HWN Suggests

Fun with Bubbles: Dysbarism and Hyperbaric Oxygen Therapy

Just like any emergency situation, the initial approach to DCS involves the ABCs. Once the patient is stabilized, targeted treatment for DCS involves IV fluids and 100% O2. IV fluids will improve flow around the bubble and 100% 02 will decrease the N2/O2 gradient

The gold standard is hyperbaric oxygen therapy (HBOT). There is no consensus on how soon after the incident the patient must be treated, but recent studies showed benefit from HBOT even after 72 -270 hours.

read full article

Featured

 A SCUBA Scary Case of Shoulder Pain

The goal in treatment of DCS is nitrogen washout. Initial management should include placing the patient on 100% oxygen via a non-rebreather mask, regardless of their oxygen saturation on pulse oximetry. This will help decrease plasma nitrogen concentration as well as decrease the size of the bubbles.5 Fluid administration at a rate of 1.5 mL/kg/hr will reverse dehydration that is common in divers.6 Definitive treatment of DCS is hyperbaric oxygen therapy.

 Decompression Sickness

Decompression Sickness (DCS) is a condition caused by the change in absorbed gas volume upon depressurization that releases gas bubbles into tissue and vasculature (1). This process can occur in divers who quickly arise from depth or who perform repetitive dives. The most common presentation of DCS in shallow dives is referred to as DCS Type 1 and is characterized by localized deep joint pain.

 Treating Decompression Sickness (The Bends)

Symptoms of DCS can occur immediately after surfacing or up to 24 hours later. On average a diver with DCS will experience symptoms between 15 minutes and 12 hours following a dive..

Articles of Interest

Altitude-Induced Decompression Sickness

There is no specific altitude that can be considered an absolute altitude exposure threshold, below which it can be assured that no one will develop altitude DCS. However, there is very little evidence of altitude DCS occurring among healthy individuals at altitudes below 18,000 ft. who have not been SCUBA (Self Contained Underwater Breathing Apparatus) diving.

Decompression Sickness Part 3: How To Treat It

The sooner you can get the injured diver to start breathing 100% oxygen the better! This is so so important. Every diving boat should carry an O2 kit on board.

It Happened to Me: Decompression Sickness / The Bends

The scenarios... are based on real-life diving incidents documented by Divers Alert Network (DAN).

What to Do if You Think Your Dive Buddy Has The Bends

Signs and symptoms typically appear within 15 minutes to 12 hours after surfacing, but symptoms may occur up to 36 hours later.

Resources

7 Easy Ways to Identify Decompression Sickness Symptoms

Decompression sickness is also known as divers’ disease, aerobullosis, generalized barotrauma, caisson disease and our personal favorite, “the bends”. The name the bends came about during the construction of the Brooklyn Bridge in New York City when a person with decompression sickness assumed a bent-over posture due to joint pain.

Life in the Fastlane

Decompression sickness, is a form of decompression illness, where a reduction in ambient pressure (‘decompression’) leads to de no intravascular and extravascular bubble formation with pathological consequences.

Radiopaedia

Decompression sickness (DCS), also known as diver's disease, aerobullosis, the bends, or caisson disease, is an uncommon diving-related decompression illness that can be an acute neurological emergency typically occurring in deep sea divers.

StatPearls

All decompression sickness cases should have initial treatment with 100% oxygen until HBO therapy is available. Neurological, pulmonary, and mottled skin lesions should be treated with HBO therapy even if seen several days after development.

WikEM

Decompression sickness is a clinical diagnosis. Pain may be reduced by BP cuff inflation over the joint to 150-200 mmHg.

WikiSM

Consider DCI in any symptom arising shortly after decompression. Symptoms that occur during descent or at depth are not due to DCI (unless there was a recent previous dive).