Broken nose and diving

[carol_swimmom]

My son was mugged last night. He got a broken nose and stitches to his face. He was kicked repeatedly in the head. He was released from emerg this morning.
We are leaving for a dive week in Curacao on sunday. The emerg doctors were vague about whether or not he could dive.

I did not buy cancellation insurance but in any case he said he still wants to go. I need to tell you what a great kid he is. My son is 18 and about to start university. He won an academic scholarship to study mechatronic engineering. He loves diving. Anyway I digress but can I have some advice on whether he should dive? We are seeing the plastics clinic this aft for his nose. I will ask them as well.

He said just now if he can't dive he will use the hotel wifi to teach himself a new programming language online.... thanks for letting me vent a bit too. What an emotional night.

 

[Agility]

Wounds should be given at least a week to heal before submerging them for an hour.
I do not know what technique he uses for equalization, but pinching his nose will be painful and he has to make sure there is no internal swelling blocking the ear trumpet.

 

[carol_swimmom]

Is it ok for him to fly?

 

[Duke Dive Medicine]

Carol,

Sorry to hear about this. What a scary thing for both of you.

Re diving: there are two potential problems. First, if the cut that was sutured isn't fully healed or if there was trauma to the mucous membranes inside his nose, he's at risk of infection from bacteria that are in the water. Second, he may have difficulty equalizing his sinuses due to swelling in the area where he was struck. Nobody can clear him to dive over the internet. The conservative advice would be to have him stay out of the water until he's well and truly healed. If you want more specifics you might consider having him evaluated by a diving physician in the hyperbaric unit at Toronto General.

Re flying: I would check with the physician who treated him or with the diving physician if you see one. Flying poses the same risk of barotrauma, albeit to a much lesser extent.

Best regards,
DDM

 

[TSandM]

Although I basically agree with DDM, if the fracture is isolated to the nasal bones alone, it should not take too much time before the soft tissue injury has resolved enough to make diving reasonable, and it should be fairly easy to tell when that time has come, because a gentle attempt to equalize the ears should both be successful and be painless. There is still the possibility of sinus ostium narrowing from swelling, so any descent should be done carefully and aborted at any sign of sinus discomfort.

If the fractures extended to the medial orbital wall or maxilla, that's quite different, and would probably preclude diving during this upcoming trip.

 

[carol_swimmom]

Thanks all. The plastic surgeon we saw this aft has cleared him to fly and snorkel assuming the mask is not hurting him. He said likely no surgery is required and he should heal nicely. The surgeon said he is also a diver. He said my son's nose is displaced with a small crack. I am not sure what that means exactly. He is on broad spectrum antibiotics. He will have the stitches out before he leaves. As far as diving goes what I was told mirrors what TSandM said. Very slowly and abort at the first sign of pain or discomfort.


---------- Post added August 12th, 2014 at 07:53 PM ----------

I guess I should add they are all very lucky (4 of them attacked by 5 thugs) because they had guns.

---------- Post added August 12th, 2014 at 07:56 PM ----------

Oh I should add also he does not need to pinch his nose to equalize - the surgeon asked him about that too.

 

[FaithC]

What a horrific experience for him and you as well. I hope he's doing ok. If it were me, I would still contact DAN to be on the safe side as they are the experts when it comes to diving & medicine.
https://www.diversalertnetwork.org/contact/

 

[TSandM]

There really is, in this case, no need to contact DAN. The plastic surgeon, as stated, is a diver; his advice is rational (and since he agreed with me, he must be right!). Not every diving medicine question needs to be referred to DAN -- sometimes the answer is pretty easy.

 

[FaithC]

Thats fine. My opinion is mostly the same, but I would feel better with the extra step, if it were me in this situation. Just because someone is a physician who happens to be a diver does not necessarily mean they will be aware of all possible issues that could arise. I am covered by DAN and if it were me, I would want to be extra cautious to avoid any complications. It's just a precautionary phone call and there's no harm in it.

 

[boulderjohn]

Thats fine. My opinion is mostly the same, but I would feel better with the extra step, if it were me in this situation. Just because someone is a physician who happens to be a diver does not necessarily mean they will be aware of all possible issues that could arise. I am covered by DAN and if it were me, I would want to be extra cautious to avoid any complications. It's just a precautionary phone call and there's no harm in it.

When you contact DAN for anything beyond routine, what they will normally do is refer you to a physician they know who is an expert in diving. That is what has already happened here, and I assure you that DAN would be more than happy with the specific individuals who participated in this thread. If they feel you should be personally seen by a doctor who knows diving, they will send you a list of those in your area. That already happened in this case as well.

In summary, everything that DAN would do has happened already.

---------- Post added August 20th, 2014 at 04:14 PM ----------

It occurred to me that more explanation is in order for those who are new to ScubaBoard.

ScubaBoard is blessed with a staff of medical moderators who are very respected physicians and highly trained divers. If you are new to ScubaBoard, you may not know that, and you may not know who they are. Two of them participated in this thread, and we have more. Some write articles for DAN. That is why you aren't going to get any better information by going to DAN. ScubaBoard is not competing with DAN, but once you have gotten a definitive response from the experts here, there is no reason to go any further.