Diving

Physiology
Workshop
Seastar
Diving
College Physiology 1
Overview
 Circulatory & Respiratory Systems
 Diving Problems with Circulatory &
Respiratory Systems
 Physiological Responses to Nitrogen
 Physiological Responses to Thermal
Changes
 Physiological Responses to Pressure
Changes on Body Air spaces
 Problems with body air spaces
Physiology 2
Circulatory and
Respiratory Systems
 Supply body tissues with oxygen
 Remove and eliminate waste carbon
dioxide
 Using oxygen is called oxidative
metabolism
 Oxidative metabolism turns chemical
energy into usable energy to support
life
Physiology 3
Organs, structure &
function
 Circulatory system:

 Blood: Red blood cells (erythrocytes)

carry oxygen to the tissues via
hemoglobin, a protein that easily
bonds with oxygen. Plasma carries
carbon dioxide away from the tissues.

Physiology 4
Cardiovascular system
 The heart is a four chamber organic
pump that circulates blood
 Arteries carry blood away from the
heart
 Veins carry blood toward the heart
 Capillaries are microscopic vessels
between arteries and veins; gas
exchange occurs in the capillaries

Physiology 5
Respiratory system
 What triggers the breathing cycle?
 Reflex respiratory centers in the brain
monitor carbon dioxide levels in the
body.
 When the carbon dioxide level rises,
the diaphragm is signaled to flex
downward

Physiology 6
Respiratory system
 Air enters through the sinuses and mouth
past the epiglottis into the trachea which
divides into the bronchi leading to the
lungs.
 These divide into smaller bronchi until
reaching the alveoli,
which are air sacs
surrounded by the
pulmonary capillaries.
 It is here that the blood releases carbon
dioxide and picks up oxygen.

Physiology 7
Path of blood flow
 Oxygen rich blood from the lungs
enters left heart; heart pumps blood
into the aorta, the body’s largest artery
 The aorta branches into arteries,
including the carotid arteries that
supply blood to the brain
 Arteries branch into smaller arteries
throughout the body until reaching the
capillaries

Physiology 8
Path of blood flow
 Blood gives up oxygen and picks up
carbon dioxide in capillaries and flows
into the venous system (veins)
 Veins branch into larger veins until a
single vein returns oxygen poor blood
to the right heart
 The heart pumps oxygen poor blood to
the lungs via the pulmonary arteries

Physiology 9
Path of blood flow
 The pulmonary arteries branch into the
pulmonary capillaries that surround
the lung alveoli
 The blood releases carbon dioxide into
the alveoli to be exhaled and picks up
oxygen
 Oxygen rich blood returns to the left
heart via the pulmonary veins to begin
another cycle

Physiology 10
Dead Air Space
 When you breath air in and out, the air in
the bronchi, trachea, mouth and sinuses
plays no part in gas exchange
 This dead air space is rebreathed
increasing carbon dioxide levels
 Snorkel / regulator increases dead air
space
 Shallow breathing, dead air space
remains high, carbon dioxide levels rise
stimulating a higher breathing rate
Physiology 11
Dead air space
 If breathing remains shallow, the
breathing rate will increase; this
requires more effort and this raises
carbon dioxide levels further.
 This may lead to hypercapnea (too
much carbon dioxide).
 With slow, deep normal breathing
carbon dioxide levels remain low and
the breathing rate remains normal.

Physiology 12
Breath hold diving
 During apnea (breath holding) we use
up oxygen stored in the lungs,
muscles and blood to supply tissues.
 In cold water, bradycardia (slowing of
the heart) occurs. This is better in
marine mammals than humans.
 Carbon dioxide build up creates the
urge to breathe forcing the diver to
surface.

Physiology 13
Breath holding
 You can increase breath hold time by
hyperventilating, this reduces levels of
carbon dioxide so it takes longer to
stimulate breathing.

 Three to four deep breaths is OK

 Excessive hyperventilation may lead

to shallow water blackout.
Physiology 14
Carotid Sinus Reflex
 Carotid sinus receptors monitor the
pressure of arterial blood reaching the
brain through the carotid arteries.

 Low blood pressure triggers a higher

heart rate.
(tachycardia)
 High blood pressure triggers a lower
heart rate. (bradycardia)
Physiology 15
Carotid sinus reflex
 Receptors interpret pressure from an
excessively tight hood, wet suit neck
seal or dry suit neck seal as high
blood pressure.
 The heart rate slows, reducing blood
flow to the brain.
 The diver feels uncomfortable and
light-headed, and may lose
consciousness if the restriction is not
relieved.
Physiology 16
Hypercapnia - too much
Carbon Dioxide
 Can be caused by dead air space, skip
breathing, shallow rapid breathing,
overexertion or a combination of
these.
 Causes headache and increased
breathing, in severe cases loss of
consciousness.
 Stops if the diver stops all activity,
breathes deeply and rests.
Physiology 17
Hypocapnia - too little
Carbon Dioxide
 Can interrupt normal breathing cycle
as carbon dioxide stimulates breathing
 Excessive hyperventilation causes
shallow water blackout
 The diver gets rid of too much carbon
dioxide by too much hyperventilation
 At depth, the body consumes oxygen
faster than carbon dioxide becomes
enough to stimulate breathing
Physiology 18
Hypocapnia - too little
Carbon Dioxide
 Less oxygen causes no problem at
depth because the high partial
pressure lets the hemoglobin bond
with what little oxygen is left.
 When the diver ascends the oxygen
partial pressure drops and the
hemoglobin can no longer bond with
the oxygen.
 The diver blacks out without warning
due to hypoxia - insufficient oxygen
Physiology 19
Carbon monoxide
poisoning
 Caused by contaminated air from a
badly maintained compressor system.
 Wrong oil
 Air intake exposed to exhaust fumes
 Insufficient filtration
 All of the above - now rare
 Can also be caused by smoking
Physiology 20
Carbon monoxide
poisoning
 Carbon monoxide bonds with
hemoglobin better than oxygen, but it
doesn’t release as easily.
 If breathed in air at depth the
hemoglobin carries less oxygen as
carbon monoxide bonds with it.
 At depth there is enough partial
pressure of oxygen to meet demands
 On ascent the diver blacks out due to
hypoxia.
Physiology 21
Carbon monoxide
poisoning
 Signs and symptoms include:

 Headache, confusion, narrow vision,

bright red lips & fingernail beds.
 Treatment : Plenty of fresh air for mild
cases, if severe give the diver pure
oxygen and contact emergency care.

Physiology 22
Oxygen toxicity
 It’s almost impossible to suffer oxygen
toxicity using air within recreational
limits (40m or less & no deco diving).
 Using enriched air nitrox you can have
oxygen toxicity.
 There are two types of oxygen toxicity
 Central nervous system (CNS) toxicity
 Pulmonary oxygen toxicity
Physiology 23
CNS oxygen toxicity
 Caused by oxygen partial pressures of
greater than 1.4 - 1.6 bar
 Symptoms include:
Visual disturbances, ear ringing,
nausea, twitching muscles, irritability
and dizziness.
 The most serious symptom is a
convulsion without warning causing the
diver to lose his mouthpiece and
drown.
Physiology 24
Pulmonary oxygen
toxicity
 Caused by long exposure to high
partial pressures of oxygen
 Only likely after a series of many dives
using enriched air
 Symptoms include burning in the
chest and coughing
 Resolved by not diving for a while
 Avoided by following oxygen exposure
tables
Physiology 25
Reponses to Nitrogen
 Nitrogen dissolves into the blood
when we dive.
 This dissolved gas still exerts
pressure. (Tissue pressure).
 Different tissues absorb and release
nitrogen at different rates.
 This is the foundation for dive tables
and computers.

Physiology 26
 Responses to Nitrogen
 If enough time is spent at depth the
body will become saturated with
nitrogen. (Can’t absorb any more). Most
dives are too short
to reach this point.
 Upon ascent from any dive, however,
the nitrogen tissue pressure is higher
than the surrounding pressure; this is
called supersaturation.

Physiology 27
Responses to Nitrogen
 If the difference between the
surrounding pressure and the tissue
pressure (the pressure gradient) is
kept within limits the nitrogen
dissolves harmlessly out of the body.
 Doppler ultrasound flow meters detect
silent bubbles after some dives, these
will also dissolve harmlessly out of the
body.

Physiology 28
 Responses to Nitrogen
 But if the nitrogen comes out
of solution faster than the
body can eliminate it
harmlessly, bubbles form in
the tissues causing
decompression sickness (the
bends).
 DSC symptoms depend on the
amount of bubble formation
and where the bubbles end up
in the body.
Physiology 29
 Decompression Illness (DCI)
versus
Decompression Sickness (DCS)

 DCI - refers to both decompression

sickness and lung overexpansion
injuries (emergency first aid is the
same for both).
 DCS - refers specifically to conditions
caused by nitrogen coming out of
solution in the body.

Physiology 30
Factors that increase risk of DCS
 Body fat  Excess carbon
dioxide
 Age
 Dehydration  Cold water
 Injuries / Illness  Heavy exercise
 Alcohol  Altitude / Flying

All these factors effect the

blood flow to the tissues

Physiology 31
The two types of DCS
 Type 1 - Identified as “pain only” DCS
 Limb or joint pain most common
 Also “skin bends” red rashes on the
shoulders and upper chest.
 Type 2 - Identified as having life
threatening symptoms; involves the brain,
nervous system and lungs.
 Numbness, tingling, paralysis, weakness,
fatigue, unconsciousness.

Physiology 32
DCS First Aid
 Give patient oxygen
 Keep breathing patient
lying level on left side.
 Keep non-breathing patient flat on
back for rescue breathing / CPR
 Monitor ABC’s and contact emergency
medical care.
 Elevating the legs in no longer
recommended

Physiology 33
DSC treatment
 Except for some “skin bends” treatment
requires putting the patient under
pressure in a recompression chamber.
 This reduces
bubble size
and forces them
back into solution,
often alleviating symptoms immediately.
 Involves a long slow decompression with
oxygen and maybe drug therapy.
Physiology 34
Never attempt to treat a
diver by putting them
back in the water
The sooner recompression
treatment begins the better
chance the patient has of a
complete recovery

Physiology 35
Nitrogen Narcosis
 Most gases cause a narcotic effect
under pressure
 Depends upon the gas solubility in
nerve cells
 Narcosis varies from person to person
 Nitrogen and oxygen have about the
same solubility and can be narcotic at
depths of 30m or deeper using air or
enriched air.
Physiology 36
Nitrogen Narcosis
 Ascending a few meters usually
relieves narcotic symptoms.
 Symptoms include euphoria (feeling
happy), anxiety, impaired coordination
and impaired judgement.
 Danger comes from poor judgement
that may delay reactions or lead to
poor decisions.
 Helium is not narcotic, which is why it
is used by commercial and technical
divers making very deep dives.
Physiology 37
Heat and Cold
 Heat is a problem before or after a dive
wearing full wet suits or dry suits in
hot weather.
 Heat exhaustion
 Weak, rapid breathing & pulse, cool
clammy skin, sweating, nausea and
thirst.
 Remove suit, seek shade or cool
place, drink fluids and rest.
Physiology 38
Heat and Cold
 Heat stroke
 Pulse strong and rapid, no sweating,
skin red and hot to touch.

 Brain damage and death possible !

 Remove exposure suit, cool diver by

whatever means available and contact
emergency medical aid.
Physiology 39
Heat and Cold
 Water conducts heat away from the
body 20 times faster than air.
 A diver in 4 degrees celcius water will
be dangerously cold in half an hour.
 Suits slow heat loss but do not stop it.
 Shivering is a warning sign, get out of
the water, get dry and warm as soon
as possible.

Physiology 40
Heat and Cold
 If shivering is ignored the condition
will get worse.
 Shivering stops, the diver may feel
warm, the core temperature drops, the
diver becomes sleepy.
 Unconsciousness, coma and death are
the result.
 Advanced hypothermia needs
emergency medical care.
Physiology 41
Pressure changes on body
air spaces
 We will first look at how pressure
changes can effect these air spaces
and then look at the problems that can
occur while diving.
 Ears
 Sinuses
 Lungs
 Mask
Physiology 42
Ears (structure)
 Outer ear - external and ear canal -
open to air/water pressure - channels
sound to the ear drum.
 Middle ear, separated from the outer
ear by the ear drum - sealed against
air/water - ear drum vibrates and
passes sound to the ossicles, small
bones that conduct sound to the inner
ear.

Physiology 43
Ears (structure)
 Inner ear - vestibular canals (control
balance) - cochlea, which turns
vibrations from the ossicles into nerve
impulses sent by the auditory nerve to
the brain.
 The ossicles connect to the cochlea at
the oval window which flexes in and
out with vibrations.
 The round window flexes out when the
oval window flexes in to compensate.
Physiology 44
Ears (response to changing pressure)
 The middle ear is connected by the
eustachian tube to the throat to
equalize with outside pressure.
 As a diver descends he feels pressure
on the ear drum; by equalizing air is
forced up the eustachian tube to
equalize the pressure in the middle ear
thus relieving the discomfort.
 On ascent the air normally exits
through the eustachian tube easily.
Physiology 45
Sinuses (structure and response
to changing pressure)
 Sinuses are spaces in the head
connected to the nose.
 They filter and moisturize air before it
reaches the lungs.
 Healthy sinuses have free air flow and
normally equalize naturally during
middle ear equalization.

Physiology 46
Lungs - (response to
pressure changes)
 When scuba diving, normal breathing
keeps the lungs equalized to the
surrounding pressure.
 When breath-hold diving, increasing
pressure compresses the lungs and
reduces their volume. (Not normally a
problem because they designed to
change volume).

Physiology 47
Mask air space
 Not a natural air space but it effects
the body.
 Diver exhale into the mask through
their noses to keep the mask
equalized.
 This is why divers cannot use goggles
for diving as there is no way to
equalize the air space.

Physiology 48
Problems in body air spaces
 Barotrauma means “pressure injury”
 Can occur on ascent or descent
 An unequalized air space can also be
called a squeeze
 We will now look at the following:
Middle
Middle ear
ear squeeze
squeeze Ear
Ear drum
drum rupture
rupture
Reverse
Reverse squeeze
squeeze Ear
Ear plug
plug problems
problems
Round
Round window
window rupture
rupture Sinus
Sinus squeeze
squeeze
Physiology 49
Middle ear squeeze
 Caused by failure to equalize
 Eardrum flexes inward from pressure
 Pressure forces blood and fluid into
the middle ear to equalize the space
 Ears feel “full” and hearing is reduced
 Should be checked by an ENT doctor
 Prevented by equalizing or stopping
descent if unable to equalize
Physiology 50
Eardrum rupture
 Also caused by failure to equalize
 Pressure increase too fast for fluids to
fill middle ear
 Eardrum tears due to the pressure
 Diver feels sharp pain, then relief
 Cold water in the middle ear causes
vertigo until water warms up
 Usually heals OK, but check with doctor
to prevent infection
Physiology 51
 Reverse squeeze
 Congestion prevents air from escaping
during ascent, flexing the eardrum
outward.
 Feels like a squeeze, but happens on
ascent.
 May help to pinch nose and inhale.
 Slow ascent and let air work its way out.
 Usually caused by diving with a cold.
Physiology 52
 Ear plug problems
 Ear plugs or a tight hood create an
airspace between the plug and the eardrum
 During descent the eardrum flexes toward
the ear plug to the unequalized space
 Feels like middle ear squeeze
 Eardrum can rupture outward if descent
continues
 Avoid by not wearing ear plugs or pulling a
tight hood away when equalizing
Physiology 53
 Round Window Rupture
 Caused by delayed equalization and a forceful
valsalva maneuver
 Pressure on the eardrum presses in on the
ossicles, which press on the oval window on the
cochlea, the round window flexes out in
response.
 Valsalva raises pressure in the chest which
causes increased pressure in the cochlea this
bursts the round window outward.
 This a serious injury requiring medical treatment.

Physiology 54
Sinuses
 Sinus squeeze is usually caused by
diving with a cold.
 Unequalized sinuses fill with blood
during the dive; may feel like a sharp
pain against the eyes.
 On ascent the expanding air pushes
blood into the nasal cavity.
 The diver surfaces with blood in his
mask. (Not usually serious).
Physiology 55
Lung squeeze
 Caused by a breath hold descent to a depth
that reduces lung volume below residual
volume.
 Not a problem if you descend with full lungs
unless you go very deep.
 Can occur shallower if you try to descend
quickly with empty lungs to reduce
buoyancy.
 Causes fluids to accumulate in the lungs.
 Can be life threatening and requires medical
attention. Remember Enzo in “The Big Blue”.

Physiology 56
Lung overexpansion
injuries
 Caused by breath holding during
ascent, by lung congestion from a
chest cold, or by local blockage due to
loss of surfactant (due to smoking)
which keeps the bronchioles from
sticking shut.
 In all cases expanding air overexpands
the lungs causing lung rupture.

Physiology 57
 Air embolism (AGE)
 Alveoli and pulmonary capillaries rupture.
 Air enters the blood stream and flows into
the arteries.
 Immediately life threatening, bubbles flow
through the carotid arteries and cause
cerebral air embolism.
 Sign and symptoms similar to stroke
 Usually collapse and unconsciousness
immediately after a dive
Physiology 58
 Pneumothorax
 Air from the rupture goes between the lung and
the chest wall causing the lung to collapse.
 Symptoms include chest pain and the patient
may cough up blood.
Mediastinal emphysema
 Air accumulates in the center of the chest and
presses on the heart interfering with circulation
 Patient will feel faint and short of breath

Physiology 59
Subcutaneous emphysema
 Air accumulates in the soft tissues at
the base of the neck.
 The victim feels fullness in the neck
and the voice may change.
 The skin may crackle to touch.
 More than one of these injuries can
occur at the same time. Always
suspect air embolism, the worst case
scenario.
Physiology 60
First Aid & Treatment
 First aid is the same as for DCS
 Giving oxygen helps supply tissues
deprived of blood flow by bubbles
 Treatment for air embolism requires
recompression to reduce bubble size
 Pneumothorax usually requires
surgery to re-inflate collapsed lung
 Air from emphysemas dissipates over
time. Oxygen breathing may help.
Physiology 61
Mask & Dry suit squeezes
 Mask squeeze caused by failure to
equalize mask on descent
 Tissues swell, capillaries in skin and
eyes rupture.
 Looks terrible, but clears without
complications.
 Dry suit squeeze caused by failure to
add air to dry suit on descent.
 May raise welts and cause severe
pinches and shortness of breath.
Physiology 62
We’ve looked at...
 Circulatory & Respiratory Systems
 Diving Problems with Circulatory &
Respiratory Systems
 Physiological Responses to Nitrogen
 Physiological Responses to Thermal
Changes
 Physiological Responses to Pressure
Changes on Body Air spaces
 Problems with body air spaces
Physiology 63