sinuses
Most symptoms of sinus barotrauma
disappear within five to ten days
Divers who experience symptoms for
longer periods; or have severe pain,
bleeding, or yellow or greenish nasal
discharge should be seen promptly
by a physician

Lungs
On a breath-hold dive
the lungs compress
with increasing depth

Lungs
This compression does
not correlate
completely to the
pressure-volume
relationship of Boyles
law due to the bodys
ability shift blood into
the thoracic blood
vessels, maintaining
larger than predicted
lung volume

Eyes
Non-compressible fluids in the eyes protect
them from increasing water pressure, but
without equalization, negative pressure in the
mask creates suction that can cause swelling,
bruising and bleeding

Photo courtesy Lester Quayle and Rita Barton

Eyes
This condition, commonly called eye
squeeze is easily avoided by exhaling into
your mask through your nose during
decent

Photo courtesy Lester Quayle and Rita Barton

Eyes
Treatment includes applying ice packs to the
damaged tissues and administering pain relievers
For serious cases, seek the services of a physician

Photo courtesy Lester Quayle and Rita Barton

Direct Effects of
Pressure During Ascent

Direct Effects of Pressure

During Ascent
During ascent, ambient pressure
decreases and air in the bodys air
spaces expands
When this gas vents freely there is
no problem
When expanding gas is blocked from
venting, over-inflation occurs and an
overpressurization injury can result

Reverse Block
A reverse block of the ears or the
sinus cavities can occur on any
ascent but it is more likely to happen
when the diver is congested
Fullness, pressure, or pain in the
sinuses and/or ears during ascent are
symptoms of a reverse block

Reverse Block
Swallowing, and wiggling the jaw are
acceptable ways to try and clear a
reverse block in the ears
Inhaling gently against your fingers
as you pinch your nose may help
clear a reverse block of the sinuses
or ears, but you should NOT Valsalva
on ascent

Reverse Block
Inhaling through the mouth and
exhaling through the nose while
remaining stationary or descending
slightly in the water column may also
help to clear a reverse block

Reverse Block
Severe reverse block cases can
produce bleeding or ruptures of the
eardrum or sinus and require medical
attention
At some point you may be forced to
ascend with a reverse block

Reverse Block
Decongestants and nasal sprays may
help open the blocked passages and
return trapped pressure to normal,
but preventing the condition by not
diving when congested is the best
course of action

Lungs
Breathing normally during ascent will
vent expanding gas without problem,
unless there are lung lesions or
conditions that obstruct air flow

Lungs
Breath-holding or insufficient
exhalation while breathing
compressed gas can result in lung
barotrauma; obstruction from chronic
or acute respiratory disease, or
bronchospasm with asthma can also
cause a lung overexpansion injury

Pneumothorax
The lungs are attached to the chest
wall by a thin, paired membrane
called the pleura
The two pleural membranes lie so
close to each other that they touch
A watery fluid lubricates the layer
between them and makes a suction
between the layers which holds the
lungs open

Pneumothorax
Air rupturing the lung wall can vent
into the pleural cavity creating a
pneumothorax breaking the suction
between the pleura

Pneumothorax
There are two types of
pneumothorax; simple and tension
A simple pneumothorax is a onetime
leaking of air into the pleural cavity
A tension pneumothorax is a repeated
leaking of air from the lungs into the
pleural cavity; progressively enlarging
the air pocket

Pneumothorax
A large amount of
air in pleural cavity
prevents the lungs
from expanding

Credit: Permission granted by Best Publishing Company (NOAA

Diving Manual 4th Ed.) Flagstaff, AZ

Pneumothorax
A lung may
collapse, the heart
may push out of
normal position
causing sudden
severe pain,
difficulty breathing,
and rarely,
coughing frothy
blood or death
Credit: Permission granted by Best Publishing Company (NOAA
Diving Manual 4th Ed.) Flagstaff, AZ

Pneumothorax
Signs and Symptoms:
Difficulty or rapid
breathing
Leaning toward the
affected side
Hypotension
Cyanosis and shock

Chest pain (deep

breathing hurts)
Shortness of breath
Decreased or absent
lung sounds on
affected side
Rapid, shallow
breathing
Death

Pneumothorax
Treatment:
Position victim on injured side
Monitor for worsening symptoms
Monitor ABCs (airway, breathing, and
circulation)
Administer 100% oxygen and treat for
shock
Transport immediately to a medical
facility

Mediastinal Emphysema
In mediastinal
emphysema, air
escapes from the
lung into tissues
around the heart,
major blood
vessels, and
trachea

Credit: Permission granted by Best Publishing Company (NOAA

Diving Manual 4th Ed.) Flagstaff, AZ

Mediastinal Emphysema
Signs and Symptoms:
Pain under the sternum
that may radiate to the
neck, collarbone, or
shoulder
Shortness of breath
Faintness
Cyanosis of the skin, lips,
or nailbeds

Difficulty breathing
Shock
Swelling around the neck
A brassy quality to the
voice
A sensation of pressure on
the windpipe
Cough
Deviation of the larynx
and trachea to the
affected side

Mediastinal Emphysema
Treatment:
Monitor ABCs
Administer oxygen and monitor for
shock
Transport to the nearest medical facility

Subcutaneous
Emphysema
Subcutaneous emphysema results from air
forced into tissues beneath the skin of the
neck
It can be associated with mediastinal
emphysema or can occur alone

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

Subcutaneous
Emphysema
Signs and Symptoms:
Feeling of fullness in the neck area
Swelling or inflation around the neck
and upper chest
Crackling sensation when skin is
palpated
Change in sound of voice
Cough

Subcutaneous
Emphysema
Treatment:
Unless complicated by gas embolism,
recompression is not normally required
Administer oxygen and have the diver
seen by a physician

Arterial Gas Embolism

An arterial gas
embolism (AGE)
occurs when a
bubble of gas
causes a blockage
of blood supply to
the heart, brain, or
other vital tissue
Credit: Permission granted by Best Publishing Company (NOAA
Diving Manual 4th Ed.) Flagstaff, AZ

Arterial Gas Embolism

Symptoms of an AGE usually occur
immediately or within five minutes of
surfacing
One, a few, or all symptoms may be
present
AGE is LIFE THREATENING, and
REQUIRES IMMEDIATE
TREATMENT

Arterial Gas Embolism

Signs and Symptoms:
Chest pain
Cough or shortness of
breath
Bloody, frothy sputum
Headache
Visual disturbances
including blindness
(partial or complete)

Numbness or tingling
Weakness or paralysis
Loss of, or change in,
sensation over part of
body
Dizziness
Confusion
Sudden
unconsciousness
Respiratory arrest
Death

Arterial Gas Embolism

Treatment:
Establish and maintain ABCs
Initiate CPR if necessary
Administer 100% oxygen with the diver
in the supine or recovery position
Transport to nearest medical facility and
initiate recompression treatment ASAP

Minimize the risk of lung

overexpansion injuries
by:

Never holding your breath when

diving compressed gases
Ascending slowly (30 feet per minute
[9 meters per minute]) while
breathing normally
Not diving with a chest cold or
obstructed air passages
Carrying sufficient quantities of gas to
complete the dive

Emergency Transport
Considerations
Decreased ambient pressure
associated with plane flight or
ground transportation ascending
over mountain passes can aggravate
lung overexpansion injuries, AGE,
and DCS

Emergency Transport
Considerations
If air transportation is required, an
aircraft capable of being pressurized
to sea level is preferred
A helicopter or unpressurized aircraft
should be flown as low as safely
possible

Stomach and Intestine

Gas overexpansion injuries of the
stomach or intestines are rare
Belching or heartburn can be
experienced

Stomach and Intestine

To prevent gastrointestinal (GI)
barotrauma, breath normally, dont
swallow air, and avoid large meals
and gas-producing food and drink
before diving

Stomach and Intestine

Should GI distress occur on ascent,
descend to relieve discomfort, and
slowly re-ascend
If surfacing is necessary before
relieving pressure, over-the-counter
anti-gas preparations may be helpful
In extreme cases, seek medical
attention

Teeth
Tooth squeeze is not common, but
prevention is worth keeping in mind
Keep teeth clean, have cavities filled
and ill-fitting crowns replaced
Before undergoing dental work, inform
the dentist that you are a diver

Contact Lenses
Bubbles have been found in the film
of tears beneath contact lenses after
ascent
Affected divers experienced
soreness, decreased visual acuity,
and the appearance of halos around
lights for about two hours after
ascent

Indirect Effects of
Pressure During
Descent

Inert Gas Narcosis

Inert gas narcosis is a state of altered
mental function ranging from mild
impairment of judgment or euphoria,
to complete loss of consciousness
produced by exposure to increased
partial pressure of nitrogen and
certain other gases

Inert Gas Narcosis

Narcosis is often first noticed at
approximately 100 ft (31 m) when
breathing compressed air
Impairment increases with depth and
there is wide variation in
susceptibility from diver to diver

Inert Gas Narcosis

Signs and Symptoms:

Loss of judgment and skill

A false feeling of well being
Lack of concern for tasks or safety
Inappropriate laughter
Euphoria

Inert Gas Narcosis

CO2, fatigue, anxiety, cold, alcohol,
medications that might cause
drowsiness or reduce alertness can
contribute to and compound the
effects of narcosis
Narcosis rapidly reverses with ascent

Narcotic Effect of Compressed Air Diving

Feet

Meters

Effect

0-100

0-30.5

Mild impairment of performance on unpracticed tasks.

Mild euphoria.

100

30.5

Reasoning and immediate memory affected more than motor coordination and
choice reactions. Delayed response to visual and auditory stimuli.

100-165

30.5-50.3

Laughter and loquacity may be overcome by self control.

Idea fixation and overconfidence.
Calculation errors.

165

50.3

Sleepiness, hallucinations, impaired judgment.

165-230

50.3-70.1

Convivial group atmosphere. May be terror reaction in some.

Talkative. Dizziness reported occasionally.
Uncontrolled laughter approaching hysteria in some.

230

70.1

Severe impairment of intellectual performance. Manual dexterity less affected.

230-300

70.1-91.5

Gross delay in response to stimuli. Diminished concentration.

Mental confusion. Increased auditory sensitivity, i.e., sounds seem louder.

300

91.5

Stupefaction. Severe impairment of practical activity and judgment.

Mental abnormalities and memory defects.
Deterioration in handwriting, euphoria, hyperexcitability.
Almost total loss of intellectual and perceptive faculties.

300

91.5

Hallucinations
(similar to those caused by hallucinogenic drugs rather than alcohol).
Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

High Pressure Nervous

Syndrome
High pressure nervous syndrome
(HPNS) occurs at depths greater than
400 fsw (123 msw)
It was first noted in the 1960s using
helium/oxygen breathing mixtures
HPNS becomes worse with increasing
pressure and rate of compression

High Pressure Nervous

Syndrome
HPNS is characterized by dizziness,
nausea, vomiting, postural and
intention tremors, fatigue and
somnolence, sudden muscle
twitching, stomach cramps,
intellectual and psychomotor
performance decrements, and poor
sleep with nightmares

High Pressure Nervous

Syndrome
Adding a small amount (5-10%) of
nitrogen into the breathing mixture
reduces HPNS
Slow compression, stage
compression with long intervals, and
careful personnel selections can also
prevent or reduce HPNS

Oxygen Toxicity
There are two types of oxygen
toxicity for which divers must be
concerned:
CNS Oxygen Toxicity (Central nervous
system)
Whole-Body Oxygen Toxicity

CNS Oxygen Toxicity

CNS oxygen toxicity can occur at the
high end of PO2 exposures (typically
above 1.6 atm)
The end result may be an epilepticlike convulsion not damaging in
itself, but could result in drowning

CNS Oxygen Toxicity

Susceptibility is highly variable from
person to person and even from day
to day in a given individual

CNS Oxygen Toxicity

Susceptibility is increased by factors
that cause an increase in internal
PCO2 such as exercise, breathing
dense gas, or breathing against
resistance
Immersion, dramatic changes in
temperature, and physical exertion
also increase susceptibility

CNS Oxygen Toxicity

Signs and Symptoms are easily
remembered with the acronym
CONVENTID

CNS Oxygen Toxicity

CON Convulsion
V Visual disturbance, including tunnel vision
E Ear ringing
N Nausea
T Tingling, twitching or muscle spasms,
especially of the face and lips
I Irritability, restlessness, euphoria, anxiety
D Dizziness, dyspnea

CNS Oxygen Toxicity

The use of air breaks to reduce or
postpone CNS oxygen toxicity
incidence is common practice in
hyperbaric treatments

CNS Oxygen Toxicity

The concept of air breaks has been
extended to diving situations where
supplemental oxygen or high oxygen
content mixtures are used for
decompression
In these types of exposures a five
minute air break every 20 minutes is
recommended

CNS Oxygen Toxicity

The use of oxygen exposure limits for
single dive exposures and exposure
to high PO2 during a 24-hour period
have been found to be effective in
preventing CNS oxygen toxicity

CNS Oxygen Toxicity

It should be noted that these limits
like those associated with dive tables
do not guarantee safety if adhered to
Exceeding the limits may not
produce a problem, but does
increase the risk

NOAA Oxygen Exposure Limits

The NOAA Oxygen

Exposure Limits
should be used to
determine your
dive time limits for
a given PO2

PO2
(atm)

Maximum Single
Exposure
(minutes)

Maximum
per 24 hr
(minutes)

1.60

45

150

1.55

83

165

1.50

120

180

1.45

135

180

1.40

150

180

1.35

165

195

1.30

180

210

1.25

195

225

1.20

210

240

1.10

240

270

1.00

300

300

0.90

360

360

0.80

450

450

0.70

570

570

0.60

720

720

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

CNS Oxygen Toxicity

NOAA Oxygen Exposure Limits

The chart shows

the maximum
single dive
exposure and the
accumulated daily
limits at a given
PO2

PO2
(atm)

Maximum Single
Exposure
(minutes)

Maximum
per 24 hr
(minutes)

1.60

45

150

1.55

83

165

1.50

120

180

1.45

135

180

1.40

150

180

1.35

165

195

1.30

180

210

1.25

195

225

1.20

210

240

1.10

240

270

1.00

300

300

0.90

360

360

0.80

450

450

0.70

570

570

0.60

720

720

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

CNS Oxygen Toxicity

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

CNS Oxygen Toxicity

NOAA Oxygen Exposure Limits
PO2
(atm)

Maximum Single
Exposure
(minutes)

Maximum
per 24 hr
(minutes)

1.60

45

150

1.55

83

165

1.50

120

180

1.45

135

180

1.40

150

180

1.35

165

195

1.30

180

210

1.25

195

225

1.20

210

240

1.10

240

270

1.00

300

300

0.90

360

360

0.80

450

450

0.70

570

570

0.60

720

720

If more than one

dive is planned to
the maximum
single dive
exposure of a PO2
of 1.6, a surface
interval of at least
90 minutes is
advised

NOAA Oxygen Exposure Limits

If one or more dives

using a PO2 less
than 1.6 reach or
exceed the
maximum single
exposure limit, the
diver should spend
a minimum of two
hours at a normoxic
PO2 (normal
oxygen, air)

PO2
(atm)

Maximum Single
Exposure
(minutes)

Maximum
per 24 hr
(minutes)

1.60

45

150

1.55

83

165

1.50

120

180

1.45

135

180

1.40

150

180

1.35

165

195

1.30

180

210

1.25

195

225

1.20

210

240

1.10

240

270

1.00

300

300

0.90

360

360

0.80

450

450

0.70

570

570

0.60

720

720

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

CNS Oxygen Toxicity

Credit: Permission granted by Best Publishing Company (NOAA Diving Manual 4th Ed.) Flagstaff, AZ

CNS Oxygen Toxicity

NOAA Oxygen Exposure Limits
PO2
(atm)

Maximum Single
Exposure
(minutes)

Maximum
per 24 hr
(minutes)

1.60

45

150

1.55

83

165

1.50

120

180

1.45

135

180

1.40

150

180

1.35

165

195

1.30

180

210

1.25

195

225

1.20

210

240

1.10

240

270

1.00

300

300

0.90

360

360

0.80

450

450

0.70

570

570

0.60

720

720

If the Maximum 24hour Limit is

reached in a 24hour period the
diver must spend a
minimum of 12
hours at normoxic
PO2 before diving
again

Whole-Body Oxygen
Toxicity
Whole-Body oxygen toxicity is a slow
developing condition resulting from
exposure to above normal PO2,
generally at levels below those
causing CNS toxicity but above a PO2
of 0.5 atm

Whole-Body Oxygen
Toxicity
Whole-Body oxygen toxicity is of little
concern to divers doing no-stop
dives, even when breathing oxygenenriched mixtures (nitrox), but it may
be seen during intensive diving
operations or long oxygen
treatments in a hyperbaric chamber

Whole-Body Oxygen
Toxicity
Signs and Symptoms:
Pulmonary irritation resulting in chest
pain or discomfort, coughing, inability to
take a deep breath without pain or
coughing, development of fluid in the
lungs, and a reduced vital capacity

Whole-Body Oxygen
Toxicity
Signs and Symptoms:
Non-pulmonary symptoms include skin
numbness and itching, headache,
dizziness, nausea, effects on the eyes,
and a dramatic reduction of aerobic
capacity during exercise

Whole-Body Oxygen
Toxicity
The risk of developing Whole-Body
Oxygen Toxicity is unlikely when
using nitrox
Procedures have been developed for
managing this risk when the diver
will be conducting many dives over
more than a three day period, and
where exposures get lengthy

Whole-Body Oxygen
Toxicity
The REPEX method
uses the single
dose Oxygen
Tolerance Unit
(OTU) to track
extended
operational
exposures

REPEX Oxygen Exposure Chart

for Tolerable Multiple Day
Exposures
Exposure
Days

OTU
Average
Dose

OTU
Total Dose

850

850

700

1400

620

1860

525

2100

460

2300

420

2520

380

2660

350

2800

330

2970

10

310

3100

11

300

3300

12

300

3600

13

300

3900

14

300

4200

15-30

300

As required

Whole-Body Oxygen
Toxicity
The total for a
given exposure
period is given in
the third column

REPEX Oxygen Exposure Chart

for Tolerable Multiple Day
Exposures
Exposure
Days

OTU
Average
Dose

OTU
Total Dose

850

850

700

1400

620

1860

525

2100

460

2300

420

2520

380

2660

350

2800

330

2970

10

310

3100

11

300

3300

12

300

3600

13

300

3900

14

300

4200

15-30

300

As required

Whole-Body Oxygen
Toxicity
The OTU Calculation Table provides Per
Minute OTU units for a range of PO2s
OTU Calculation Table
PO2 (atm)

OTU Per
Minute

PO2 (atm)

OTU Per
Minute

PO2 (atm)

OTU Per
Minute

0.50

1.05

1.08

1.55

1.85

0.55

0.15

1.10

1.16

1.60

1.92

0.60

0.27

1.15

1.24

1.65

2.00

0.65

0.37

1.20

1.32

1.70

2.07

0.70

0.47

1.25

1.40

1.75

2.14

0.75

0.56

1.30

1.48

1.80

2.21

0.80

0.65

1.35

1.55

1.85

2.28

0.85

0.74

1.40

1.63

1.90

2.35

0.90

0.83

1.45

1.70

1.95

2.42

0.95

0.92

1.50

1.78

2.00

2.49

1.00

1.00

Indirect Effects of
Pressure During Ascent

Inert Gas Elimination

Assuming your body remains at a
constant pressure long enough the
gases your body absorbs are at
equilibrium with the surrounding
pressure

Inert Gas Elimination

Increasing ambient pressure causes
the body to absorb or on-gas
Decreasing ambient pressure causes
the body to eliminate or off-gas

Inert Gas Elimination

Nitrogen, the inert gas making up the
largest percentage of the air we
breathe, is of particular concern to
divers
The rate at which nitrogen on-gases
and off-gases is measured in tissue
or compartment half-times

Inert Gas Elimination

Half-times refer to the time in
minutes necessary to uptake or
eliminate enough nitrogen (or other
gas) to fill or empty half the area
with gas
Tissue or compartment refers to
body areas that on-gas and off-gas at
the same rate

Inert Gas Elimination

Similar compartments can be
scattered throughout the body
Theoretical tissues are further
differentiated as being slow or
fast tissues depending on their
capacity to absorb the dissolved gas

Inert Gas Elimination

The speed of a given tissue group
depends on the blood supply and the
makeup of the tissue

Inert Gas Elimination

Fatty tissues are examples of slow
compartments
They hold more gas than watery
tissues, and take longer to absorb
and eliminate gas

Inert Gas Elimination

Fast compartments usually build
higher amounts of nitrogen after a
dive than slower ones because they
on-gas more in the same time period

Inert Gas Elimination

When a compartment fills to
capacity, it is called saturated
On most dives there is not enough
time for total saturation
Faster compartments may become
saturated, while slow compartments
may be practically empty, while still
others are somewhere in between

Inert Gas Elimination

Differences in solubility and rates of
gas diffusion give different gases
different half-times
Helium is much less soluble in tissues
than nitrogen, but it diffuses faster;
allowing helium to reach equilibrium
faster than nitrogen

Inert Gas Elimination

On ascent the divers tissues,
especially slow compartments, may
continue to absorb nitrogen
During ascent, ambient pressure can
drive nitrogen into slow tissues, even
as higher pressure, fast
compartments off-gas

Inert Gas Elimination

After ascending to the surface (or a
shallower depth), it may require 24
hours for equilibration due to halftime gas elimination

Inert Gas Elimination

No matter how much gas a
compartment starts with, it takes six
half-times to empty or fill
For practical purposes 99% is
completely saturated or de-saturated

Inert Gas Elimination

For practical applications like
calculating decompression tables,
off-gassing is considered to proceed
at the same half-time rate as ongassing
Safety stops and slow ascent rates
(30 fsw [9 msw]) are recommended
to allow for proper off-gassing

Inert Gas Elimination

Decompression requirements are
dictated by the off-gassing of inert
gases

Inert Gas Elimination

By breathing 100% oxygen, the inert
gas gradient is significantly
increased. This can result in an
increase in the rate that inert gases
are eliminated from the body
Switching to gases with higher
contents of oxygen at appropriate
depths can shorten required
decompression times

Decompression Sickness
Decompression sickness (DCS, aka
the bends) is the result of
inadequate decompression following
exposure to increased pressure

Decompression Sickness
If the diver ascends to quickly, the
nitrogen absorbed by the divers
body during a dive can come out of
solution and form bubbles in the
bodys fluids and tissues

Decompression Sickness
The exact trigger for bubble
formation is not understood and
adhering to accepted decompression
limits and proper ascent rates is no
guarantee of avoiding symptoms of
DCS

Decompression Sickness
So called silent bubbles have been
known to form after dives; producing
no symptoms
Bubbles that do produce symptoms
can effect the lymphatic and
circulatory systems, damage nerves,
and trigger immune system reactions

Decompression Sickness
The major determinants of risk of
DCS are depth, time at depth, ascent
rate, and multiple dives
Individual variation is also a factor,
but this area is poorly understood

Decompression Sickness
Fatigue, dehydration, smoking,
alcohol consumption, and carbon
dioxide retention may predispose a
diver to DCS
Environmental factors including
chilling at the end of a dive, heavy
work, and the use of heated suits
have also been identified as possible
predisposing factors

Decompression Sickness
It has been common to describe
decompression sickness as one of
three Types, or to categorize it by the
area of involvement and the severity
of symptoms

Decompression Sickness
Type I includes skin itching or
marbling; brief, mild pain called
niggles, which resolve typically
within ten minutes; joint pain;
lymphatic swelling, and sometimes
included extreme fatigue

Decompression Sickness
Type II DCS is considered to be
respiratory symptoms, hypovolemic
shock, cardiopulmonary problems,
and central or peripheral nervous
system involvement

Decompression Sickness
Type III includes arterial gas
embolism and is also called
decompression illness (DCI)

Decompression Sickness
Categorizing DCS by area involved
and severity of symptom includes:
Limb Bends
Central Nervous
System (CNS) DCS
Cerebral
Decompression
Sickness

Pulmonary DCS
Skin Bends
Inner-Ear
Decompression
Sickness

Decompression Sickness
Limb Bends Dull, throbbing, deep
pain in the joint or tissue; usually in the
elbow, shoulder, hip, or knee
Pain onset is usually gradual and slowly
intensifies
In severe cases limb strength can be
affected
In divers, upper limbs are affected
about three times as often as lower
limbs

Decompression Sickness
Central Nervous System (CNS)
DCS May cause muscular
weakness, numbness, pins and
needles, paralysis, loss of sensation,
loss of sphincter control, and, in
extreme cases, death

Decompression Sickness
Central Nervous System (CNS)
DCS Symptoms are often different
from the usual history of traumatic
nerve injury
Strange neurological complaints or
findings should not be dismissed as
imaginary

Decompression Sickness
Cerebral Decompression
Sickness May produce almost any
symptom: headache, visual
disturbance, dizziness, tunnel vision,
tinnitus, partial deafness, confusion,
disorientation, emotional or
psychotic symptoms, paralysis, and
unconsciousness

Decompression Sickness
Pulmonary DCS aka the Chokes
accounts for about 2% of DCS cases
Symptoms include: pain under the
breastbone on inhalation, coughing
that can become paroxysmal, and
severe respiratory distress that can
result in death

Decompression Sickness
Skin Bends Come in two forms:
harmless simple itchy skin after
hyperbaric chamber exposure, or
rashy marbling on the torso that may
warn of serious DCS

Decompression Sickness
Inner-Ear Decompression
Sickness aka Vestibular DCS or Ear
Bends
Signs and symptoms include vertigo,
tinnitus, nausea, or vomiting

Decompression Sickness
Inner-Ear Decompression
Sickness
Ear Bends occur more often after deep
dives containing helium in the
breathing mixture; particularly after
switching to air in the later stages of
decompression
Shallow water and/or air divers are not
immune

Decompression Sickness
While you can do everything correctly and
still suffer DCS, prevention can be
enhanced if you:

Ascend slowly (30 ft/min [9 m/min])

Make safety stops
Use longer surface intervals
Plan the dive, dive the plan and have a backup
plan
Maintain good physical fitness, nutrition, and
hydration

Decompression Sickness
First aid and treatment of DCS
includes:
Administering 100% oxygen by
demand/positive-pressure valve or nonrebreather mask at 15 Lpm constant
flow with the injured diver in the supine
or recovery position

Decompression Sickness
First aid and treatment of DCS
includes:
Interviewing the victim and their dive
buddy to collect information on the
dive(s) within the past 24 hours
Making the victim comfortable
Monitoring vital signs and addressing
issues as necessary

Decompression Sickness
First aid and treatment of DCS
includes:
Re-hydration of the victim (fluids by
mouth should only be administered to
fully conscious persons)
When appropriate, conducting a field
neurological examination

Decompression Sickness
First aid and treatment of DCS
includes:
Contact with a physician schooled in
hyperbaric medicine and transport to a
chamber for recompression
The Divers Alert Network [DAN] is
available for information or emergency
assistance
emergency (24/7) at 919-684-8111
information (normal business hours) at 919684-2948

Aseptic Bone Necrosis

Aseptic bone necrosis is an
occupational hazard of professional
divers and others exposed to
hyperbaric stresses

Aseptic Bone Necrosis

Surfaces of the long-bone ends can
die when bubbles formed during
decompression obstruct blood flow
resulting in pain, spasm around the
joint, and finally, disabling arthritis

Aseptic Bone Necrosis

The hip and shoulder are most often
affected
Bone necrosis is seldom seen in the
elbows, wrists, or ankles, and lesions
occurring in the shafts of the long
bones rarely cause symptoms or
disability

Aseptic Bone Necrosis

Lesions in the hip are often bilateral
and the joint can degrade to the
point of total collapse
The only treatment known to have
any degree of success is surgical
repair or replacement of the joint

Patent Foramen Ovale

The foramen ovale is a flap-like
opening in the septum wall
separating the right and left atria of
the heart, normally open in a
developing fetus
This opening allows fetal blood to
bypass the non-functional lung (since
fetal gas exchange takes place in the
mother)

Patent Foramen Ovale

Within a year after birth the foramen
ovale closes in most people
However, in an estimated 20-30% of
the general population the foramen
ovale remains partially or fully open
and is termed a Patent Foramen
Ovale (PFO)

Patent Foramen Ovale

In normal activities at sea level a PFO
poses no problem and most people
with PFO are unaware they have the
condition
PFO can cause severe problems for
divers by allowing bubbles
accumulated during a dive to be
shunted from one side of the heart to
the other, bypassing the lungs

Patent Foramen Ovale

PFO has been implicated in a number
of otherwise unexplained cases of
DCS/DCI

Pregnancy and Diving

Specific safety guidelines regarding
pregnancy and diving are difficult to
provide based on existing
experiences of humans and animal
studies, but it is the consensus of the
diving medical community that there
are risks for both the mother and the
fetus with diving during pregnancy

Pregnancy and Diving

Women should not dive during
pregnancy

Hypothermia

Effects of Cold
Chilling, even if not life threatening,
increases fatigue and reduces
dexterity making it difficult to do
useful work and impacts on diver
safety

Effects of Cold
Susceptibility to chilling increases
with dehydration, fatigue, hunger,
and illness
Being out of shape, underweight, a
smoker, or using drugs or alcohol
also increase susceptibility to chilling

Signs and Symptoms of Dropping Core Temperature

Core
Temperatu
re
o

Symptoms
CHILLING

98.6

37

Cold sensations, skin vasoconstriction, increased muscular tension,

increased oxygen consumption

97

36

Sporadic shivering suppressed by voluntary movements, gross

shivering in bouts, further increase in oxygen consumption,
uncontrollable shivering

MODERATE HYPOTHERMIA
95

35

Voluntary tolerance limit in laboratory experiments; mental confusion,

impairment of rational thought, possible drowning, decreased will
to struggle

93

34

Loss of memory, speech impairment, sensory function impairment,

motor performance impairment

91

33

Hallucinations, delusions, partial loss of consciousness; in shipwrecks

and survival history, 50% do not survive; shivering impaired

SEVERE HYPOTHERMIA
90

32

Heart rhythm irregularities, motor performance grossly impaired

88

31

Shivering stopped, failure to recognize familiar people

86

30

Muscles rigid, no response to pain

84

29

Loss of consciousness

80

27

Ventricular fibrillation (ineffective heartbeat), muscles flaccid

Effects of Cold
A diver experiencing any of the following
should terminate a dive and begin rewarming:
Loss of dexterity and grip strength
Difficulty performing routine tasks, confusion,
or repeating tasks or procedures
Intermittent shivering, even though routine
tasks can still be performed
Behavioral changes in a buddy that may
indicate existing or approaching hypothermia

First Aid for

Hypothermia
Severe hypothermia is life-threatening
and needs to be treated by trained
medical personnel
First aid includes:
Monitoring and addressing the divers ABCs
(airway, breathing, and circulation)
Handling the victim extremely gently
Preventing further heat loss
Activating EMS

Thermal Protection
A wetsuit does not stop heat loss, it merely
slows it
Diving in water temperature below 50oF
(10oC) usually requires a drysuit

Thermal Protection
Body fat, the bodys ability to generate
heat, the ability to constrict blood vessels
to the limbs to shunt and save heat,
physical conditioning, and regular cold
exposure are important contributors to
cold tolerance and protection

Prevention of
Hypothermia
Check air and water
temperature before
diving
Wear adequate
thermal protection for
conditions
After the dive, get out
of wet cloths
Move to a warm
protected area
Dry your hair

Wear a hat
Drink warm liquids
between dives
Be adequately
nourished, well
hydrated, and avoid
alcohol and caffeine
Repetitive dives
should not be made
until diver is
completely re-warmed

Prevention of
Hypothermia
For maximum cold water
performance, divers should swim in
cold water on a regular basis to
improve cold tolerance

Hyperthermia

Overheating &
Hyperthermia
Overheating can be problematic in
diving
A rise in core temperature of as little
as 7.5oF (3.2oC) will make most
people convulse
Thermal protection necessary for inwater exposures can complicate
normal thermal regulation leading to
serious hyperthermic conditions

Types of Heat Stress

Heat syncope The sudden loss of
consciousness due to heat
It is usually experienced by
individuals with prolonged exposure
to a hot environment to which they
are not acclimatized, or who have
been moving about in extreme heat
while dressed in heavy garments

Types of Heat Stress

Heat cramps A mild response to
heat stress in the form of muscle
cramps
Cramping usually occurs in the legs,
arms, or abdomen
Best treatment is rest, oral fluids,
cooling down, ice, and stretching and
massaging the muscles

Types of Heat Stress

Heat exhaustion A serious
problem in which hypovolemia (low
blood volume) results from fluid loss
Signs & Symptoms include profuse
sweating, nausea, vomiting, a weak and
rapid pulse, ataxia (lack of
coordination), low blood pressure,
headache, dizziness, altered mental
state, and general weakness

Types of Heat Stress

Heat exhaustion
Severe cases require intravenous (IV)
fluids, aggressive cooling, and medical
attention

Types of Heat Stress

Heat stroke A serious, life-threatening
emergency
The bodys capacity to cool itself has failed
The skin becomes hot and dry, core
temperature can soar above 105oF (40.8oC)
leading to convulsions, delirium, and coma
If unchecked, permanent brain damage or
death can occur

Types of Heat Stress

Heat stroke
Victims must be removed from the hot
environment, cooled aggressively, taken to an
emergency medical facility and given IV fluids

Overheating &
Hyperthermia
To reduce the risk of overheating:
Drink water and juices liberally and
before becoming thirsty
Avoid alcohol, coffee and other diuretics
Avoid drugs that increase susceptibility
to overheating

Overheating &
Hyperthermia
To reduce the risk of overheating:
Maintain good physical condition
Acclimate gradually
Minimize exposure by efficient pre-dive
preparations and cooling down as
needed

Thermal Stress Irrespective

of Ambient Temperature
Hypothermia and Hyperthermia can
occur irrespective of ambient
temperature
Monitor and address thermal issues
as soon as possible to have the best
chance of avoiding these conditions

Drugs and Diving

Prescription Drugs
The hyperbaric environment may
change how some drugs act in the
body
Specific concerns include:
How the body absorbs, metabolizes, and
excretes the drug

Prescription Drugs
The hyperbaric environment may
change how some drugs act in the
body
Specific concerns include:
Possible physical effects of the type of
breathing gas, increased density of the
gas, water temperature, and other
environmental factors

Prescription Drugs
The hyperbaric environment may
change how some drugs act in the
body
Specific concerns include:
Side effects; acceptable side effects on
the surface may lead to accidents if
experienced underwater

Prescription Drugs
Beta blockers, motion sickness
medications, antihistamines,
amphetamines, tranquilizers,
sedatives, hypertensive drugs, and
decongestants are commonly used,
but may affect a divers
performance, the ability to
thermoregulate, and diver safety

Prescription Drugs
Consult with a physician
knowledgeable in diving medicine
before diving while using prescription
drugs

Smoking
Cigarette smoke contains poisons
including hydrogen cyanide, nitrox
oxides, and carbon monoxide
Smoking has detrimental affects on
the respiratory and cardiovascular
systems that are undesirable in
diving

Smoking
Smoking reduces the oxygen
carrying capacity of the blood and
may predispose the diver to DCS
Smoking is not recommended and
should be discouraged

Illicit Drugs & Alcohol

Alcohol, barbiturates, and marijuana
are commonly abused nervous
system depressants
Depressed motor function is
hazardous underwater

Illicit Drugs & Alcohol

Cocaine and other commonly abused
CNS stimulants render a diver
incapable of properly responding to
an emergency, and can increase the
likelihood of an oxygen toxicity
seizure

Illicit Drugs & Alcohol

Alcohol is a diuretic and may accelerate
and multiply the effects of nitrogen
narcosis
Alcohol predisposes a diver to thermal
stress
There appears to be a relationship
between the number of drinks consumed
and the severity of DCS
You should not dive when under the
influence of alcohol or illicit drugs

Types of Heat Stress

Heat stroke A serious, life-threatening
emergency
The bodys capacity to cool itself has failed
The skin becomes hot and dry, core
temperature can soar above 105oF (40.8oC)
leading to convulsions, delirium, and coma
If unchecked, permanent brain damage or
death can occur
Victims must be removed from the hot
environment, cooled aggressively, taken to an
emergency medical facility and given IV fluids

Study Questions
Use the following study questions to
review some of the information
presented in this self study module
When you are finished you can print
out your study questions results

Self Study Questions

From a diving perspective the ________
are the last tissues to become
saturated with inert gas.
A.Bones
B.Muscles
C.Brain and spinal cord
D.Digestive system

Self Study Questions

From a diving perspective the ________
are the last tissues to become
saturated with inert gas.
A.Bones
B.Muscles
C.Brain and spinal cord
D.Digestive system

Self Study Questions

Match the body system with the basic function .
A.Musculoskeletal system
B.Nervous System
C.Digestive System
provides the structure around which the body
the body is formed; provides protection for
vital organs; causes movement by contracting
uses approximately 20% of the blood's
available oxygen supply
converts food to a form that can be
transported and utilized by the cells

Self Study Questions

Match the body system with the basic function .
A.Musculoskeletal system
B.Nervous System
C.Digestive System
provides the structure around which the body
the body is formed; provides protection for
vital organs; causes movement by contracting
uses approximately 20% of the blood's
available oxygen supply
converts food to a form that can be
transported and utilized by the cells

Self Study Questions

Match the body system with the basic function .
A.Musculoskeletal system
B.Nervous System
C.Digestive System
provides the structure around which the body
the body is formed; provides protection for
vital organs; causes movement by contracting
uses approximately 20% of the blood's
available oxygen supply
converts food to a form that can be
transported and utilized by the cells

Self Study Questions

Match the body system with the basic function .
A.Musculoskeletal system
B.Nervous System
C.Digestive System
provides the structure around which the body
the body is formed; provides protection for
vital organs; causes movement by contracting
uses approximately 20% of the blood's
available oxygen supply
converts food to a form that can be
transported and utilized by the cells

Self Study Questions

Respiration is the process of getting oxygen
into the body and carbon dioxide out.
Select the correct path of gas being
inhaled:
A. Nose/mouth, trachea, bronchi, bronchioles,
alveoli
B. Nose/mouth, bronchi, bronchioles, trachea,
alveoli
C. Nose/mouth, alveoli, trachea, bronchi,
bronchioles
D. Nose/mouth, trachea, alveoli, bronchi,
bronchioles

Self Study Questions

Respiration is the process of getting oxygen
into the body and carbon dioxide out.
Select the correct path of gas being
inhaled:
A. Nose/mouth, trachea, bronchi, bronchioles,
alveoli
B. Nose/mouth, bronchi, bronchioles, trachea,
alveoli
C. Nose/mouth, alveoli, trachea, bronchi,
bronchioles
D. Nose/mouth, trachea, alveoli, bronchi,
bronchioles

Self Study Questions

The lungs contain five lobes; three for
the right lung and two for the left.
A.True
B.False

Self Study Questions

The lungs contain five lobes; three for
the right lung and two for the left.
A.True
B.False

Self Study Questions

The single cell, semi-permeable, wall
separating _____ and capillary is
where the gas exchange between
lungs and blood flow takes place.
A.Alveoli
B.Bronchioles
C.Bronchi
D.Trachea

Self Study Questions

The single cell, semi-permeable, wall
separating _____ and capillary is
where the gas exchange between
lungs and blood flow takes place.
A.Alveoli
B.Bronchioles
C.Bronchi
D.Trachea

Self Study Questions

During the normal mechanics of
respiration the diaphragm _____ on
inhalation and _____ during
exhalation.
a.Contracts / relaxes
b.Relaxes / contracts
c.Pushes / pulls
d.Constricts / expands

Self Study Questions

During the normal mechanics of
respiration the diaphragm _____ on
inhalation and _____ during
exhalation.
a.Contracts / relaxes
b.Relaxes / contracts
c.Pushes / pulls
d.Constricts / expands

Self Study Questions

The need to breathe is controlled by
_____ levels in the body.
A.Carbon dioxide
B.Oxygen
C.Carbon monoxide
D.nitrogen

Self Study Questions

The need to breathe is controlled by
_____ levels in the body.
A.Carbon dioxide
B.Oxygen
C.Carbon monoxide
D.nitrogen

Self Study Questions

The ______ brings oxygenated blood
from the lungs to the heart.
a.Pulmonary vein
b.Pulmonary artery
c.Aorta
d.Superior vena cava

Self Study Questions

The ______ brings oxygenated blood
from the lungs to the heart.
a.Pulmonary vein
b.Pulmonary artery
c.Aorta
d.Superior vena cava

Self Study Questions

At sea level, about 98% of the oxygen
in the blood is carried by _____.
a.Hemoglobin
b.Plasma
c.Water
d.Carbon dioxide

Self Study Questions

At sea level, about 98% of the oxygen
in the blood is carried by _____.
a.Hemoglobin
b.Plasma
c.Water
d.Carbon dioxide

Self Study Questions

Most carbon dioxide reacts with water
in the blood cells and is transported
into bicarbonate ions, many of which
diffuse into the blood plasma for
transport to the lungs.
a.True
b.False

Self Study Questions

Most carbon dioxide reacts with water
in the blood cells and is transported
into bicarbonate ions, many of which
diffuse into the blood plasma for
transport to the lungs.
a.True
b.False

Self Study Questions

Oxygen and carbon dioxide diffuse
across tissues from areas of lower
concentration to areas of higher
concentration.
a.True
b.False

Self Study Questions

Oxygen and carbon dioxide diffuse
across tissues from areas of lower
concentration to areas of higher
concentration.
a.True
b.False

Self Study Questions

At rest, the body inhales approximately
_____ oxygen and exhales about _____
oxygen.
a.21% / 16%
b.25% / 10%
c.21% / 25%
d.21% /4%

Self Study Questions

At rest, the body inhales approximately
_____ oxygen and exhales about _____
oxygen.
a.21% / 16%
b.25% / 10%
c.21% / 25%
d.21% /4%

Self Study Questions

People who are aerobically fit are able
to deliver, extract, and use more
oxygen when exercising.
a.True
b.False

Self Study Questions

People who are aerobically fit are able
to deliver, extract, and use more
oxygen when exercising.
a.True
b.False

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Match the respiratory problem with its description.
a. Hypoxia
b. Hyperventilation
c. Hypercapnia
d. Shallow Water Blackout
e. Carbon Monoxide Poisoning
f. Lipoid Pneumonia

results when tissue oxygen pressure drops below normal from an

inadequate supply of oxygen
short term, rapid deep breathing beyond the need for the activity;
lowers carbon dioxide level in blood
occurs from too much carbon dioxide in the breathing gas, or
because carbon dioxide produced by the body is not eliminated
properly
falling ambient pressure during ascent reduces the partial
pressure of oxygen in the body; can cause unconsciousness
results from contamination of a scuba cylinder by fumes from the
exhaust of an internal combustion engine or partial combustion of
compressor lubricating oil
can result if a diver breaths gas containing suspended petroleum
vapor

Self Study Questions

Swallowing, yawing, or the Valsalva
Maneuver are acceptable methods to
equalize the pressure increase on the
middle ear experienced during
decent.
a.True
b.False

Self Study Questions

Swallowing, yawing, or the Valsalva
Maneuver are acceptable methods to
equalize the pressure increase on the
middle ear experienced during
decent.
a.True
b.False

Self Study Questions

Over the counter and prescription
drugs can open sinus passages with
no risk to diving situations.
a.True
b.False

Self Study Questions

Over the counter and prescription
drugs can open sinus passages with
no risk to diving situations.
a.True
b.False

Self Study Questions

On a breath-hold dive, the lungs
compress with increased depth. This
compression does not correlate
completely to the pressure-volume
relationship of Boyle's law.
a.True
b.False

Self Study Questions

On a breath-hold dive, the lungs
compress with increased depth. This
compression does not correlate
completely to the pressure-volume
relationship of Boyle's law.
a.True
b.False

Self Study Questions

An "eye squeeze" is caused by
negative pressure creating suction in
the mask when a diver descends
without equalization.
a.True
b.False

Self Study Questions

An "eye squeeze" is caused by
negative pressure creating suction in
the mask when a diver descends
without equalization.
a.True
b.False

Self Study Questions

To clear a reverse block, the diver
should Valsalva as they ascend.
a.True
b.False

Self Study Questions

To clear a reverse block, the diver
should Valsalva as they ascend.
a.True
b.False

Self Study Questions

Match the lung overexpansion injury with its signs and
symptoms.
a. Pneumothorax
b. Mediastinal Emphysema
c. Subcutaneous Emphysema
D. Arterial Gas Embolism
difficulty or rapid breathing; leaning toward the affected
side; deep breathing hurts; decreased or absent lung sounds
on affected side; death
pain under the sternum that may radiate to the neck,
collarbone, or shoulder; swelling around the neck; a brassy
quality to the voice; cough; deviation of the Adams apple to
the affected side
feeling of fullness in the neck area, swelling or inflation
around the neck and upper chest; crackling sensation when
skin is palpated; change in sound of voice; cough
chest pain; cough or shortness of breath; bloody, frothy
sputum; headache; visual disturbances; numbness or
tingling; weakness or paralysis; loss of, or change in,
sensation over part of the body; dizziness; confusion; sudden
unconsciousness, death

Self Study Questions

Match the lung overexpansion injury with its signs and
symptoms.
a. Pneumothorax
b. Mediastinal Emphysema
c. Subcutaneous Emphysema
D. Arterial Gas Embolism
difficulty or rapid breathing; leaning toward the affected
side; deep breathing hurts; decreased or absent lung sounds
on affected side; death
pain under the sternum that may radiate to the neck,
collarbone, or shoulder; swelling around the neck; a brassy
quality to the voice; cough; deviation of the Adams apple to
the affected side
feeling of fullness in the neck area, swelling or inflation
around the neck and upper chest; crackling sensation when
skin is palpated; change in sound of voice; cough
chest pain; cough or shortness of breath; bloody, frothy
sputum; headache; visual disturbances; numbness or
tingling; weakness or paralysis; loss of, or change in,
sensation over part of the body; dizziness; confusion; sudden
unconsciousness, death

Self Study Questions

Match the lung overexpansion injury with its signs and
symptoms.
a. Pneumothorax
b. Mediastinal Emphysema
c. Subcutaneous Emphysema
D. Arterial Gas Embolism
difficulty or rapid breathing; leaning toward the affected
side; deep breathing hurts; decreased or absent lung sounds
on affected side; death
pain under the sternum that may radiate to the neck,
collarbone, or shoulder; swelling around the neck; a brassy
quality to the voice; cough; deviation of the Adams apple to
the affected side
feeling of fullness in the neck area, swelling or inflation
around the neck and upper chest; crackling sensation when
skin is palpated; change in sound of voice; cough
chest pain; cough or shortness of breath; bloody, frothy
sputum; headache; visual disturbances; numbness or
tingling; weakness or paralysis; loss of, or change in,
sensation over part of the body; dizziness; confusion; sudden
unconsciousness, death

Self Study Questions

Match the lung overexpansion injury with its signs and
symptoms.
a. Pneumothorax
b. Mediastinal Emphysema
c. Subcutaneous Emphysema
D. Arterial Gas Embolism
difficulty or rapid breathing; leaning toward the affected
side; deep breathing hurts; decreased or absent lung sounds
on affected side; death
pain under the sternum that may radiate to the neck,
collarbone, or shoulder; swelling around the neck; a brassy
quality to the voice; cough; deviation of the Adams apple to
the affected side
feeling of fullness in the neck area, swelling or inflation
around the neck and upper chest; crackling sensation when
skin is palpated; change in sound of voice; cough
chest pain; cough or shortness of breath; bloody, frothy
sputum; headache; visual disturbances; numbness or
tingling; weakness or paralysis; loss of, or change in,
sensation over part of the body; dizziness; confusion; sudden
unconsciousness, death

Self Study Questions

Match the lung overexpansion injury with its signs and
symptoms.
a. Pneumothorax
b. Mediastinal Emphysema
c. Subcutaneous Emphysema
D. Arterial Gas Embolism
difficulty or rapid breathing; leaning toward the affected
side; deep breathing hurts; decreased or absent lung sounds
on affected side; death
pain under the sternum that may radiate to the neck,
collarbone, or shoulder; swelling around the neck; a brassy
quality to the voice; cough; deviation of the Adams apple to
the affected side
feeling of fullness in the neck area, swelling or inflation
around the neck and upper chest; crackling sensation when
skin is palpated; change in sound of voice; cough
chest pain; cough or shortness of breath; bloody, frothy
sputum; headache; visual disturbances; numbness or
tingling; weakness or paralysis; loss of, or change in,
sensation over part of the body; dizziness; confusion; sudden
unconsciousness, death

Self Study Questions

The treatment common to all lung
overexpansion injuries is:
a. administrator 100% oxygen
B. recompression in a chamber
c. place the diver in a sitting position
d. administer fluids by mouth

Self Study Questions

The treatment common to all lung
overexpansion injuries is:
a. administrator 100% oxygen
B. recompression in a chamber
c. place the diver in a sitting position
d. administer fluids by mouth

Self Study Questions

There are ways to minimize the risk of lung
overexpansion injuries while diving. Select all
that apply. There are at least four correct
answers.
a. Never hold your breath when diving compressed
gasses
b. Ascend slowly while breathing normally
c. Don't dive with a chest cold or obstructed air
passages
d. Carry sufficient quantities of gas to complete
the dive
e. Ascend at 30 feet per minute or slower
f. skip breathing
g. use of antihistamines
h. not exceeding your planned dive time

Self Study Questions

There are ways to minimize the risk of lung
overexpansion injuries while diving. Select all
that apply. There are at least four correct
answers.
a. Never hold your breath when diving compressed
gasses
b. Ascend slowly while breathing normally
c. Don't dive with a chest cold or obstructed air
passages
d. Carry sufficient quantities of gas to complete
the dive
e. Ascend at 30 feet per minute or slower
f. skip breathing
g. use of antihistamines
h. not exceeding your planned dive time

Self Study Questions

Match the indirect effect of pressure with its description.
a. Inert Gas Narcosis
b. High Pressure Nervous Syndrome
c. CNS Oxygen Toxicity
d. Whole-Body Oxygen Toxicity

a state of altered mental function ranging from mild

impairment of judgment or euphoria, to complete loss
of consciousness, produced by exposure to increased
partial pressure of nitrogen and certain other gases
occurs at depths greater than 400 fsw (123 msw);
characterized by dizziness, nausea, vomiting;
twitching, decrements to performance, and poor sleep
with nightmares
an epileptic-like convulsion resulting from exposure to
high partial pressures of oxygen (typically above 1.6
atm)
a slow developing condition resulting from exposure to
above normal partial pressures of oxygen

Self Study Questions

Match the indirect effect of pressure with its description.
a. Inert Gas Narcosis
b. High Pressure Nervous Syndrome
c. CNS Oxygen Toxicity
d. Whole-Body Oxygen Toxicity

a state of altered mental function ranging from mild

impairment of judgment or euphoria, to complete loss
of consciousness, produced by exposure to increased
partial pressure of nitrogen and certain other gases
occurs at depths greater than 400 fsw (123 msw);
characterized by dizziness, nausea, vomiting;
twitching, decrements to performance, and poor sleep
with nightmares
an epileptic-like convulsion resulting from exposure to
high partial pressures of oxygen (typically above 1.6
atm)
a slow developing condition resulting from exposure to
above normal partial pressures of oxygen

Self Study Questions

Match the indirect effect of pressure with its description.
a. Inert Gas Narcosis
b. High Pressure Nervous Syndrome
c. CNS Oxygen Toxicity
d. Whole-Body Oxygen Toxicity

a state of altered mental function ranging from mild

impairment of judgment or euphoria, to complete loss
of consciousness, produced by exposure to increased
partial pressure of nitrogen and certain other gases
occurs at depths greater than 400 fsw (123 msw);
characterized by dizziness, nausea, vomiting;
twitching, decrements to performance, and poor sleep
with nightmares
an epileptic-like convulsion resulting from exposure to
high partial pressures of oxygen (typically above 1.6
atm)
a slow developing condition resulting from exposure to
above normal partial pressures of oxygen

Self Study Questions

Match the indirect effect of pressure with its description.
a. Inert Gas Narcosis
b. High Pressure Nervous Syndrome
c. CNS Oxygen Toxicity
d. Whole-Body Oxygen Toxicity

a state of altered mental function ranging from mild

impairment of judgment or euphoria, to complete loss
of consciousness, produced by exposure to increased
partial pressure of nitrogen and certain other gases
occurs at depths greater than 400 fsw (123 msw);
characterized by dizziness, nausea, vomiting;
twitching, decrements to performance, and poor sleep
with nightmares
an epileptic-like convulsion resulting from exposure to
high partial pressures of oxygen (typically above 1.6
atm)
a slow developing condition resulting from exposure to
above normal partial pressures of oxygen

Self Study Questions

Match the indirect effect of pressure with its description.
a. Inert Gas Narcosis
b. High Pressure Nervous Syndrome
c. CNS Oxygen Toxicity
d. Whole-Body Oxygen Toxicity

a state of altered mental function ranging from mild

impairment of judgment or euphoria, to complete loss
of consciousness, produced by exposure to increased
partial pressure of nitrogen and certain other gases
occurs at depths greater than 400 fsw (123 msw);
characterized by dizziness, nausea, vomiting;
twitching, decrements to performance, and poor sleep
with nightmares
an epileptic-like convulsion resulting from exposure to
high partial pressures of oxygen (typically above 1.6
atm)
a slow developing condition resulting from exposure to
above normal partial pressures of oxygen

Self Study Questions

The speed at which a given tissue
group absorbs or eliminates an inert
gas is dependent on the blood supply
and makeup of the tissue.
a.True
b.False

Self Study Questions

The speed at which a given tissue
group absorbs or eliminates an inert
gas is dependent on the blood supply
and makeup of the tissue.
a.True
b.False

Self Study Questions

On ascent, the diver's tissues,
especially slow compartments, may
continue to absorb nitrogen.
a.True
b.False

Self Study Questions

On ascent, the diver's tissues,
especially slow compartments, may
continue to absorb nitrogen.
a.True
b.False

Self Study Questions

Adhering to accepted decompression
limits and proper ascent rates is
guarantee to avoiding
decompression sickness.
a.True
b.False

Self Study Questions

Adhering to accepted decompression
limits and proper ascent rates is
guarantee to avoiding
decompression sickness.
a.True
b.False

Self Study Questions

While you can do everything correctly and still suffer
DCS, prevention can be enhanced if you: (Select all
that apply. There are at least 5 correct answers.)
Ascend slowly (30 feet per minute)
Make safety stops
Use longer surface intervals
Plan the dive, dive the plan, and have a backup
plan
Maintain good physical fitness, nutrition, and
hydration
Use a dive computer rather than dive tables
Avoid "reverse profile dives" at all cost
Exercise post dive

Self Study Questions

While you can do everything correctly and still suffer
DCS, prevention can be enhanced if you: (Select all
that apply. There are at least 5 correct answers.)
Ascend slowly (30 feet per minute)
Make safety stops
Use longer surface intervals
Plan the dive, dive the plan, and have a backup
plan
Maintain good physical fitness, nutrition, and
hydration
Use a dive computer rather than dive tables
Avoid "reverse profile dives" at all cost
Exercise post dive

Self Study Questions

Aseptic Bone Necrosis is an
occupational hazard of professional
divers and others exposed to
hyperbaric stresses. The _____ and
_____ are most often affected.
hip / shoulder
elbow / wrist
ankles / long bone shafts
knee / vertebra

Self Study Questions

Aseptic Bone Necrosis is an
occupational hazard of professional
divers and others exposed to
hyperbaric stresses. The _____ and
_____ are most often affected.
hip / shoulder
elbow / wrist
ankles / long bone shafts
knee / vertebra

Self Study Questions

It is estimated _____ is present in 20-30% of the
general population. This condition can cause
severe problems for affected divers by allowing
bubbles accumulated during a dive to be shunted
from one side of the heart to the other, bypassing
the lungs.
Patent Foramen Oval (PFO)
Arterial Gas Embolism (AGE)
Capillary Bed Lesions (CBL)
Mitral Valve Defect

Self Study Questions

It is estimated _____ is present in 20-30% of the
general population. This condition can cause
severe problems for affected divers by allowing
bubbles accumulated during a dive to be shunted
from one side of the heart to the other, bypassing
the lungs.
Patent Foramen Oval (PFO)
Arterial Gas Embolism (AGE)
Capillary Bed Lesions (CBL)
Mitral Valve Defect

Self Study Questions

Women should not dive during
pregnancy.
a.True
b.False

Self Study Questions

Women should not dive during
pregnancy.
a.True
b.False

Self Study Questions

Select all that apply to hypothermia.
susceptibility increases with dehydration,
fatigue, hunger, and illness
susceptibility increases if you are out of
shape, underweight, a smoker, or using
drugs or alcohol
keeping your wetsuit on between dives is
a good prevention strategy
minimize exposure by efficient pre-dive
preparations and cooling down as needed

Self Study Questions

Select all that apply to hypothermia.
susceptibility increases with dehydration,
fatigue, hunger, and illness
susceptibility increases if you are out of
shape, underweight, a smoker, or using
drugs or alcohol
keeping your wetsuit on between dives is
a good prevention strategy
minimize exposure by efficient pre-dive
preparations and cooling down as needed

Self Study Questions

Hypothermia and Hyperthermia can
occur irrespective of ambient
temperature.
a.True
b.False

Self Study Questions

Hypothermia and Hyperthermia can
occur irrespective of ambient
temperature.
a.True
b.False

Self Study Questions

Beta blockers, motion sickness
medications, and antihistamines
have been shown to have no affect
on diver performance, the ability to
thermoregulate, or diver safety.
a.True
b.False

Self Study Questions

Beta blockers, motion sickness
medications, and antihistamines
have been shown to have no affect
on diver performance, the ability to
thermoregulate, or diver safety.
a.True
b.False

Self Study Questions

Smoking reduces the oxygen carrying
capacity of the blood and may
predispose the diver to DCS.
A.True
B.False

Self Study Questions

Smoking reduces the oxygen carrying
capacity of the blood and may
predispose the diver to DCS.
A.True
B.False

Self Study Questions

Alcohol protects a diver from thermal
stress.
a.True
b.False

Self Study Questions

Alcohol protects a diver from thermal
stress.
a.True
b.False