DCS: Definition and Early Management

Decompression Sickness

First described in 1841, decompression sickness has gradually become better understood. Sport divers have provided a large body of material to study causing us to be able to learn more about the illness. It’s safe to say that DCS is caused by the production of nitrogen bubbles in the circulation, and this is related to the depthand time of a dive and to rate at which the diver ascends from depth. DCS and AGE combined form what is known as “decompression illness”.

Called “bends” by early investigators, it is now classically divided into Type I, Type II and “Type III” (a phrase coined by Bove and Neumann to describe a combination of DCS and arterial gas embolism). Type I DCS includes cutaneous manifestations and minor joint pain, or “pain only”; Type II includes severe symptoms related to the cardiopulmonary and neurological systems. Type III is a combination of AGE and DCS with neurologic symptoms.

Pain syndromes spot the pain in the limbs-not the central skeleton. It is dull, difficult to characterize and localize and is located in the shoulders, elbows and hands in divers. Compressed air workers have more pain in their lower extremities.

It is caused by bubbles, intravascular and extravascular with large gas stores in the fatty bone marrow. This is a cause of dysbaric osteonecrosis.

Neurologic Syndromes are increasing in sport divers and the spinal cord is the most commonly involved site. Symptoms include abdominal, low back, lower extremity pain, weakness and loss of feeling and function. Cerebral involvement is much more common than previously thought and may account for a portion of the “spinal cord” lesions. Peripheral nerves can also be involved causing numbness, limb pains and weakness.

Early Treatment

Recognition: Symptoms usually appear 15 minutes to 12 hours after surfacing.

Signs

  • Blotchy rash
  • Paralysis or weakness
  • Coughing spasms
  • Staggering or instability
  • Unconsciousness

Symptoms

  • Tired feeling
  • Itching
  • Pain, arms, legs or trunk
  • Dizziness
  • Numbness, tingling or paralysis
  • Chest compression or shortness of breath

Early Management
Immediate oxygen breathing, continue even if person improves markedly
Stabilize patient the same way as for Air Embolism
Urgent recompression after stabilization in trauma facility
Early recompression treatment for all forms of decompression sickness. There is a lightweight, portable recompression facility that would appear to be ideal for the liveaboard or dive operation far from a fixed-base chamber. This is the ‘SOS Hyperlite Stretcher’.

AUTHOR

Ernest S. Campbell, M.D., FACS

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