subcutaneous emphysema risk factors?

[JustJules]

I've been coming the DAN site without success on this one, so I thought I would ask here to see if anyone has seen any material on this. Are there any risk factors in particular that make certain divers more prone to subcuteaneous or mediastinal emphysema?I'm particularly curious about whether obesity is considered a special risk factor (either directly becuase of the health issues that arise from obesity or indirectly because of the buoyancy issues that obesity causes). Any input is welcome!

 

[DocVikingo]

Hi JustJules,

.... is breath holding on ascent, or ascending faster than air can be vented from the lungs even in the absence of breath holding.

Medical factors that may contribute to the risk of DCI conditions of the type you have referenced include asthma, bronchitis, blisters on the lung (cause largely unknown) & damage from tuberculosis.

I am not aware that obesity per se contributes to the risk of dive-induced subcutaneous or mediastinal emphysema, but it is a risk to general health, especially cardiovascular health, and may be problematic when the exertional demands of a dive become great. There is a fair amount of data suggesting that obesity is related to increased DCS risk, apparently due to the gas solubility properties of fatty tissue.

One would hope that the buoyancy issues occasioned by obesity would have been solved early in the diver's training.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

 

[JustJules]

I appreciate the response. I figured you had read a bit more on the subject than I had!

Is there anywhere else besides DAN where I can find reading on the subject?

 

[Dr Deco]

Dear JustJules:

My thanks to DocVikingo for the response. While not a clinician, I am not aware of obesity and lung-instigated problems in diving.

Naturally, obesity and diving are bad companions as overweight divers are generally in bad physical shape. As mentioned before, there is now experimental evidence that good physical condition is a factor in DCS mitigation. Divers have suspected this for decades. Exercise and weight control are factors that go hand in hand.

Dr Deco (on vacation this week)
:mean:

 

[scubadoc]

In addition to the information above, for further reading you might want to visit this site at http://scuba-doc.com/obesity.html .

Also, here is a web page about reducing the risks of pulmonary barotrauma. http://scuba-doc.com/SpiralCT.html .

 

[Laurence Stein DDS]

JustJules.

Out of curiousity, did you have any dental treatment, especially surgery on the lower jaw just prior to the event.

Periodontal infections and extractions of lower teeth can act as an entry point for air--especially under pressure.

The chances are really slim, I know, but I doubt that anyone else has mentioned the possiblity.

Just asking. Hope everything is OK--although I'm not sure you have had the problem or are wondering if you are prone to the problem.

Larry Stein

 

[DocVikingo]

Hi Larry,

Periodontal infections & extractions as risk factors in subcutaneous or mediastinal emphysema?

Do tell, doctor.

Best regards.

DocVikingo

 

[Laurence Stein DDS]

DocV,

Yep. Dentistry 101. Don't aim the air thingy into an extraction socket or deep periodontal pocket because it can cause
subcutaneous or mediastinal emphysema.

This is one of the reasons a patient should wait following extractions before diving. A subcutaneous emphysema can occur on either the upper or lower arches and there are enough potential spaces on the inside of the mandible and in the neck that air may work its way down to the mediastinum. Crepitis and all. Rare but possible.

Compressed air from a regulator blowing into an extraction THEORETICALLY can do the same thing if the opening is fresh. Deep periodontal pockets too.

Ain't dentistry neat?!

Regards,

Larry Stein

 

[DocVikingo]

Hi Larry,

.... Old Pippin, but you're the dentist.

Thank you.

DocVikingo

 

[Laurence Stein DDS]

DocV,

You never asked if I have ever been guilty of, well, subq emphysema. It actually occurred when I was a resident doing a root canal. Alternate irrigation with hydrogen peroxide and sodium hypochlorite. It was considered proper treatment.
Unfortunately, the chemical combination releases free O2 as a fizz. The patient was young with a large lesion at the end of his upper front tooth that had a large apical opening.

His face began to swell and it felt really strange to the touch--crepitis. Never used the combination again.

The mediastinal emphysema is extremely rare from dental causes. Like it's something you read about and your instructors tell you about but you will never see it until you are working on someone 1) who's father is a lawyer and 2) tomorrow is her wedding.

Another BTW. Did you ever blow really hard into your mouth or blow up lots of balloons for a kid's party and your cheeks felt strange? You forced air into the parotid gland. It must have a medical name but I've never heard of it.

While it's really a long shot, as we say in the profession..."spit happens".

Larry Stein