Dougherty Scott, Khorsandi Maziar, Adelbai Myra, Zamvar Vipin, Francis James
Department of Internal Medicine, Ministry of Health, Belau National Hospital, Koror, Republic of Palau (Drs Dougherty and Adelbai).
Department of Cardio-Thoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom (Drs Khorsandi and Zamvar).
Wilderness Environ Med. 2017 Sep;28(3):225-229. doi: 10.1016/j.wem.2017.03.012. Epub 2017 May 10.
We discuss the case of an experienced diver who ran out of air during his final ascent while scuba diving. He lost consciousness rapidly after surfacing and despite immediate cardiopulmonary resuscitation, could not be revived. On arrival at the emergency department he was noted to have copious amounts of blood in his upper airway and had developed extensive subcutaneous emphysema. Large amounts of air were observed in the central circulation following a postmortem computerized tomography scan as well as pneumomediastinum, a small right-sided hemothorax, and extensive subcutaneous emphysema. We discuss several potential pathophysiological mechanisms that might explain these findings. Finally, we end with a recommendation for an expedient whole-body postmortem computerized tomography scan and autopsy by a suitably qualified pathologist in the investigation of all dive-related fatalities, where possible.
我们讨论了一名经验丰富的潜水员的案例，他在水肺潜水的最后上升过程中耗尽了空气。浮出水面后他迅速失去意识，尽管立即进行了心肺复苏，但仍未能苏醒。到达急诊科时，发现他的上呼吸道有大量血液，并且出现了广泛的皮下气肿。尸检计算机断层扫描显示中央循环中有大量空气，同时伴有纵隔气肿、右侧少量血胸和广泛的皮下气肿。我们讨论了几种可能解释这些发现的潜在病理生理机制。最后，我们建议在可能的情况下，对所有与潜水相关的死亡事件进行调查时，由合格的病理学家进行快速的全身尸检计算机断层扫描和尸检。
