Barotrauma and Arterial Gas Embolism: A Diving Emergencies Simulation Case for Emergency Medicine Residents

MedEdPORTAL Publications
Leah Marion Bralow, Mark Piehl

Abstract

Arterial gas embolism (AGE) is a rare but severe complication of scuba diving. While AGE is most commonly encountered in coastal areas with high volumes of recreational divers, at-risk populations exist throughout the United States, making basic knowledge of the disease important for all emergency medicine (EM) physicians. We used a hypothetical simulation case to train EM residents on diagnosis and management of AGE. A 32-year-old male presented with shortness of breath and unilateral neurologic deficits immediately after scuba diving. Residents were challenged to emergently diagnose and treat tension pneumothorax followed by diagnosis and treatment of AGE. A resident, attending, and simulation technician ran the case for four separate simulation teams in the simulation center with the addition of chest tube supplies to the basic resuscitation bay setup. Teams were allowed to use the internet in real time as a reference tool. Most teams arrived at the correct diagnosis using real-time internet searches, but none found the Divers Alert Network Emergency Hotline. Learners were debriefed both immediately and in a formal lecture. A follow-up survey showed good retention of knowledge. This case fills a significant knowledge and tra...Continue Reading

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