The Lungs - Potential Problems While Diving (Part 1)

There are 4 types of injuries that can occur to the lungs by holding your breath on ascent.

LUNG EXPANSION INJURIES IN GENERAL

Most body air spaces respond to pressure decrease with neither complications nor voluntary action by the diver. The Lungs respond to this as well, provided the diver breathes continuously to them keep equalized to the declining pressures. If the diver holds their breath or air traps within a section of the lungs, and as pressure declines expanding air will almost always cause an over-expansion injury.

The "GOLDEN RULE" in diving - never hold your breath while on scuba and while underwater. Panic and ignorance have been the causes of divers holding their breath. Nausea, choking and carelessness have also been causes to this as well.

Obstruction in the lungs may also trap air in certain parts and in effect "hold its breath." A chest cold, or respiratory infection can cause mucus accumulation and cause an obstruction. Smoking has also been implicated in these injuries.

Lung injuries can occur from even a small amount of over-pressurization. Research has shown that starting with full lungs, holding ones breath and surfacing can have an injury in as little as a 3 to 4 feet distance.

Rather than the lungs bursting like a balloon, an over-pressurization tears the lungs. The injury does not occur from the tear to the lungs, but from the air escaping and entering the tissues and / or the bloodstream. Lung injuries can result in 1 of 4 ways: Air embolism, Pneumothorax, mediastinal emphysema, and subcutaneous emphysema.

Any lung injury causes pulmonary capillaries and alveoli to rupture, mixing blood and air in the lungs. This results, often times, to the victim coughing up blood.

AIR EMBOLISM (AGE)

This is the most serious type of lung over-pressurization injury. This results was the air enters the blood stream from a rupture of the alveoli into the pulmonary capillaries, causing an air embolism or arterial gas embolism. Click on image for larger view.

An embolism is any foreign object that enters the bloodstream that blocks its flow. An air embolism is the same but now it is an air bubble that blocks the flow of blood. So as you ascend the once small bubbles become larger and larger due to the expanding nature of the ascent. This is a bubble on the arterial side of the circulation.

Air enters the bloodstream in the lungs flows through the pulmonary vein into the heart, to the left side of the heart into the aorta and then the arterial system. This air bubble can lodge almost anywhere in the circulatory system - can cause severe damage by blocking blood flow to the tissue.

The first main branch off the aorta which include the carotids. The carotids supply the majority of blood to the brain. If bubbles travel into the carotids, which is likely, they will go to the brain and cause cerebral air embolism.

The bubbles deny the brain of oxygenated blood, which causes a stroke. The symptoms include dizziness, confusion, shock, personality changes, unconsiouness, and death. Compared to DCS, the effects of cerebral air embolism and other lung injuries tends to be rapid and dramatic. DCS tends to be delayed.

If the bubbles were to miss the carotids and block the coronary arteries, the result would be a heart attack.