Decompression Sickness

Decompression sickness - also known as caisson disease, diver's paralysis, or "the bends" - is a painful condition that results from a too-rapid change from a high- to low-pressure environment (decompression). The victim usually is a scuba diver who ascends too quickly from water deeper than 33' (10 m). Signs and symptoms appear during or within 30 minutes of rapid decompression, but may be delayed for as long as 24 hours.

Causes

Decompression sickness results from an abrupt change in air or water pressure that causes nitrogen to spill out of tissues faster than it can be diffused through respiration. As a result, gas bubbles form in blood and body tissues. These bubbles can accumulate over several dives.

Symptoms

The symptoms of decompression sickness vary because the nitrogen bubbles can form in different parts of the body.

The diver may complain of headache or vertigo, unusual tiredness or fatigue. He or she may have a rash, pain in one or more joints, tingling in the arms or legs, muscular weakness or paralysis. Less often, breathing difficulties, shock, unconsciousness or death may be seen

Diagnostic tests

Diagnosis requires taking a medical history (questioning the patient about his or her health and recent activities) and conducting a physical examination .

Treatment

Treatment consists of supportive measures, including recompression and oxygen administration. Recompression takes place in a hyperbaric chamber (not available in all facilities), in which air pressure is increased to 2.8 absolute atmospheric pressure over 1 to 2 minutes. This rapid increase in pressure reduces the size of the circulating nitrogen bubbles and relieves pain and other clinical effects. Analgesics, such as aspirin, also may be given for pain.

During recompression, intermittent oxygen administration, with periodic maximal exhalations, promotes gas bubble diffusion. When signs and symptoms subside and diffusion of gas bubbles is complete, a slow air pressure decrease in the chamber allows for gradual, safe decompression.

Supportive measures may include fluid replacement in hypovolemic shock and sometimes corticosteroids to reduce the risk of spinal edema. Shortacting barbiturates may be given to treat seizures. Narcotics are contraindicated because they may further depress impaired respiration.

Prevention

The obvious way to minimize the risk of falling victim to DCS is to follow the rules on safe diving and air travel after a dive. People who are obese, suffer from lung or heart problems, or are otherwise in poor health should not dive. And because the effect of nitrogen diffusion on the fetus remains unknown, diving while pregnant is not recommended.

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