DECOMPRESSION SICKNESS (DCS)

See Arterial Gas Embolism and Decompression Illness (DCI)

Decompression sickness is due to nitrogen gas coming out of supersaturated solution and forming bubbles in the circulation or tissues following depressurisation during dive ascent.

Consult with local hyperbaric unit (RAH) or Dr. David Teubner (see Hyperbaric therapy)

Classification

DCS I - Skin/Joints

DCS II - CNS/Respiratory

Joints ('the bends')

Arthralgia

(relieved with BP cuff inflated to 150-200mgHg)

Skin

Pruritis
Erythema
Marbling (esp. trunk)

Spinal

Limb weakness/paraesthesia/prickliness
Low back pain/abdominal pain
Bladder/bowel involvement
(symptoms advance proximally)

Brain

Headache
Blurred vision
Diplopia
Dysarthria
Fatigue
Behavioural change/Derealism

Inner ear ('the staggers')

Nausea
Dizziness
Vertigo
Nystagmus

Lung ('the chokes')

Cough/SOB
Chest pain
ECG - Right heart strain
Elevated CVP
Decrease ETCO2

MANAGEMENT

See Decompression Illness (DCI)

POST-TREATMENT ADVICE

No flying or diving for at least 4 weeks and possibly indefinitely (obtain further advice from Hyberbaric specialist)

Prevention

Maintain hydration
Prevent fatigue
Beware of obesity
Avoid flying
Avoid diving at altitude
Keep to dive limits

Dr. David Teubner MBBS FACEM