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During the winter of 1942–1943, Jacques Cousteau and Emile Gagnan collaborated to develop and patent the first commercially successful open-circuit self-contained underwater breathing apparatus (SCUBA), which was later named the Aqua Lung. The apparatus consisted of a demand valve regulator that could be attached to a portable cylinder containing stored compressed breathing gas. The regulator reduced the relatively high pressure of the stored gas to ambient pressure, which could then be breathed by a diver submersed in water. Prior to the development of reliable SCUBA equipment, divers were limited by surface supplied breathing gas requiring direct and continuous surface support.

The mass production of SCUBA diving equipment revolutionized underwater exploration. While this was a significant development for the military and commercial diving communities, it marks the beginning of the sport diving era. SCUBA diving has since evolved into a popular recreational activity.

Although diving-related injuries were described prior to the development of modern-day SCUBA equipment, their relative importance increased as more divers became equipped to explore the underwater world. The most accurate available statistics of diving-related injuries are published online by the Divers Alert Network (DAN) in an Annual Review of Recreational Scuba Diving Injuries and Fatalities.

A recent detailed and thorough analysis of 947 recreational SCUBA diving fatalities from 1992 to 2003 identified the cause of death (COD) along with triggers, disabling agents, and disabling injuries that contributed to the COD.1 The leading COD was drowning (70%), but the identifiable disabling injuries that contributed to the COD told a more useful story. The most common disabling injuries included: asphyxia with no preceding disabling injury (33%), arterial gas embolism (AGE) (29%), cardiac events (26%), trauma (5%), decompression sickness (DCS) (3%), unexplained loss of consciousness (2%), and inappropriate gas mixture (2%). In addition, risk factors associated with each disabling injury were identified (Table 93-1).

Table 93-1Disabling Injuries and Associated Risk Factors Contributing to the Cause of Death in Recreational Diving Fatalities

Of all the possible causes of diving-related injuries, this chapter focuses only on those caused by dissolved or embolic gas. In addition, this chapter includes a discussion of nondiving-related gas embolism. A number of excellent sources for review of diving-related injuries are available.27

Fundamental Concepts

Before presenting individual clinical entities, fundamental concepts related ...

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