patient presents after diving ___ hours ago.

Ascent was controlled.
Complains of joint/extremity pain to ___.
Complain of skin changes including ___.
Complains of paresthesias to ___.

Above symptoms after recent dive consistent with Type 1 Decompression Sickness.
Patient without weakness, other neuro deficits, incontinence, new vertigo, or significant respiratory symptoms concerning for a more severe Type 2 Decompression Sickness or air gas embolism.
History and presentation not consistent with infectious state, CVA, ingestion. 

ED interventions: 0.9%NS IVF @ 250 cc/hr, 100% nonrebreather for denitrogenation

Consult: Hyperbarics Specialist, Divers Alert Network (DAN) Emergency Hotline at 1-919-684-2948

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PEARLS

• Physiology
  • Type 1 DCS: Bubbles in venous system–> block flow –> inflammation–> pain (often in extremities)
  • “Type II decompression syndrome is more common among recreational divers and is more serious. Symptoms start with a feeling of truncal constriction and develop ascending paresthesias or paralysis, mimicking transverse myelitis. Type II decompression syndrome is thought to be due to bubbles in the venous plexus preventing venous outflow from the spinal cord.”
    • (Rosh Review qBank)
• Tx
  • Hyperbaric oxygen works by decreasing the size of the air bubbles in the venous system as well as easing washout of nitrogen by increasing its diffusion gradient from the bubbles and tissue to plasma
• Disposition
  • Avoid air transfer if possible or fly low below 1000ft if possible

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