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Grade III Barotrauma with DCS in Honduras

After multiple days of diving within recreational limits, a diver began to display signs of DCS and experience neurological symptoms. After being evaluated by a dive medicine specialist, the diver was diagnosed with severe barotrauma and DCS.

The cost of treatment was US$ 31,763. Her primary insurance covered a fraction of these expenses, but DAN Dive Accident Insurance helped cover the remaining eligible expenses.

DAN.org/Join A DAN member made 9 dives over the course of her 4-day vacation. On the last day she made 3 dives: the first to 60ft (18.3 M) for 45 minutes, the second to 48ft (14.6 M) for 50 minutes and the third in the afternoon to 42ft (12.8 M) for 27 minutes. The diver observed appropriate surface intervals between dives, made no rapid ascents and completed a safety stop after each dive.The diver reported difficulty equalizing her ears on her last dive but completed the dive anyway. After surfacing around 5:50 PM, the diver was able to shower and make it to dinner, but after eating began to feel dizzy, confused and had difficulty walking so she retired to her room to rest. Within an hour she had begun feeling sick to her stomach, noted tingling sensations and numbness in her right arm, and experienced
extreme fatigue. She was put on 100% O2 and monitored by a nurse, but her disorientation escalated and soon she was unable to walk without assistance.

At about 9:30 PM, she was seen at the local Honduran emergency medical center and evaluated by a dive medicine specialist, who observed Barotrauma Grade III (tympanic membrane with hemorrhagic effusion, with hearing loss) of the right ear. Barotrauma does not require hyperbaric treatment, but since the diver presented with neurological symptoms, the physician could not rule out Decompression Illness, so a
USN TT6 hyperbaric treatment was administered. During treatment, she experienced a reduction and resolution of residual vertigo, an increase of strength in the affected limbs and total resolution of paresthesia.

Upon re-evaluation the following afternoon, her condition had generally improved with regard to vertigo and limb strength, but the paresthesia in the upper right arm had reappeared. In an attempt to improve the symptoms of DCI without aggravating her stable otic barotrauma, she was given a more conservative hyperbaric treatment. She tolerated the treatment well but continued to have residual symptoms of mild paresthesia. She was given oral anti-inflammatories for her ear issues and advised to wait 72 hours before flying.

Despite waiting 4 days after her second treatment to fly home, she still had difficulty clearing both ears on the flight and her symptoms of right upper extremity pain, numbness and paresthesia, and lower extremity weakness reappeared. She also experienced episodes of mental fogginess, and severe vertigo with nausea, and was unable to drive a car after arriving home. She then contacted DAN who referred her to a hyperbaric medical center close to home where she was able to get the treatment and therapy she needed to recover. This member's DAN dive accident insurance paid the Honduran provider in full upon receipt of the invoice and DAN TravelAssist coordinated and arranged payment for her new flight home since her original flight was missed. The member's primary medical insurance offset the cost of most of her follow-up care after returning home. Her DAN dive accident insurance covered the balance which included remaining deductibles and co-insurance.

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