Barotrauma, Hypoxia, or Decompression-Related Illness Evaluation Note

Date/Time: [Date and time of encounter]

Location: [Clinical setting]

Clinician: [Name, credentials]

History Source: [patient / crew / EMS / dive buddy / records]

Reliability limitations: [None / confusion / suspected hypoxia / language barrier / intoxication / other] (If limited, briefly state why)

Chief Concern & Operational Context

[Brief narrative of presenting concern with patient's own words when they clarify perception of impairment. Include operational role (pilot / aircrew / flight attendant / parachutist / diver / passenger / ground support), duty status at time of event, and immediate safety actions taken (descent, oxygen application, diversion, EMS activation).]

Exposure / Pressure-Change Profile

Exposure type(s): [aviation/unpressurized altitude / pressurized aircraft with suspected malfunction / rapid decompression event / hypobaric chamber / SCUBA/hyperbaric with subsequent altitude/flight / mountain ascent after diving / other]

Aviation/Altitude Exposure Details (Complete if applicable)

• Aircraft type & pressurization: [Description]
• Planned vs. maximum altitude reached: [Values]
• Cabin altitude: [Value / unknown]
• Rate of ascent/descent: [Values / unknown]
• Duration at altitude: [Duration]
• Supplemental oxygen: [Device type, flow/setting, time started, interruptions or equipment issues]
• Environmental modifiers: [Cold / exertion / dehydration / none / unknown]
• Co-exposures: [Smoke/fumes / suspected CO / sedating meds / alcohol / none]
• Descent performed: [yes / no] Symptom response to descent/oxygen: [improved / unchanged / worsened]

Diving/Hyperbaric Exposure Details (Complete if applicable)

• Date/time of last dive(s): [Details / unknown]
• Number of dives in past 24–72 hours: [Count / unknown]
• Max depth and bottom time: [Values / unknown]
• Gas mix: [air / nitrox / trimix / unknown]
• Decompression stops required: [yes / no / unknown]
• Ascent rate and deviations: [within limits / rapid ascent / missed stops / unknown]
• Surface interval before altitude exposure/flight: [Duration / none / unknown]
• Symptom onset relative to surfacing and to flight: [Timeline]
• First aid given: [Surface oxygen / fluids / recompression advice / hotline contacted / none]

Exposure plausibility statement: [One to two sentences synthesizing whether the exposure profile is consistent with significant altitude hypoxia, decompression illness, and/or barotrauma risk. If critical details are unavailable, explicitly state what is unknown.]

Symptom Timeline & HPI

[Brief narrative anchoring symptoms to the exposure event, e.g., "After [exposure], patient developed..."]

• T0 (start of exposure): [Time and context]
• T+X (symptom onset): [Time from T0 and symptoms]
• T+Y (intervention): [Time and details of oxygen, descent, pressurization, medications]
• T+Z (resolution/persistence): [Current status, delayed symptoms if any]

Symptoms by syndrome cluster (Document presence, absence, and pertinent negatives explicitly)

• Neurologic: [Confusion, behavior change, headache, vision changes, vertigo, weakness, paresthesias, gait issues, seizure, syncope] (Note onset, laterality, progression)
• Pulmonary/chokes: [Dyspnea, cough, pleuritic pain, hemoptysis, wheeze] (Note severity, response to oxygen)
• ENT barotrauma: [Ear pain/fullness, hearing changes, tinnitus, vertigo, sinus/tooth pain, epistaxis, inability to equalize] (Note laterality)
• Musculoskeletal/bends: [Deep joint pain with location and severity, pain with motion, swelling]
• Skin: [Pruritus, mottling/marbling, rash, edema]
• Constitutional/performance: [Fatigue, poor coordination, impaired judgment]

Pertinent History & Risk Modifiers

• Prior similar events: [Prior DCS/AGE / barotrauma / hypoxia episodes / chamber training recognition symptoms / none / unknown]
• Pulmonary risk factors: [Prior pneumothorax / lung blebs/bullae / asthma / none]
• ENT factors: [Chronic rhinitis / sinusitis / Eustachian tube dysfunction / recent URI / none]
• Relevant medical conditions: [Cardiopulmonary disease / anemia / pregnancy / neurologic disorders / migraine history / none]
• Medications/substances: [Sedating meds / decongestants / tobacco/vaping / alcohol in prior 24 hours / exhaust/heater exposure / none]
• Aviators: [Certificate class, typical mission altitude] (State if unknown)
• Divers: [Training level, dive computer use] (State if unknown)

Objective

Vitals: BP [value], HR [value], RR [value], Temp [value], SpO2 [value] on [room air / supplemental oxygen], pain [score]. (Include serial vitals when clinical status is evolving)

Mental status: [Alertness, orientation, speech, psychomotor status]

Focused Exam (Document pertinent positives and negatives; note limitations if full exam not feasible)

• General: [Distress, diaphoresis, cyanosis, ability to speak full sentences]
• ENT: [Otoscopy findings including TM appearance, hemotympanum, perforation; nasal mucosa; sinus tenderness; oral exam if tooth pain]
• Pulmonary: [Work of breathing, breath sounds symmetry, wheeze/crackles, chest wall tenderness]
• Cardiac: [Rhythm, rate, perfusion]
• Neurologic: [Cranial nerves, motor strength proximal/distal, sensation, coordination, gait, Romberg, speech/cognition] (If limited exam, specify what was assessed and why)
• MSK/joints: [Site-specific exam for suspected bends]
• Skin: [Rash, urticaria, marbling/mottling, edema]

Diagnostics Reviewed

[List tests ordered and results with brief interpretations. Include pulse oximetry trends, ABG/VBG, CBC, carboxyhemoglobin if CO risk, ECG if syncope/arrhythmia concern, CXR for pulmonary barotrauma/pneumothorax, audiology if significant ENT symptoms, as applicable. Note external data reviewed (dive logs, flight data, outside records) and consultation discussions with hyperbaric, ENT, pulmonology, or flight medicine services.]

Treatment & Response

• Oxygen therapy: [Device, FiO2/flow, start time] Response: [Symptom change, SpO2 change, neuro status change]
• Descent/pressurization restoration: [Details and timing if applicable]
• IV fluids: [Type, volume, timing]
• Medications: [Analgesia, antiemetics, ENT-directed therapies with doses and response]
• Recompression/hyperbaric referral: [Initiated / not initiated; facility; timing; rationale]

Assessment

[Two to four sentence synthesis of exposure plausibility, symptom pattern, and current clinical status. Explicitly state when decompression illness cannot be excluded.]

[Problem 1]: [Diagnostic label] - [suspected / confirmed / ruled out]

• Supporting features: [Key findings favoring diagnosis]
• Opposing features: [Key findings against diagnosis]
• Severity/acuity: [Description]
• Immediate risks: [Incapacitation, progression, operational safety concerns]

(List additional problems as needed, prioritizing safety-critical diagnoses such as neuro DCS/AGE and pneumothorax first)

Plan

[Problem 1]

• Immediate management: [Actions and interventions]
• Diagnostics planned: [Studies to obtain]
• Consults: [Hyperbaric / ENT / pulmonology / flight medicine / other] (Include escalation triggers)
• Disposition: [Observe / discharge / admit / transfer] (Include criteria and timeframe)

(Address additional problems as needed)

Aeromedical Risk & Restrictions

• Risk of sudden incapacitation: [Assessment addressing neuro deficits, pneumothorax, recurrent hypoxia, vertigo]
• Risk of recurrence with altitude: [Assessment]
• Transport safety: [Safe for ground transport only / safe for commercial flight as passenger / return to cockpit not permitted]
• Operational restrictions: [Flight/diving/altitude restrictions with duration; clearance authority (flight surgeon / AME / hyperbaric specialist / ENT); objective clearance criteria]

Return-to-flight criteria (Select based on condition)

• Hypoxia event: Symptoms resolved, stable oxygenation off supplemental oxygen, contributing factors addressed
• ENT barotrauma: Pain resolved, able to equalize without difficulty, otoscopy without concerning findings
• Suspected decompression illness: No altitude exposure until hyperbaric/flight medicine clearance with documented monitoring period for delayed symptoms
• Pulmonary barotrauma risk: Pneumothorax excluded or treated, respiratory stability confirmed

Return Precautions

Return immediately for: [worsening neurologic symptoms / dyspnea or chest pain / new or worsening rash or mottling / recurrent confusion or impaired judgment]. Activity restrictions: [restrictions]. Medication cautions: [cautions related to operational impairment].

Follow-up

• Consultations obtained: [Services, names, key recommendations]
• Records sent/requested: [Recipients]
• Scheduled follow-up: [Specialty, timeframe, location]

(When exposure or symptom information is unavailable, document unknowns explicitly. Never infer operational fitness from symptom improvement alone; require documented examination, testing, and follow-up criteria.)