Decompression sickness: Difference between revisions
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===Type I (Pain only DCS)=== | ===Type I (Pain only DCS)=== | ||
*Involves the joints | *Involves the joints and extremities, with constitutional symptoms | ||
*Usually only single joint is involved | *Usually only single joint is involved | ||
*Skin and lymphatics | *Skin and lymphatics |
Revision as of 15:50, 16 October 2018
Background
- Also known as "the bends"
- Dissolved nitrogen (and occasionally helium) comes out of solution and forms bubbles in blood and tissue
Clinical Features
- Symptom typically start soon after surfacing
Type I (Pain only DCS)
- Involves the joints and extremities, with constitutional symptoms
- Usually only single joint is involved
- Skin and lymphatics
- Pruritis, stinging, paresthesias, hot/cold sensations
- Fine scarletiniform rash from nitrogen movement through sweat glands
- Cutis marmorata - marbling rash, purplish-bluish discoloration, otherwise common and normal in infants
- Pitting edema, peripheral swelling from lymphatic blockage
Type II (Serious DCS)
- Spinal cord involvement
- Ascending paralysis
- Signs often cannot be traced to single location in the cord (may have skip lesions)
- Limb weakness, paresthesias, or paralysis
- Urinary retention, fecal incontinence, or priapism
- Vestibular ("staggers") involvement
- Vertigo, hearing loss, tinnitus
- Differentiated from inner ear barotrauma which usually occurs on descent
- Vertigo, hearing loss, tinnitus
- Pulmonary "chokes"
- Cough, hemoptysis, dyspnea, substernal chest pain
Type III (Type II + gas embolism)
- Variety of stroke symptoms/signs
- May spontaneously resolve
Differential Diagnosis
Diving Emergencies
- Barotrauma of descent
- Otic barotrauma
- Pulmonary barotrauma
- Sinus barotrauma
- Mask squeeze
- Barodentalgia (trapped dental air causing squeeze)
- Barotrauma of ascent
- Pulmonary barotrauma (pulmonary overpressurization syndrome)
- Decompression sickness (DCS)
- Arterial gas embolism
- Alternobaric vertigo
- Facial baroparesis (Bells Palsy)
- At depth injuries
- Oxygen toxicity
- Nitrogen narcosis
- Hypothermia
- Contaminated gas mixture (e.g. CO toxicity)
- Caustic cocktail from rebreathing circuit
Workup
Decompression sickness is a clinical diagnosis
- In patients that are ambiguous or decompensated, consider additional workup without delaying definitive treatment
- Other considerations
- Fingerstick
- CBC
- Chem10
- Lactate
- PT/PTT
- VBG (or ABG)
- Ethanol level
- Consider UDT
Management
Treatment based almost solely on case reports and series
- ABCs/BLS/ACLS
- 100% NRB regardless of SpO2
- Keep supine, Trendelenburg not recommended[4]
- Hyperbaric oxygen
- Contact Divers Alert Medicine (DAN) at 1-800-446-2671
- Similar function as to poison control
- Consider adjuncts
- Lidocaine
- Perfluorocarbon emulsions
Disposition
- Hyperbaric chamber and admission
Prognosis
- One study showed at an average of 6.1 yrs, almost 50% of patients had impairments[7]
- These include impaired urination, defication, and sexual function
See Also
External Links
References
- ↑ Navy Department. US Navy Diving Manual. Revision 6. Vol 5: Diving Medicine and Recompression Chamber Operations. NAVSEA 0910-LP-106-0957. Washington, DC: Naval Sea Systems Command, 2008.
- ↑ Francis TJ, et al. Central nervous system decompression sickness: latency of 1070 human cases. Undersea Biomed Res. 1988; 15:403–417.
- ↑ Freiberger JJ, et al. The relative risk of decompression sickness during and after air travel following diving. Aviat Space Environ Med. 2002; 73:980–984.
- ↑ Moon RE, ry sl. Guidelines for treatment of decompression illness. Aviat Space Environ Med. 1997; 68:234–243.
- ↑ Marx et al. Rosen's Emergency Medicine - Concepts and Clinical Practice. 8th Ed. 2013. Ch 143. Pg. 1925.
- ↑ Edmonds C et al. Diving and Subaquatic Medicine, Fifth Edition. 2015. Decompression Sickness: Treatments. Pg 173.
- ↑ Vann RD, et al. Decompression illness. Lancet. 2011; 377(9760):153-164.