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Nitrogen Narcosis
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Contents
Other Names
- Nitrogen Narcosis
- Rapture of the Deep (as described by Jacques Cousteau)
- Depth Intoxication
- Narks
- Inert gas narcosis
- Martini effect
Background
- This page refers to the toxic effects of breathing nitrogen-containing gases at depth
History
- First described by Albert Behnke in 1935[1]
- Rare at depths less than 30 meters (100 ft) unless breathing non-standard air mixtures
Epidemiology
- Responsible for up to 9% of diving deaths[2]
Pathophysiology
- General
- Occurs as a result of inhalation of compressed nitrogen at depth
- Generally manifests as intoxication and euphoria
- Impaired judgement and euphoria can produce dangerous circumstances
- The condition is reversible and resolves rapidly with ascent
Etiology
- Develops between 3-4ATM (99-132 feet)[1]
- Sensitive divers may develop symptoms at 3 ATM
- Other divers may not be affected until 6 ATM
- Divers can develop "tolerance"[3]
- Similar to alcohol consumption
- Impairment remains despite tolerance
- Other inert gases
- Almost universally occurs with nitrogen
- However, can also occur when other inert gases, such as neon, argon, krypton, and xenon
- Note that helium does not cause inert gas narcosis, which is why it is used in deep diving
Risk Factors
- Diving related[4]
- Exertion during dive
- Cold conditions
- Alcohol consumption before dive
- Diving to greater depth
- Fatigue before diving
- Apprehension before or during a dive
Differential Diagnosis
Differential Diagnosis Dive Medicine
- Barotrauma of descent
- Otic Barotrauma: "ear squeeze"
- Sinus Barotrauma: "sinus squeeze"
- Mask Squeeze: air in the mask decreases in volume during a dive, creating negative pressure
- Barodentalgia: trapped dental air causing squeeze
- At depth injuries
- Oxygen Toxicity: harmful effects of breathing oxygen at higher partial pressures than normal
- Nitrogen Narcosis: toxic effects of breathing nitrogen-containing gases while at depth
- Hypothermia: decrease core temperature with prolonged exposure to cold water
- Carbon Monoxide Toxicity: CO toxicity typically results from a faulty air compressor
- Caustic Cocktail: Inhalation of absorbent material used to scrub CO2 mixes with water
- Barotrauma of ascent
- Pulmonary Barotrauma: occurs when diver breathing compressed air ascends too rapidly
- Decompression Sickness: Dissolved nitrogen comes out of solution, forms bubbles in blood and tissue ("the bends")
- Arterial Gas Embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- Other
- Immersion Pulmonary Edema: also termed swimming induced pulmonary edema
- Salt water aspiration
- Submersion Injury: includes drowning, near drowning
Clinical Features
- History
- Onset is typically insidious
- Early: euphoria, false sense of security, impaired judgement, diminished reaction times
- Later: impaired concentration and memory, hallucinations, parasthesia
- Final: lethargy, loss of consciousness (typically occurs at depths of 10-13 ATM or 333 to 429 feet)
- Physical Exam
- Symptoms typically resolve upon surfacing
- Exam is often normal
Evaluation
- Diagnosis is primarily clinical
Classification
- There is no classification system
Management
- Ascent
- Reduces the partial pressure of dissolved nitrogen
- Symptoms will reverse within minutes of ascension to a shallower depth[5]
- Typically no long term effects from this
- If symptoms persist after ascent, consider broader differential diagnosis
- Hospitalization is typically not required
Prevention
- See: Dive Medicine Prevention
- Preventing nitrogen narcosis
- Avoid diving to depths >100 feet
- Use nitrogen free gas mixture (e.g. heliox)
- Use mixture with reduced nitrogen content (e.g. Trimix = helium-nitrogen-oxygen)
- Frequent check on diving companions
Rehab and Return to Play
Rehabilitation
- Not applicable
Return to Play/ Work
Complications and Prognosis
Prognosis
- Prognosis is very favorable if divers ascend upon recognition of the disease
Complications
- Death/ drowning
- Occurs due to impaired judgement at depth
See Also
References
- ↑ 1.0 1.1 Grover CA, Grover DH. Albert Behnke: nitrogen narcosis. J Emerg Med. 2014 Feb;46(2):225-7.
- ↑ Levett, D. Z. H., and I. L. Millar. "Bubble trouble: a review of diving physiology and disease." Postgraduate medical journal 84.997 (2008): 571-578.
- ↑ Unsworth, I. P. "Inert gas narcosis: An introduction." Postgraduate medical journal 42.488 (1966): 378.
- ↑ Spira, Alan. "Diving and marine medicine review part II: diving diseases." Journal of travel medicine 6.3 (1999): 180.
- ↑ Melamed, Yehuda, Avi Shupak, and Haim Bitterman. "Medical problems associated with underwater diving." New England Journal of Medicine 326.1 (1992): 30-35.
Created by:
John Kiel on 30 June 2019 23:02:49
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Last edited:
25 July 2022 20:48:56
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