http://www.baue.org/library/irvine_baue_talk.html#Bounce_diving
Good answers to the question...
George: The lungs are and incredible filter of all kinds of garbage. Fat globules, tissue damage that breaks away, all kinds of other things get caught here. Bubbles get stopped in the lungs. The capillary beds of the lungs get so small it stops them. It's one area where if you do block the flow of blood, since it's still being directly exposed to oxygen it doesn't damage the lung tissue. If you block the flow of blood some place else that doesn't have a supply of oxygen it dies. If you treat somebody with oxygen right away especially at an elevated partial pressure where oxygen is dissolved in the fluids of the blood and in the tissues and you can surround an area with oxygen you can keep it alive. But effectively this area right here in the lungs is always exposed. It filters out the bubbles and allows you to off-gas in bubble form. In fact, when you get out of the water you are generally off-gassing violently at your last step, say, 10ft to the surface. That last decompression step is huge. Because that's how you get the last of the gas out, by relieving that pressure. You're bubbling into the bloodstream and the lungs are catching it.
If the lungs don't catch the bubbles or they get around the lungs you get central nervous system hits, cerebral hits and spinal hits. Bubbles will not come out of tissue into arteries. Arteries are a working mechanism tubes. They'll end in capillaries. The capillary areas are where the arteries turn to veins and get into bigger and bigger and bigger vessels going back to the heart and lungs. Whereas the arteries coming from the heart are the bigger vessels going into smaller and smaller ones. So if you send a bubble down through the arteries it's going to go until it catches something and then it's going to block the surrounding tissue. Generally the first place blood goes right out of the heart is right up here in the brain and to the spine. The brain, spine, and heart. The spine and brain are where that bubble catches usually. So you get these spinal hits and brain hits and they're instantaneous if bubbles get by. Bubbles can get by if you had larger vessels some place in your lung matrix. Then it would just go right by. People with that defect can't dive at all they get hit [snaps fingers]. They look at water and they're bent. There's no way around it. You can't give them anything that will stop it. The other defect is the valve across the atria of your heart, simply because it's open before you're born. This is because in the womb (A) you're not breathing, and (B) you're getting all your oxygen from the placenta. Once you're born the lungs are used and the left side pressure increases and pushes the valve shut. Then the blood goes from the right side to the lungs and back through the left side. If that hole doesn't heal up in roughly 30% of the population it's either somewhat open or opens or can open or there's a defect. If it's just an ongoing hole you won't be able to dive because you'll get bent every time. If it's just a mild one you may never know about it until 2000 dives later and then you get wheelchair bent.
It's a good idea to get tested for it. The other thing is to treat yourself as if you have a PFO all the time. In other words, don't do anything to press the bet. In other words you don't get out of the water from 50ft. You don't ascend straight-line to the surface. You ascend slowly over the last little bit so that you give a chance for that gas coming into the blood stream enters in a nonviolent fashion while there's still pressure on you and you still compressed somewhat. Get that gas out of the tissues with some pressure on you. You don't just let it fly. Because if something gets by, it's going to be bad. So you just follow some general cautionary things. You don't exert right away. It's best just to lay around on the surface of the water. You don't want to be bending over or coughing or doing anything that would press against the heart in any way. Picture the heart with a vertical wall between the atria. You do not want to cause pressure to be put on that wall or along its length either, since this will flex the wall and allow any unsealed flap to open. You don't want to tempt fate. People that get central nervous system hit bent are getting it that way.
The other way to get it to do a dive and then to another quick dive down and come back up again. In other words, you've done a dive, you're getting out of the water and you are bubbling. Now you remember, "Oh, I left my oxygen bottle at 20ft." So you jump down with your mask on, grab the oxygen bottle and come right back up. Well, as you go down you compress the bubbles that are coming on the venous side enough to get by the heart, by the lungs. It just takes you a couple seconds to go down, a few seconds to go back up. Now they're expanding on the arterial side, and lodging in tissue. That's how we bent a bunch of support divers. That's how we found out about it. These guys didn't even do a dive, they'd be in a chamber. All he'd done is get oxygen bottles and be bent like a pretzel from that bouncing. Free diving after a dive, that's a classic one. Bent free diving. Central nervous system hit free diving.