Browse the corpus

Recreational scuba diving is a popular sport, with 2.6 million active divers in the U.S. and approximately 6 million worldwide in 2025. The prevalence of diving-related injuries and illnesses corresponds to this participation. Diving at altitude introduces additional risk by exposing divers to lower ambient pressure than at sea level, the reference point for standard decompression tables. Upon surfacing, the reduced atmospheric pressure increases decompression stress, promoting intravascular and extravascular bubble formation. Contributing factors include dive depth, duration, ascent rate, and altitude of the dive site. Individual susceptibility and repetitive diving further modify risk. Clinical manifestations may range from mild decompression sickness, including joint and cutaneous symptoms, to severe neurological or cardiopulmonary events. Management emphasizes prompt recognition, oxygen administration, and, when indicated, hyperbaric therapy. Preventive strategies focus on dive planning using altitude-adjusted decompression tables or algorithms, staged ascents, and conservative dive profiles. This activity for healthcare professionals is designed to improve learners' competence in evaluating risk factors for decompression-related injuries and managing altitude-associated decompression stress in divers. Participants will advance their mastery of safe dive planning, risk assessment, and best practices in preventing decompression-related complications arising from altitude diving. Enhanced skills will prepare clinicians to collaborate with interprofessional teams caring for individuals at risk of developing altitude-associated diving complications. Objectives: Identify patients at risk of decompression-related complications during recreational or occupational diving at altitude. Implement altitude-adjusted decompression calculations to promote dive safety and prevent injuries. Improve patient awareness of risks, early signs of decompression sickness, and safe practices when engaging in recreational or occupational diving at altitude. Collaborate with the interprofessional team to educate, treat, and monitor individuals engaging in recreational or occupational altitude diving to improve health outcomes. Access free multiple choice questions on this topic.

Recreational scuba diving is widely practiced, with 2.6 million active divers in the U.S. and approximately 6 million worldwide in 2025. (Source: Wallmo et al, 2021) Participation spans recreational, commercial, and military contexts. High-altitude diving introduces additional risk, increasing the likelihood of diving-related injuries and illnesses. Exposure to lower atmospheric pressure at altitude may compound inherent risks present in recreational, occupational, scuba, or surface-supplied air diving. Diving at altitude introduces exposure to atmospheric pressures lower than those at sea level, which serve as the reference point for standard decompression tables. Upon surfacing, the reduced atmospheric pressure increases decompression stress, necessitating adjustment of standard dive tables used in basic certification programs. The relative pressure change associated with altitude correlates with an increased probability of decompression illness, proportional to the magnitude of atmospheric pressure reduction. Under this assumption, risk approximations may correspond to that experienced by a diver surfacing from a depth greater than the one actually reached. In addition to altitude adjustments, water density must be considered, as mountain lakes often contain freshwater rather than saltwater. Accounting for these factors enables calculation of a standardized equivalent sea depth (SESD), converting the actual lake diving depth to an equivalent sea-level dive depth. Using this equivalent depth, divers can adjust bottom time, decompression stop duration if required, surface intervals, and residual nitrogen load for repetitive dives, thereby reducing overall risk of decompression illness. Adjustment of dive profiles at altitude assumes risk comparable to sea-level dives. However, additional environmental factors may further elevate risk. These factors include freshwater versus saltwater density, weather conditions, dehydration, acute mountain sickness (AMS), and relative hypoxia.[1][2] (Source: Chimiak and Nord, 2026)

The incidence of decompression illness is rising with increasing participation in water-based activities. Management of decompression illness requires an interprofessional approach due to the diverse clinical presentation and potential for high morbidity. Emergency department physicians and nurse practitioners should promptly refer all symptomatic patients to a hyperbaric chamber. Public education on scuba diving and the critical importance of gradual ascent is essential to reduce risk.