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SHARKY'S DIVE MALADIES
AND DIVING ACCIDENT MANAGEMENTA Review From Sharky's DivePlease take a minute and sign our Log Book
BAROTRAUMA: Any injury resulting from unequal pressure. The tissues of the body are made of incompressible water. Under water the inside and outside pressure of the body must be equal, including all air spaces. If these spaces are not equalized a pressure SQUEEZE develops, causing damage in that area. A. EAR BAROTRAUMAS: 1. MIDDLE EAR BAROTRAUMA Air must flow freely through the Eustachian tubes within the inner ear to allow equalization. Effects of unequal pressure on the eardrum will cause BAROTRAUMAS. Caused on descent by inadequate equalization due to: Poor equalizing technique Diving with a cold, hay fever or flu Rapid descent Caused on ascent by: Rapid ascent SYMPTOMS:
TREATMENT:
PREVENTION: Equalize ear pressure by forcing air, at ambient pressure, from the throat through the eustatian tube(s), by the use of the Valsalva or Frenzel Maneuver. NOTE: If dizziness, hearing loss or ringing continues, consult a diving doctor immediately. 2. EXTERNAL EAR BAROTRAUMA Caused on descent by: Tight hood Blocked outer ear canal Mask SYMPTOMS: Ear pain, not relieved by equalization Bleeding or Discharge from the ear(s) TREATMENT: Surface and exit water Pack affected ear(s) with cotton Consult a physician PREVENTION: Never dive if you are having a problem equalizing the middle ear. 3. INNER EAR BAROTRAUMA Caused by the forceful clearing of ears SYMPTOMS:
TREATMENT: Sit down and keep still and quite Avoid exertion, coughing, sneezing, bending over and further attempts to clear the ears. Consult diving doctor; Ear, Nose and Throat Specialist immediately. PREVENTION: Avoid forcefully equalizing your ears 4. REVERSE SQUEEZE Caused by failure of air to exit via the Eustachian tubes on ascent. The use of nasal decongestants is the most common cause of this condition, because they allow the diver to equalize on descent with a cold or allergy yet frequently wear off while he/she is diving. SYMPTOMS: Same as Middle Ear BAROTRAUMA TREATMENT: Reverse equalization- pinching the nose and inhaling against it. PREVENTION: Avoid diving with a cold or allergy. Avoid the use of decongestants for diving . 5. ROUND-WINDOW RUPTURE Rupture of the round window on the cochlea occurs if a diver delays equalization. The round window in the divers ear bulges outward in response to the pressure transmitted to the cochlea. If the diver makes a forceful or lengthy Valsalva at the same time, the perilymph pressure increases to the point that it causes the round window to rupture. SYMPTOMS:
TREATMENT: IMMEDIATELY: seek medical treatment, preferably by an Otolaryngologist NOTE: Failure to seek medical attention can lead to permanent hearing reduction or deafness in the affected ear, which may also affect balance. 6. OTITUS EXTERNAL (SWIMMER'S EAR) Although not actually a form of barotrauma, swimmer's ear is probably the most common ear problem of divers. Caused by the pH of the ear canal becoming alkaline instead of acidic due to repeated exposure to water and humidity. SYMPTOMS:
TREATMENT: * Flush the ear canal with a Solution prepared with Isopropyl Alcohol. Many products are available from your dive store or pharmacy. If Severe: Consult an Otolaryngologist because often a fungal infection can hide in the ear.
PREVENTION:
A DIVER SHOULD NEVER DIVE WITH A COLD. B. SINUS BAROTRAUMA 1. SINUS SQUEEZE Equalization difficulties caused by diving with a cold or allergy. Diving with blocked sinuses will cause pressure to push in on trapped air pockets, which may or may not be felt. SYMPTOMS:
TREATMENT: Sinus squeeze usually requires little or no medical treatment,unless accompanied by severe or extended pain. PREVENTION:
2. CAROTID SINUS SYNDROME Caused by a tight fitting wetsuit top exerting excess pressure on the neck. SYMPTOMS:
TREATMENT: Loosen or remove the wetsuit top. 3. SINUS BAROTRAUMA Caused by equalization problems due to nasal congestion or anatomical deformity. SYMPTOMS:
TREATMENT:
PREVENTION: Avoid diving with a cold or allergy C. TOOTH SQUEEZE: Caused by an air pocket becoming trapped under a tooth, filling and/or caps. SYMPTOMS:
TREATMENT:
PREVENTION: Make sure your dentist knows you are a diver so he/she can make sure to pack the filling(s) so there are no air spaces. D. PULMONARY BAROTRAUMA Caused by a diver holding his/her breath on ascent Rapid ascent with inadequate exhalation Trapping of air in lungs due to asthma, mucous, water inhalation, laryngeal spasm, common cold or cough. SYMPTOMS:
TREATMENT:
Note 1. Arrange a consultation between the attending medical person and a dive doctor. Note 2. The patient should receive medical treatment even if he appears to return to normal. Doctor Note: Insert a chest drain for tension pneumothorax if indicated. 1. THORACIC (LUNG) SQUEEZE Occurs when the lungs are compressed smaller than their risidual volume. If the lungs are compressed past their residual volume, compression can produce injury,but this requires a breath-hold dive to extreme depths, if a diver descends with full lungs. 2. LUNG RUPTURE: Over expansion of the lungs which causes alveoli, or small air sacs, to rupture allowing air to escape into other parts of the body. Alveoli are extremely fragile and can only withstand a pressure change of about 2 to 3 PSI (approximately four to six feet of water). As the diver ascends the outside pressure reduces allowing the air in the lungs to expand. . * If you should hold your breath while ascending this expanding air will escape into other parts of the body. 3. ESCAPING AIR CAUSE THE FOLLOWING 1. CEREBRAL AIR EMBOLISM: Air bubbles forced into the blood stream form the ruptured alveoli, finds its way to the brain and blocks all blood flow to the brain. SYMPTOMS: (USUALLY NO WARNING) Sudden unconsciousness-Dizziness-Distortion of vision- paralysis-blood froth at the mouth. TREATMENT: IMMEDIATE Recompression Chamber. PREVENTION: Never hold breath on ascent. Breath normally throughout ascent. 2. MEDIASTINAL EMPHYSEMA: Air forced into the tissue and spaces in the middle of the chest surrounding the heart. SYMPTOMS: Pain in chest, trouble in breathing, trouble in swallowing - Shock restriction of blood flow and blueness of skin. TREATMENT: Recompression chamber if of degree otherwise, rest and general medical care. PREVENTION: Never hold breath on ascent. Breath normally throughout ascent. 3. SUBCUTANEOUS EMPHYSEMA: Caused by air escaping and collecting under the skin usually in the neck. SYMPTOMS: This can affect breathing, blood flow. The neck usually swells with difficulty in speaking and swallowing. TREATMENT: Trapped air may possible be removed by needle: But in most cases you would have a mediastinal emphysema. Treatment the same as Mediastinal emphysema. PREVENTION: Never hold breath on ascent. Breath normally throughout ascent. 4. PNEUMOTHOROX: Air in the spaces between the lungs and the lining of the chest wall on either side. SYMPTOMS: Pain and difficulty in breathing rapid, shallow breathing, blueness of skin. TREATMENT: Recompression chamber and air removed with a needle. PREVENTION: Never hold breath on ascent - breath normally throughout ascent. 5. GASTROINESTINAL BAROTRAUMA (INTESTINE SQUEEZE) A scuba diver will develop some excess gas in the stomach and intestines. this can happen from swallowing to much air while equalizing, or by eating gas forming foods prior to diving,Equalizing ears when swimming head down. The gases form under pressure and as the diver ascends the pressure drops and the gases expand. Normally this will vent off by natural processes. SYMPTOMS: Stomach Pain/Cramps Burping Flatulence Sometimes difficulty breathing. TREATMENT: Stop the ascent Release the gas Continue ascent when comfortable. F. FACE MASK SQUEEZE: During descent face mask will feel as if it is being pushed into face. This is caused by relative vacuum inside the mask. SYMPTOMS: Pain, blood shot or blackened eyes(bleeding behind eyes.) (SEVERE CASES) PREVENTION: Exhale lightly through the nose until ambient and mask pressures balance. G. INDIRECT EFFECTS OF PRESSURE 1. ANOXIA OR HYPOXIA: Lack of sufficient oxygen in the tissues. Skin Divers: Holding breath to long. Scuba Divers: Skip breathing. SYMPTOMS: Unconsciousness, Cyanosis (blueness) TREATMENT: Restore normal air supply, mouth to mouth respiration if breathing has stopped. PREVENTION: Do not hyperventilate or skip breath - breath normal. 2. CARBON DIOXIDE TOXICITY (CO2) Interference with normal eliminator of CO2. Skin Diver-Holding breath to long. Scuba Diver- Skip breathing. Faulty regulator Tight wetsuit Exertion Contamination of the air supply (rare) SYMPTOMS: Rapid breathing Headache Dizziness Nausea Vomiting Confusion Flushed appearance TREATMENT: Cease movement Breathe normally Oxygen if available Expect rapid improvement PREVENTION: Practice good breathing techniques. 3.CARBON MONOXIDE {CO} Caused by CO in the air your breathing (Causes) These ways:
SYMPTOMS: Same as Anoxia. Redness under finger. TREATMENT: Same as Anoxia. PREVENTION: Know your air source: get air form a reputable dive shop. 4. OXYGEN EXCESS (O2) POISONING: Caused by excessive partial pressure of Oxygen (Below 296 ft. with scuba) or around 30 feet and below on pure Oxygen. SYMPTOMS: Convulsions - unconsciousness (Without Warning). TREATMENT: Prevent injury during convulsion restore fresh air. (DO NOT GIVE O2) PREVENTION: Never use pure Oxygen in diving tanks. Never dive below 296 feet with scuba. 5. NITROGEN NARCOSIS (N2) RUPTURE OF THE DEEP: When breathing under pressure nitrogen has an intoxicating effect.The effect will be experienced by all divers breathing air at depths in excess of 100 feet (30m), although some will notice the effect at shallower depths. it increases with depth but is readily reversed on ascent. SYMPTOMS:
TREATMENT: Protect the diver from injury until ascent is sufficient to eliminate the narcosis. NOTE: If the symptoms persist after the ascent to the surface the cause is something other than narcosis. 6. DECOMPRESSION SICKNESS: (Bends) Decompression sickness is caused by the presence of nitrogen in our bodies.It other occurs when decompression tables have been exceeded but CAN OCCUR EVEN ON DIVERS THAT ARE WITHIN THE NO DECOMPRESSION LIMITS. The following predisposing factors will increase a person's likelihood of getting decompression sickness even if the tables are followed correctly. Age - risk increases with age Obesity Lack of fitness Exercise before,during or after the dive Ingestion of alcohol or various drugs and medication before the dive Cold water Illness or injury Fatigue Dehydration Decompression diving Repetitive diving Flying after diving NOTE: With current understanding it is impossible to identify an "at risk dive" therefore never exclude decompression sickness because of what is conventionally believed to be a safe dive. SYMPTOMS: Although these usually occur within six hours of diving they may develop 24 to 36 hours after the dive. The most frequent symptoms of decompression sickness are malaise(feeling unwell) and lethargy. Although lethargy by itself is not a treatable symptom, a person suffering from extreme fatigue should be observed for other symptoms. Although the symptoms of decompression sickness often disappear they may have serious implications (e.g.bone necrosis) . Common: Chest,torso or back pain Lethargy Malaise Numbness Pain/discomfort at or near a joint Tingling sensations Weakness OTHER: Blood in stools, Blotchy skin Confusion Convulsions, Coughing, Difficulty passing urine, Dizziness Headaches Hearing loss Incoordination/ Itch Loss of balance, Nausea Paralysis Rash Ringing in the ear Shortness of breath Unconsciousness Visual disturbances. Loss of bladder/bowel control. TREATMENT:
WARNING: DO NOT RETURN PATIENT TO THE WATER. PREVENTION: Staying within the no decompression limits and assenting at a rate of 60 F.P.M. (Flying after diving) Do Not fly for 12 hours after diving. STUDY & KNOW your decompression tables and use them. H. HEART ATTACK: Predisposing factors: Over exertion,High blood pressure,History of heart disease,Family history of heart disease,Heavy smoking,Obesity, Diabetes ect. SYMPTOMS:
TREATMENT: Unconscious patient Conscious patient: Sit the patient up if short of breath Give oxygen Monitor the airway, Breathing and pulse Medical assistance I. HEAT EXHAUSTION: CAUSE: Exposure to high temperatures and wearing a wetsuit in the tropics. SYMPTOMS: Rapid pulse Headache Pale skin Excessive sweating Hot dry skin Cramps Faintness TREATMENT: Transfer the patient to cool surroundings Remove the patient's excess clothing Sponge the patient with cool water Treat for shock Medical advice J. HYPOTHERMIA: Cooling of the body core temperature. SYMPTOMS: MILD: Numbness Blotchy skin Pallor,Blueness of extremities Shivering SEVERE: Uncontrollable shivering No shivering in spite of being very cold Incoordination Confusion,Weakness Apathy, Irritability,Slurred speech Muscle rigidity Unconsciousness Heart irregularities Death TREATMENT: MILD: * Remove the patient's wetsuit and replace it with dry clothing or dry covering of some kind. * Insulate the patient from the cold. * Place hot water bottles/heat packs in the groin,under the armpits and around the head,chest and neck. * Warm drinks (See Note 2) SEVERE:
NOTE: 1 A. If the patient is semi-conscious,unconscious,or if you are near a medical facility, do not rewarm the field. B. Gentle rewarming is for alert, conscious persons when you are a great distance form a medical facility. C. Resuscitation must never be stopped until the body core temperature has returned to normal(98.6'F,37'C) NOTE: 2 A. No coffee or alcohol B. Warm fluids can be given only after uncontrollable shivering stops and the victim has a clear level of consciousness and the ability to swallow. k. HYPOXIA IN BREATH HOLD DIVING: CAUSE: Hyperventilation before a breath hold dive. Deep breath hold diving. SYMPTOMS: Sudden unconsciousness during ascent or immediately after surfacing. TREATMENT:
L. NEAR DROWNING: Cause: Inhalation of fluids SYMPTOMS:
TREATMENT:
IF PATIENT UNCONSCIOUS: IF PATIENT CONSCIOUS Administer oxygen Treat for shock Send for ambulance Patient must go to hospital M. SALT WATER ASPIRATION SYNDROME: Cause: Inhalation of a fine mist of water vapor due to: Faulty regulator Inadequate mouthpiece seal Inadequate purging of regulator SYMPTOMS: Immediate cough Possibly a latent period then: Shortness of breath Chest pain Coughing Cyanosis Uncontrollable shivering Hot and cold flushes/fever Rapid pulse Nausea, Vomiting Aches TREATMENT: Administer oxygen (should cause rapid improvement) Keep warm Give analgesics as directed Discourage unnecessary movement Medical advice Patient must go to hospital WARNING: Symptoms of salt water aspiration syndrome may be similar to those of pulmonary barotrauma. If in doubt,treat as the latter. N. SHOCK Cause: Reduction in effective circulation due to decompression sickness,haemorrage,injury,infection illness,burns,dehydration,vomiting,diarrhoea,fright anxiety or emotional distress . May be associated with any other injury,illness or emotional upset. SYMPTOMS: Cold
TREATMENT:
O. OMITTED OR INTERRUPTED DECOMPRESSION: If required decompression stops have not been completed due to lack of air,or due to equipment failure, and recompression facilities are not close at hand the diver is advised to complete one of the following provided that.
WARNING: 1. These are not treatment tables and should not be used if the diver is displaying sings/symptoms of decompression sickness. (See Note) 2. If you originally used U.S.N. tables,use U.S.N. Omitted Decompression Schedule,as below. 3. The Omitted Decompression Schedule have a decompression sickness incidence in excess of 3% UNITED STATES NAVY OMITTED OR INTERRUPTED DECOMPRESSION
ALTERNATIVE PROCEDURE: While waiting for definitive treatment administer 100% oxygen (on the surface) and fluids. NOTE: If symptoms are present medical assistance. CROSS REFERENCE OF SINGS AND SYMPTOMS Possible Problem: ACHES Decompression sickness, Ear Barotrauma, Murine animals injury, Salt water aspiration ANXIETY Nitrogen narcosis, Shock APATHY Decompression sickness, Heat exhaustion, Hypothermia, Shock BITE Small: Fish, Sea snake Large: Shark, Barracuda, Moray eel,Boat propeller BLEEDING/BLOOD Blister: Cone shell sting From Ears: Ear Barotrauma From Mouth: Dental Barotrauma,Ear Barotrauma, Pulmonary Barotrauma, Sinus Barotrauma From Nose: Ear Barotrauma, Sinus Barotrauma In Sputum: Near Drowning, Pulmonary Barotrauma Sinus Barotrauma. BLOTCHY SKIN Decompression Sickness, Hypothermia, Sting. BLUE LIPS/BLUE SKIN Carbon Monoxide Toxicity, Heart Attack, Hypothermia Near Drowning, Pulmonary Barotrauma. BREATHING DIFFICULTY Carbon Dioxide Toxicity,Carbon Monoxide Toxicity, Decompression Sickness, Heart Attack, Near Drowning, Pulmonary Barotrauma, Salt water Aspiration,Sea Snake BRUISED FACE Facial Barotrauma, Rubber Allergy (mask) CHEST PAIN Decompression Sickness, Heart Attach, Pulmonary Barotrauma, Salt Water Aspiration COLD/HOT flushes Near Drowning, Salt Water Aspiration Syndrome COLD,CLAMMY SKIN Shock COLD SKIN Hypothermia CONVULSIONS Arterial gas embolism, Decompression sickness. CONFUSION Arterial Gas Embolism, Carbon Monoxide Poisoning Carotid Sinus Syndrome, Decompression Sickness, Hypothermia, Nitrogen Narcosis (If symptoms only occurs at depth), Pulmonary Barotrauma, Shock. COUGHING Decompression Sickness, Near Drowning, Pulmonary Barotrauma, Salt Water Aspiration CRACKLY OR CRUNCHY SKIN WHEN CHEST,NECK OR THROAT AREA IS FELT WITH FINGERTIPS. Pulmonary Barotrauma. CRAMPS IN STOMACH Decompression Sickness, Heat Exhaustion Gastrointestinal Barotrauma. CRY,GASPING,GRUNTING,on surfacing Arterial Gas Embolism CYANOSIS (Blueness) Carbon Monoxide Toxicity, Decompression Sickness, Heart Attack, Hypothermia, Near Drowning, Pulmonary Barotrauma. DEAFNESS Decompression Sickness, Ear Barotrauma DIFFICULTY SWALLOWING Arterial Gas Embolism,Decompression Sickness, Pulmonary Barotrauma. DIZZINESS Alternobaric Vertigo, Arterial Gas Embolism, Carbon Dioxide Toxicity, Carbon Monoxide Toxicity, Carotid Sinus Syndrome, Decompression Sickness Ear Barotrauma, Shock. EAR PAIN Ear Barotrauma, 'Tight Jaw' (i.e.clamping on mouthpiece to hard, too long) EQUALIZING DIFFICULTY Ear Barotrauma FAINTING FLUSHED APPEARANCE Carbon Dioxide Toxicity, Carbon Monoxide Toxicity Heat Exhaustion FLUID FROM EAR Ear Barotrauma, Fractured skull FROTH FROM MOUTH Decompression Sickness, Near Drowning, Pulmonary Barotrauma FULLNESS IN THROAT Pulmonary Barotrauma HALLUCINATIONS Drug/Medication, Nitrogen Narcosis (If symptoms occurs only at depth) HEADACHE Arterial gas Embolism, Carbon Dioxide Toxicity Carbon Monoxide Toxicity, Cold Water (No hood). Decompression Sickness, Heat Exhaustion, 'Tight Jaw' (i.e.Clamping on mouthpiece too hard,too long) Sinus Barotrauma HEARING LOSS See Deafness HEART IRREGULARITY Arterial Gas Embolism, Carotid Sinus Syndrome, Decompression Sickness, Decongestants (e.g.Pseudoephedrine), Heart Attach, Heat Exhaustion, Hypothermia. Pulmonary Barotrauma, Shock HOT FLUSHES Salt Water Aspiration Syndrome INCOORDINATION Arterial Gas Embolism, Decompression Sickness, Hypothermia, Nitrogen Narcosis(If symptoms occurs only at depth) ITCHING Decompression Sickness, Marine Stings, Wetsuit allergy/squeeze JOINT PAIN Decompression Sickness, Traumatic injury LEANING TO ONE SIDE Arterial Gas Embolism,Decompression Sickness, Ear Barotrauma, Pulmonary Barotrauma. LIGHT HEADED Arterial Gas Embolism, Decompression Sickness, Ear Barotrauma, Nitrogen Narcosis (If symptoms occurs only at depth) MEMORY LOSS Arterial Gas Embolism, Carbon Monoxide Toxicity, Decompression Sickness, Nitrogen Narcosis(If symptoms occurs only at depth MUSCULAR CONVULSIONS Arterial Gas Embolism, Decompression Sickness MUSCULAR PARALYSIS Cone Shell, Decompression Sickness,Pulmonary Barotrauma, Sea Snake. MAUSEA Carbon Dioxide Toxicity, Carbon Monoxide Toxicity, Decompression Sickness,Ear Barotrauma, Fish stings, Gastrointestinal Barotrauma, Shock,Salt Water Aspiration NUMBNESS Arterial Gas Embolism, Cone Shell, Decompression Sickness, Hypothermia, Sea Snake PAIN BACK &/or NECK: Possible causes include: Decompression sickness, Muscle Strain EARS: Ear Barotrauma HEADACHE: Arterial Gas Embolism, Carbon Dioxide Toxicity Carbon Monoxide Toxicity Decompression Sickness Sinus Barotrauma JOINTS: Decompression Sickness STOMACH: Decompression Sickness Gastrointestinal Barotrauma TEETH: Dental Barotrauma Sinus Barotrauma URINARY: Decompression Sickness PAIL SKIN Heat Exhaustion, Hypothermia, Shock PARALYSIS Arterial Gas Embolism, Cone Shell, Decompression Sickness, Sea Snake PINS AND NEEDLES Arterial Gas Embolism, Decompression Sickness Hyperventilation PULSE RAPID AND WEAK: Shock, Heat Exhaustion SLOW AND WEAK: Carotid Sinus Syndrome, Hypothermia PUNCTURE MARKS Cone Shell, Fish Sting, Sea Snake RAPID PULSE Heat Exhaustion, Shock RASH Decompression Sickness, Hydroid Sting, Jellyfish Sting Wetsuit Allergy RED EYES Facial Barotrauma, (Mask Squeeze) RED LIPS Rubber Allergy (Mouthpiece) RINGING EARS Decompression Sickness, Ear Barotrauma SHIVERING Hypothermia, Salt Water Aspiration Syndrome, Shock SHORT OF BREATH Carbon Dioxide Toxicity, Carbon Monoxide Toxicity, Decompression Sickness, Heart Attach, Near Drowning, Pulmonary Barotrauma, Salt Water Aspiration Syndrome, Sea Snake Bite, Shock SHOCK SKIN (COLD) Hypothermia, Shock SLOW PULSE Carotid Sinus Syndrome, Hypothermia SPEECH DIFFICULTY Arterial Gas Embolism, Decompression Sickness, Hypothermia STIFFNESS IN LIMBS Decompression Sickness, Hypothermia STINGING SENSATION Marine Stings STOMACH CRAMPS Decompression Sickness, Heat Exhaustion Gastrointestinal Barotrauma THIRST Dehydration after diving, Heat Exhaustion, Shock TIGHTNESS OF FACE Facial Barotrauma, Rubber Allergy (Mask) TINGLING Arterial Gas Embolism, Decompression Sickness, Hyperventilation TOOTH PAIN Dental Barotrauma, Sinus Barotrauma UNCONSCIOUSNESS Arterial Gas Embolism Carbon Dioxide Toxicity, Carbon Monoxide Toxicity Cone Shell, Carotid Sinus Syndrome, Decompression Sickness, Heat Exhaustion, Hypoxia in breath hold diving, Nitrogen Narcosis, Pulmonary Barotrauma, Sea Snake, Shock URINARY/BOWEL LOSS OF CONTROL to urinate/defecate Arterial Gas Embolism, Decompression Sickness VERTIGO Alternobaric Vertigo, Arterial Gas Embolism, Carbon Dioxide Toxicity, Carbon Monoxide Toxicity Decompression Sickness, Ear Barotrauma, Shock VISUAL DISTURBANCES Arterial Gas Embolism, Decompression Sickness VOICE CHANGES Arterial Gas Embolism, Decompression Sickness Pulmonary Barotrauma VOMITING Carbon Monoxide Toxicity, Decompression Sickness Ear Barotrauma, Shock WEAKNESS Arterial Gas Embolism, Carbon Monoxide Toxicity Decompression Sickness, Hypothermia, Marine Animal Injuries, Pulmonary Barotrauma WEALS Decompression Sickness, Marine Stings,Wetsuit Allergy WOUND, RAGGED Fish Bite, Stingray Sting deafness in the affected ear, which may also affect balance.
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