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Pulmonary Barotrauma S020

Last amended 
10 July 2023
Current RMA Instruments
Reasonable Hypothesis SOP
64 of 2023
Balance of Probabilities SOP
65 of 2023
Changes from previous Instruments

SOP Bulletin 237

ICD Coding

ICD-10-AM Code: T70.31

Brief description

This is an acute lung injury due to barometric pressure change.  Rapid or significant change in the pressure within the lungs or the surrounding airways results in damage or injury to the lungs.  It is generally a serious condition and can be fatal.  Pulmonary barotrauma is commonly associated with scuba diving or other activities involving exposure to high or low pressures.  It can also occur due to explosive blasts, as a complication of mechanical lung ventilation or as a result of abnormal pulmonary conditions such as bulla, blebs and cysts.  Vomiting, forceful coughing or using the Valsalva or Muller Manoeuvres may also generate this type of lung injury.  

Pulmonary barotrauma results in pulmonary haemorrhage (presence of blood in the lungs), pneumothorax (air trapped in the space between the lung and chest wall), pneumopericardium (air entering the pericardial sac which surrounds the heart), subcutaneous emphysema (air under the skin) or arterial gas embolism (air bubbles entering the bloodstream).

Confirming the diagnosis

Diagnosis is made from the history and physical findings, together with imaging (CT or MRI scan).

The relevant medical specialist is a respiratory physician or emergency physician.

Additional diagnoses covered by SOP
  • Arterial gas embolism due to pumonary barotrauma
  • Burst lung
  • Lung or thoracic squeeze when compression occurs during diving 
Conditions not covered by SOP
  • Arterial gas embolism due to decompression illness
  • Decompression illness*
  • Decompression sickness* - decompression illness SOP
  • Dysbaric osteonecrosis* - osteonecrosis SOP
  • Pneumothorax due to non-pressure causes (e.g. lung disease, penetrating trauma, surgery etc.) 
  • Pneumopericardium (e.g. lung disease, penetrating trauma, surgery etc.) 
  • Pneumoperitoneum (e.g. lung disease, penetrating trauma, surgery etc.) 
  • Fat embolism#
  • Emphysema*
  • Otitic barotrauma*
  • Sinus barotrauma*

* another SOP applies

# non-SOP condition

Clinical onset

Onset will be acute and immediately follow an event such as a scuba dive, an explosion, or being mechanically ventilated.  Symptoms may include shortness of breath, cough, coughing blood and chest pain.

Clinical worsening

This is an acute injury.  The only SOP worsening factor is for inability to obtain appropriate clinical management.  The condition requires urgent medical attention and may be fatal.