- Also known as "the bends"
- Dissolved nitrogen (and occasionally helium) comes out of solution and forms bubbles in blood and tissue
- Occurs in rapid ascent in diving, and more rarely in military operations rapid ascent in high altitude aviation or hypobarics training
- 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, most commonly:
- 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)
- Some consider multiple joint involvement qualifies as Type II
- 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
- Barotrauma of descent
- Barotrauma of ascent
- At depth injuries
Decompression sickness is a clinical diagnosis
- Pain may be reduced by BP cuff inflation over the joint to 150-200 mmHg
- In patients that are ambiguous or decompensated, consider additional workup without delaying definitive treatment
- Other considerations
- VBG (or ABG)
- Ethanol level
- Consider UDT
Treatment based almost solely on case reports and series
- Denitrogenation with 100% NRB regardless of SpO2, and continue 2 hours after symptom resolution
- Keep supine, Trendelenburg not recommended
- Initiate IV crystalloid fluids, rate of 250 cc/hr for first few hours
- Hyperbaric oxygen
- If due to high altitude aviation or hypobarics
- Descend to ground level ASAP
- Contact Divers Alert Network (DAN) Emergency Hotline at 1-919-684-2948
- Similar function as to poison control
- If patient requires transport to another facility, consider ground transport, air transport at max of 1000 ft, or air transport with pressurization capability
- O2 with tight fitting mask during flight
- Consider adjuncts such as Lidocaine, Perfluorocarbon emulsions
- Hyperbaric chamber and admission
- One study showed at an average of 6.1 yrs, almost 50% of patients had impairments
- These include impaired urination, defication, and sexual function
- 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.
- https://www.diversalertnetwork.org/medical/ Accessed 11/15/2018
- Vann RD, et al. Decompression illness. Lancet. 2011; 377(9760):153-164.