Travel Reference
In-Depth Information
Ifthepressurewithinthechambersisnotequalizedwiththeatmosphere,asenseoffull-
ness or pain develops. Hearing is diminished if the middle ear is involved. As the pressure
differential increases, the ears and sinuses become more and more painful. Involvement of
the middle ear also can cause sensations of noise, lightheadedness, and hearing loss.
Immediately upon becoming aware of symptoms in the nose or ears, an individual
should begin trying to equalize the pressure. Scuba divers, for whom barotrauma is a con-
stant threat, commonly pinch their nose shut and forcibly exhale against the obstruction to
open their eustachian tubes. Individuals with colds or hay fever should be aware of their
increased risk of barotrauma and should not dive, or at least should use decongestants to
reduce mucosal swelling before a dive. Oxymetazoline sprays are usually adequate. The
spray must be applied a second time after an interval of several minutes so it can enter
the deeper recesses of the nose. A systemic decongestant can also be taken in advance
of the descent. (Decongestants are often combined with antihistamines, which often cause
drowsiness. Such combinations should not be taken if drowsiness is likely to create prob-
lems.)
If precautions are not successful or are neglected, or the individual is unconscious, an
aerotitis media or aerosinusitis may develop. The reduced pressure (negative pressure)
within the chamber causes hemorrhage into the mucosa, which usually is quite painful.
However, it rarely causes any other problems, and the pain usually disappears within
twenty-four hours. The person should be given a systemic decongestant to promote drain-
age. Acetaminophen, ibuprofen, or a stronger analgesic may be given to help relieve the
pain.
NECK INJURIES
Injuriestotheneckcandamagevitalstructures.Massivehemorrhageusuallyfollowsinjury
of the large blood vessels. Hoarseness, coughing up blood, or diffuse swelling that feels
spongy or crackles (crepitance) indicates injury to the air passages. Persons with such in-
juries must be evacuated without delay. Swelling associated with the injury may lead to
airway obstruction, so preparations should be made for a tracheostomy or cricothyrotomy.
Ifthebandageoverthewoundencirclestheneck,whichisundesirablebutisoftentheonly
way to keep the bandage in place, it must be loose enough to accommodate subsequent
swelling that could result in obstruction of blood flow.
VERTEBRAL FRACTURES
An injury to the vertebral column (spine) must be suspected in any individual who has
sustained a fall from a height, independent of the presence of neurologic impairment. The
higher the level of the fracture, the greater the risk for a serious injury to the spinal cord.
Pain in the back or neck is the dominant symptom of an acute spine injury, which can be
diagnosed with certainty only by X-ray. In the wilderness, the adequate management of a
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