Diving is an exhilarating activity that brings people closer to the wondrous depths of the underwater world. However, as with any adventure, there are risks involved. Understanding dive-related medical conditions is crucial for divers to ensure their safety and well-being. By familiarizing ourselves with these conditions, we can learn how to prevent, recognize, and manage them, thus maximizing our enjoyment and minimizing the potential hazards associated with diving. Let us delve into the depths of this essential knowledge and explore the fascinating realm of dive-related medical conditions.

Decompression Sickness (DCS)

Decompression sickness (DCS) occurs when divers do not allow sufficient time for nitrogen to be released from the body. Due to the breathing of compressed air, divers' body tissues are saturated with inert nitrogen. The excess nitrogen cannot be eliminated as quickly as with the simple pressure change to the higher surface pressure immediately after a dive has ended. Small quantities of excess nitrogen can escape the body through the lungs and skin into the environment. Making too rapid a change back to atmospheric pressure can lead to the formation of bubbles in the body tissues called decompression sickness or bends and/or serious injury to vital organs called pulmonary/arterial barotrauma or arterial gas embolism. It is quite important to note that each new dose of inert gas from a deep dive with a new pressure is added to that dose which has not yet been eliminated. This makes repetitive dives a high-risk activity. The deeper or longer the dive, the more nitrogen is absorbed and builds up in body tissues.

Causes, Symptoms, and Treatment

The most important factors influencing the occurrence of Eustachian congestion relate to pressure differences during descent and, to a lesser extent, to changes in ambient temperature during diving. Symptoms of Eustachian barotrauma about ear pressure differences involve those that occur only during descent: pressure, pain in the ear, or feelings of fullness or blockage in the ear. More severe problems that occur during ascent happen less frequently and involve the same symptoms plus some signs of damage to the eardrum. Symptoms and signs of decompression illness about diving or flying within the previous four days and the presence of other symptoms are also important. After the release of pressure at altitude, the patient quickly felt well and could no longer localize the right-sided pain. A follow-up examination the next day was normal.

Prompt descent is often recommended to treat divers with unresolved Eustachian tube dysfunction that does not respond to conservative therapy. Pseudoephedrine used in prophylaxis is generally not recommended. Diving immediately after balloon inflation should be avoided. Sinusitis of odontogenic origin is an unusual but potentially severe complication of dental barotrauma or dental extraction close to the time of scuba diving. To avoid problems, divers and their physicians need to communicate with their dentists and understand scuba diving-related implications and risks of dental procedures. All dentists should be aware of the potential consequences of diving after a recent dental extraction so that they can prescribe necessary postoperative precautions. Diving after dental procedures is not recommended because the absence of definitive guidelines increases the risk of post-extraction complications, and treatment for dental barotrauma may require assistance from specialist providers.

Although the patient does not specify the date of injury, he attributes his pain to pressure and states that it started while scuba towing, which suggests that the injury occurred within two weeks of the dive. Divers must prioritize their safety and be aware of the potential risks associated with Eustachian congestion and barotrauma. Regular communication with healthcare providers, especially dentists, is essential to ensure a safe diving experience. Understanding the symptoms and treatment options for such conditions is paramount in preventing complications and maintaining overall well-being when engaging in underwater activities.

Expanding upon this topic, it is important to mention that proper equalization techniques, such as the Valsalva manoeuvre and Toynbee manoeuvre, can aid in preventing Eustachian congestion and barotrauma. These techniques involve applying gentle pressure to the nose while swallowing or blowing air into the nose with the mouth closed, respectively. By doing so, divers can effectively equalize the pressure in their middle ear and avoid potential discomfort or injury.

Additionally, it is worth noting that individuals with pre-existing conditions, such as allergies, sinusitis, or nasal congestion, may be more susceptible to Eustachian tube dysfunction and related complications. Therefore, these individuals need to consult with their healthcare providers before engaging in scuba diving activities to ensure their safety and well-being.

Furthermore, regular check-ups with healthcare providers, including ear, nose, and throat specialists, are crucial for divers who have experienced unresolved Eustachian tube dysfunction or barotrauma. These specialists can provide expert guidance and recommend appropriate treatments or therapies to alleviate symptoms and prevent further complications.

In conclusion, the occurrence of Eustachian congestion and barotrauma during diving is influenced by various factors, including pressure differences and changes in ambient temperature. Prompt treatment, proper equalization techniques, and regular communication with healthcare providers are key in preventing and managing these conditions. By prioritizing safety and understanding the potential risks involved, divers can enjoy a safe and enjoyable underwater experience.

Prevention Strategies and Safe Ascent Practices

Previous sections have provided an overview of the various factors that contribute to the decompression sickness (DCS) hit profile of divers. Because Haldane’s initial laws of diving, combined with Boyle’s law, converge on a net effect of the development of gas bubbles in tissues, prevention strategies have historically involved minimizing the potential for the development of over-nitrogenation, off-gassing of evolved nitrogen, or both. Implementation of technical, operational, and individual-based measures to prevent DCS are best described as components of a multi-layered and synergistic approach. The primary prevention goals are ultimately to minimize the potential for bubble development, minimize the risk for a bubble to form whether or not inert gas exfoliation is occurring, minimize the potential bubble growth, and therefore achieve the goal of inducing either stable supersaturation or no residual inert gas concentrations at any point in time within dive profiles.

As the dive progresses, ascents are the primary segment of each cycle that exerts the most significant influence on the off-gassing of dissolved gases. In terms of this medical problem error theory, taking on a different direction into an engineering-based model yields a different outcome. In medical problem definition, a failure to recover the patient’s health status activates one or a collection of medical interventions to 'correct' the defined state of affairs for the better. This line of thinking is compelling in several ways because an active dive treatment model provides an adequate medical analogy that represents the forces and physical or mechanical behaviours that are exerted and manipulated for the safety and control of the dive.

The importance of a controlled rate of ascent in minimizing the risk of bubble formation and subsequent DCS is at least 200 years old. It is noted that the early breath-hold divers recognized the value of a slow ascent to the surface but remained ignorant of the gas laws that promoted the biological explanation behind the findings of 'decompression illness' experienced by divers during both breath-hold and diving bell ventures. This lack of knowledge and understanding led to significant setbacks in the transition of scientific diving from a recreational adventure to an applied science and the subsequent development of safety-related physiological technology.

However, technical and medical advancements provided the mechanism for informing safe operational controls and providing the magnitude of increased safety to divers by segmenting and timing exposure and controlling the rate of ascent during their underwater extrusion. A slow ascent is employed to facilitate bubble involution, and it is essential to provide an uninterrupted gas phase flux path for inert gas to off-gas and to minimize the potential for the growth of preexisting gas phase nuclei. Control of the rise to the surface has been achieved through the command prompt for ascent rates recorded in policy, directives, guidelines, and annual startup, turnaround, and shutdown tactical orders of writing, programmable dive computers, and fixed-height decompression stops. These technological advancements have revolutionized the approach to diver safety and have played a crucial role in preventing DCS.

Moreover, it should be noted that in addition to controlling the rate of ascent, other factors such as hydration, thermal protection, and proper breathing techniques also contribute to minimizing the risk of DCS. Adequate hydration helps maintain the body's fluid balance and facilitates the elimination of dissolved gases. Thermal protection, on the other hand, helps regulate body temperature, which can affect gas solubility and the risk of bubble formation. Proper breathing techniques, including slow and controlled exhalations, also aid in off-gassing and can help prevent the onset of DCS symptoms.

In conclusion, the prevention of DCS requires a comprehensive and multi-faceted approach that considers various factors contributing to bubble formation and growth. Through a combination of technical advancements, operational controls, and individual-based measures, the diving community has made significant strides in ensuring diver safety and minimizing the risk of DCS. Continued research and advancements in technology will further enhance our understanding and ability to prevent this potentially life-threatening condition, thus safeguarding the well-being of divers worldwide.

Barotrauma

Prevention is the key to the management of barotrauma because barotrauma is a predictable condition. It results from a change in the pressure exerted on a gas-filled or gas-containing space in the body and can be divided into two subgroups: direct and indirect. In the case of direct barotrauma, mechanical or physical forces exerted upon the ear or sinus structures may result in trauma. These mechanical forces may result in the shearing of the layers between the perilymph-containing spaces and the endolymph-filled structures such as the round and oval windows. They may cause direct rupture of the oval and/or round windows, fistular rupture of the semicircular canals, or fracture of the stapes. In diving medicine, it is safe to say that direct barotrauma usually results from difficult or incorrect pressure equalization of the middle ear in face mask-wearing divers. Indirect barotrauma is the result of a change in the volume of a gas-containing space in the body, and so the term volume-change barotrauma is used synonymously.

The most commonly affected structure is the middle ear via its association with the inner ear structures. The ostium to the eustachian tube is located back in the superior postero-wall of the middle ear and surrounds the petrous portion of the carotid artery. When the surrounding skin and muscles of the pharynx retract during descent, the ostium widens in response to the reduced pressure on the middle ear. Ascent results in the opposite pressure changes with the same retraction of the tissue lining the pharynx. When the middle ear can become more negative, the ostium closes to prevent air from escaping. This form of gas trapping is necessary to maintain middle ear pressure and volume integrity, so mutual face pain is a common finding, particularly following ascents of significant speed. Nasal decongestants that constrict the anterior portion of the eustachian trumpet create a pharmacologic valve whose employment sometimes results in reduced morbidity during equalization manoeuvres. The bent shape of the eustachian tube in the posterior end makes the task of tensioning its torus shelf with air more difficult. Frequent repetitive heavy loads are required to form and maintain the muscular strength to make this safe and effective. Due to the added potential obstacles to equalization function, commercial divers are more likely than recreational and military divers to experience circumstances under which the eustachian tube fails to open and the middle ear becomes a vacuum with subsequent damage to the pneumatic structures or even their full collapse.

Types and Mechanisms

Sinus barotrauma is one of the medical problems that a scuba diver confronts. The diver should have no nasal congestion and completely normal middle ear function, measured by normal clinical examination of mucosal disease and normal pneumatic otoscopy. The stimulus for the descent to the depth of the barotrauma is usually brought about by unequal pressure between the middle ear of the diver underwater and ambient pressure. The body's automatic venting mechanism is designed and developed to equalize the pressure. Several things can go wrong to prevent this from happening correctly, which then results in barotrauma. These are classified as distal versus proximal Eustachian tube obstruction and functional versus mechanical problems. Factors contributing to the ease of middle ear equalization are experience, the friendliness of the diving environment, physical fitness, and correct techniques. Diving with a cold or a heavy head is foolish and often leads to serious sickness, requiring medical intervention and cessation of diving activities.

Middle ear squeeze is the most common type of barotrauma encountered during ascent or descent. Otoscopic findings appear at the end of the dive and completely resolve during the initial ascent. Large pressure differences may lead to rupture of the tympanic membrane and may cause permanent hearing loss. The squeeze can occur unilaterally or bilaterally. During the latter case, the tympanic membranes will be intact. A 3.5-year-old, untrained female swimmer went for a commercial dive, accompanied by her father's friend. After descending a few meters, the middle ear pressure equilibrated at a different level between the father's friend and the girl. Upon surfacing, the girl felt a sharp pain in both ears, which lasted 5 minutes and then disappeared. During the return to the father's village, the patient felt dizzy and ataxic. Upon examination at the local hospital, she was found to have spontaneous nystagmus, with the fast component to the right, and gaze towards the left producing right-beating nystagmus. The girl was hospitalized. A Barany test showed, again, the nystagmus findings, which were reversed by mastoid vibration. All other neurologic and physical examinations were negative. Upon otorhinolaryngologic examination, large serous otitis of green color was found in the middle ear cavities. She was treated with nasal decongestants orally, 3 doses for 3 days, and bottled boric water, which she instilled in her ears daily. An ENT examination 11 months later did not reveal any ear problems. The child's recovery was slow but total.

Symptoms and Treatment

In severe cases, thoracic decompression illness may have serious consequences resulting in pneumothorax and cerebral air emboli. In the case of recurrent pleuritic chest pain, skin or subcutaneous crepitus, a pneumothorax should be suspected. These symptoms may occur without other signs or symptoms of DCI. Additional pathological conditions include hemothorax and chylothorax, which can develop under like circumstances and should not be overlooked. It is readily explicable how compressing a lung with a sufficiently large quantity of gas can cause injury. Much more thought-provoking is the apparent ease of self-cure for the vast majority of thoracic DCI cases if recompression treatment is not readily available. It was noted that the bubbles seen in deployed amphibious force personnel were not attached to bronchial walls. They merely lay in the airways of the affected segment of the lung. They disappeared, on average, about a day after 30 minutes of 100% oxygen breathing.

A likely explanation begins by remembering that the vast majority of DCI cases, no matter what their cause or what therapy is applied, have spontaneously resolved or are significantly improved in a majority of cases. This is most remarkable given the fact that hyperbaric treatment was not available for the vast majority of oxygen pre-breathing failures. There are very few volutrauma failures following oxygen pre-breathing. It is as though lesions were due to reversible mechanisms, although the mechanism of obstruction was unknown. The only lesion was an air pocket. However, ultimately rare, the neurologic component has the potential to be the most catastrophic of the DCI manifestations, while the other components are generally much less consequential. The air pocket may act as a mechanical blockage of a portion of the cerebral microcirculation; bubbles can serve as the nidus for platelet-fibrin thrombi.

Nitrogen Narcosis

Also known as raptures of the deep, it describes the altered state of consciousness during underwater diving or hyperbaric exposure; it has been encountered with hyperbaric therapy. The mechanism is a highly debated subject with many factors that are thought to contribute; however, the most crucial factor of depth is heavily documented. It is the more controversial of the two most common types of gas narcosis that affect divers. The second most long-term use of the gas, oxygen, becomes toxic under conditions of partial pressure above 0.5, potentially through the formation of reactive oxygen species and oxidative damage to nerve cells. The combination of high pressure and a high partial pressure of inert gas leads to an increase in the production of free radicals. Another side effect that lasts only about 20 minutes during deep dives is that nitrogen narcosis impairs the memory of divers both during the time of the narcosis and subsequently. This effect has been demonstrated in nitrogen-oxygen and nitrogen-helium mixtures.

One study showed impairment of memory consolidation from the time of the narcosis, with performance on a non-language-based memory test decreasing with the higher partial pressure of nitrogen in the gas breathed by the study subjects. This impairment presumably exacerbates as the diver comes to rest in the dive but can be counteracted after the fact through methods that follow up a treatment that counters the symptoms of nitrogen narcosis and oxygen toxicity. Several solvents released by the body as metabolites and free radicals produced by the compression of gases are all possible causes of nitrogen narcosis. Other signs of nitrogen narcosis are slowing of mental functioning, confusion, anxiety, paranoia, panic, and symptoms similar to alcohol intoxication, such as slurred speech, overconfidence, and impaired decision-making.

Definition and Causes

Both decompression illness (DCI) and arterial gas embolism (AGE) are due to gas forming in tissue or the vascular system or reaching there in a way that is not simply dissipated during the initial ascent. Any symptoms or signs referable to the CNS or any other body system within 10 minutes of reaching the surface also satisfy this criterion. Rapid ascent to an altitude higher than 18,000 feet—while breathing with a SCUBA regulator—would be expected to result in AGE because the effective diameter of the lung vessels, and hence their capacity to trap gas bubbles, would be maximized upon surfacing. Those deep diving with electrolysis would be expected to be very resistant to AGE because the lungs are filled with 1/3 atm of O2 throughout the dive. Divers with impaired consciousness who do not regain awareness before being brought to the surface have a high risk of developing AGE because they do not protect themselves by exhaling either normally or via free-flowing vented equipment.

DCI is a term that encompasses both AGE and other abnormalities involving gases following diving. However, the syndrome of non-localizing DCI is poorly defined. Airlines expect divers to have a constant supply of nitrogen while their pressurized cabins descend to sea level, but this trivial difference between travellers and their other passengers seems unlikely to be the mechanism by which their symptoms are attributed to DCI. A low-grade non-localizing symptom that is misidentified as DCI may form part of the HACE/DAPE complex and improve en route or when the aircraft has landed. In tropical regions, bubbles may be formed in the blood of all individuals who ascend underwater because that is the standard method of blood sampling. A diver fits the first criterion for DCI if, and only if, appropriate symptoms or signs are recorded within the first 10 minutes of ascent.

Symptoms and Management

Concise support will be required from the surface escort crew during all underwater training, exercises, or dives so that medical conditions that the diver may be suffering from while he is underwater may be addressed quickly. If symptoms from several different complaints occur at the same time, priority should be given to managing the one complaint that could become the most dangerous in the shortest time. The most urgent conditions in such cases are likely to be hyperventilation-induced loss of consciousness, panic, oxygen convulsions, and O2 toxicity.

The use of oxygen in all cases except for an emphysematous diver or one who is overheated has advantages. It is not hypoxic and can be rapidly absorbed into the blood. It is non-flammable and safe to breathe, and full-face masks with an instructor or with a buddy breathing regulator can be utilized. In all other cases, treatment should be administered in order of the urgency of response to oxygen. The diver will reduce his depth and/or ascend and assume a continuous-flow immobile elbow or slack position for hyperbaric firm treatment. For rapid damage in all other cases except serious decompression sickness, oxygen should be given with a front flow mask or demand regulator, dosed to a maximum of 2.8 bar, but allowing for periods without treatment to prevent convulsions due to the oxygen. Oxygen should not be given continuously when there is little or no damage.

Oxygen Toxicity

The term oxygen toxicity refers to a spectrum of conditions that may occur when an individual is exposed to oxygen because of the development of an excessive partial pressure of oxygen within tissues and cells. Clinically relevant hyperoxia, and therefore oxygen toxicity, generally occurs at inspired oxygen partial pressures greater than two atmospheres absolute, compared with a pressure of 150 mmHg for the oxygen in the ambient air. Reoxygenation injury compounds toxicity from oxygen exposure in the presence of simultaneous partial pressure changes, particularly at lower levels of inspired oxygen. The risk of neurological oxygen toxicity is raised in hypercapnic conditions causing carbon dioxide retention, either from excessive dead space or blockage of the sampling tube or sensor. The risk of pulmonary oxygen toxicity is raised in hypercapnic or hypoxic conditions. In the context of commercial and military high-pressure working diving, the primary risks relate to respiratory oxygen toxicity, CNS oxygen toxicity, and the risk of oxygen use during the treatment of decompression illness. In the context of recreational divers and sport scuba divers, the primary risks relate to CNS oxygen toxicity and the risks of planning and executing repetitive, deep, decompressing dives. The key issue with CNS oxygen toxicity is that the symptoms are extremely rapid in onset and the same as those of convulsion and drowning. Any diver at risk of the condition must be appropriately trained in what to do and what not to do, should this very distressing event occur.

Effects and Symptoms

The severity of effects and symptoms depends on various factors such as the time, depth, type of gas used in breathing, and individual health conditions of the diver. Barotraumas are the most common dive complications at a speed of descent and sometimes lead to other diving diseases. Acute symptoms are usually intense and easily observed by other divers who can help a suffering diver. They usually appear immediately after immersion and within 24 hours but can be delayed as long as 36 hours after the cessation of a dive. Symptoms related to chronic complications arise after several months or even years following sustained barotrauma. The high-risk categories for diving accidents are inexperienced divers, divers who supply inadequate oxygen, those who have an instance of barotrauma but continue diving regardless, and fishermen who engage in multiple repetitive dives along with muscular effort after the initiation of barotrauma. Very often, the victims of diving-related health complications quickly resolve the symptoms by themselves and give incomplete information to the operator for the planning of Hyperbaric Oxygen Treatment. This may lead to insufficient application of oxygen, the repetition of treatment, and under pressure, which increases the operator's contribution to physiopathology.

Prevention and Treatment

The ultimate prevention of diving accidents relies on several factors. It is thought that a well-informed and competent diver can limit the risk of diving accidents. This competency can be achieved through strict adherence to diving rules and standards. In the event of any injury, several treatment approaches have been suggested. Airway management is very important, especially in diving emergencies, not only for the prevention of hypoxic brain injury but also, in the worst scenario, for the prevention of death. Breathing normally, if able to force ventilation, should be encouraged, while for an unconscious patient, stimulation by calling their name is mandatory. Ventilation with 100% oxygen should be promptly administered as quickly as possible in the diving emergency setting, particularly in cases of suspected drowning. Appropriate training can facilitate controlling the airway, particularly when 'head-up' drowning occurs.

Whenever a subtree compression treatment is directed, the ABCD airway, breathing, circulation, and disability protocol is fundamental for a detailed clinical assessment of the injured. A supine patient should be immediately positioned to promote systemic reperfusion. Marine bites or punctures are assessed by allergens and foreign bodies and treated accordingly. Ocular and tympanic membrane barotrauma should be treated with appropriate techniques, while peripheral and cerebral decompression sickness can be treated with medical hyperbaric therapy only. Standard first aid procedures on the boat before medical assistance should also be included in the curriculum for divers. The goal of this paper is to sensitize divers to the risks of diving and provide them with essential information to create awareness of the necessity of closely following the rules and standards associated with scuba diving. In the event of a diving accident, this information may help or lead the community to save lives by applying the correct first aid measures. The most common conditions in this field are diving-related lung conditions, ear disorders, decompression illness, oxygen toxicity, and barotrauma, as well as sea and coral injuries, animal-related injuries involving marine bites and punctures, and the consequences of geographic miscalculation and marine dive health hazards. The main goal is prevention, knowing the diseases and ailments associated with diving and common treatment measures.

Ear and Sinus Squeeze

Middle and Inner Ear Barotrauma is usually seen when descent is too fast in the presence of Eustachian tube blockage, mostly due to an upper respiratory tract infection or allergic rhinitis. Middle Ear Barotrauma results in serous effusion, leading to conductive hearing loss, a feeling of fullness, dizziness, and the classical otic barotrauma symptoms with interspecies differences. Treatment includes oral and topical decongestants, anti-inflammatory agents, and observation. Simultaneous sinusitis might lead to the evacuation of a mucocele through the Eustachian tube. In case of perforation of the tympanic membrane, avoidance of water exposure is needed, and possibly repair. Pneumolabyrinth might accidentally occur, with the main risk of hearing loss. Ear prophylaxis protects divers from Ear Barotrauma by assisting Eustachian tube function for barometric pressure equilibration. It should be considered before underwater diving.

Sinus squeeze is often related to sinusitis and inefficient sinus ventilation, mostly due to an upper respiratory infection, a deviated septum, abnormal sinus anatomy, or other causes of mucus production or blocked ducts. During descent, pressure imbalance between the external environment and the paranasal sinus causes negative pressure to develop in the sinuses, which might restrict gas escape. Seal and/or dry suit squeeze, as well as pneumopressure dressings and/or forced massages, might cause or augment periorbital and nasal dermatitis. Landing squeeze usually refers to a sinus disorder seen in aviation. Symptoms vary greatly among species. Treatment options include local decongestants Valsalva manoeuvres, and/or swimming with an open mouth. Sinus prophylaxis protects divers from sinus squeeze by enhancing mucus clearance and encouraging gas flow.

Causes and Symptoms

Your no-decompression limit (NDL) is a given amount of time to stay out of the water after a certain dive. If you exceed your NDL, meaning you surface too late after that dive, the dive becomes a decompression dive, and you need to spend a longer time out of the water before going on another dive to let gases dissolve. This additional time depends on your computer or dive tables' calculations or the depth and time you spent underwater in an unplanned decompression situation. Therefore, this is why it is so crucial. During decompression, inert gases in your body require more time to get out and bubble more when you come up to the surface. Decompression sickness (DCS) or an arterial gas embolism (AGE) is much more than just inconvenient little injuries that keep you out of the water for a certain period.

Finding out the symptoms is the first step to approaching treatment and not worsening the situation. DCS symptoms might start to occur from simple pain, such as muscle or joint pain in a specific body part, and can progress to neurological and cardiopulmonary issues – such as tingling, numbness, joint or bone pain, unsteadiness, dizziness, headache, paralysis, abnormal sensations, unconsciousness, air hunger, cough, persistent bronchospasm, or other unusual signs. AGE occurs mostly during the ascent phase of a dive but can also affect free divers. A loss of consciousness and/or a cardiac or pulmonary arrest are very critical symptoms that need immediate action due to the patient having very little time. Immediate attention is needed because, upon surfacing, if the obstruction is not cleared, it might result in permanent neurological damage and death. Any symptoms in the water require immediate attention. Prompt and early assistance many times lead to a full recovery.

Prevention and Management

A major component of preventive dive medicine is the education of prospective divers. Candidates must be aware of the need to obtain certification through a recognized dive training organization. They must also be made alert to the dangers of diving without reasonable fitness or when suffering from potentially harmful conditions or drugs. All of the information necessary to avoid hazardous diving conditions cannot, of course, be included in a brief article. The following brief guidelines attempt to bring together some of the most important aspects and emphasize important points that are not always emphasized in dive classes. In considering whether or not to dive, adults, and especially ageing individuals, must carefully consider the presence of diseases that might compromise their ability to safely and enjoyably scuba dive. By obtaining an optimal level of wellness that would not preclude safe diving, prospective divers can learn how to manage dermatological, ENT, ocular, pulmonary, cardiovascular, its primary subunits, renal, hematologic, metabolic, infectious, gastrointestinal, genitourinary, nicotine, and psychological problems. Prompt recognition and appropriate management of the recurrent presentation of dive-related disorders may prevent interruption of vacation plans and reduce medical risk.