A diver ascends rapidly and develops coughing pink frothy sputum, dyspnea, and chest pain shortly after surfacing. What condition should you suspect and treat?

• A. Air embolism
• B. Decompression sickness
• C. Pneumothorax
• D. Myocardial infarction

Answer: (A)

Rapid ascent in diving can force dissolved gases, especially nitrogen, to come out of solution and enter the bloodstream, causing an air embolism. When air bubbles lodge in the pulmonary circulation, they disrupt gas exchange and can trigger pulmonary edema, which presents as dyspnea and chest pain. Coughing pink, frothy sputum reflects this pulmonary involvement from the bubbles leaking into the lung’s microvasculature.

This scenario points to air embolism as the best fit because the symptoms appear shortly after surfacing and include respiratory distress with frothy sputum, a hallmark of bubble-induced edema in the lungs. Decompression sickness can cause chest symptoms too, but it more commonly features joint pain, neuro signs, and skin findings rather than the brisk pulmonary edema pattern described. Pneumothorax would typically show unilateral breath sounds and hyperresonance rather than frothy sputum, and myocardial infarction is not tied to the diving event in the same way.

The immediate treatment is high-flow 100% oxygen and rapid transport to a facility capable of hyperbaric recompression, which helps shrink and dissolve the gas bubbles and improves oxygen delivery.