Decompression Sickness

Decompression sickness (DCS) or The Bends and Caisson Disease is a medical condition that occurs as a consequence of altered barometric pressure. ^{[1] [2]} The condition is often mild but it can be potentially dangerous since it can involve multiple organ systems. The condition is usually observed among divers, aviators and astronauts. ^[3]          

Causes

The chief risk factor for DCI is a decrease in ambient pressure. ^[4] Risk factors identified that increases an individual’s chance of having DCS include deep or prolonged dives, cold water and difficult exercise at depth. Closely associated to DCS development is rapid ascent to the surface. Having lung or heart disease is another significant factor. Other factors which are still on way to be proven are obesity and dehydration. Some suggest that fatigue, lack of sleep and having an age greater than 30 years old puts a person at higher risk for DCS.  ^[3]

Signs and Symptoms

There are essentially two types of DCS. Type 1 generally manifests with pain that tends to go away within 10 minutes of onset, itching and rashes. The pain is typically localized in the shoulder joint described as dull or throbbing. Some patients may notice their skin to appear like orange-peel while some may have edema.

The second type usually involves the pulmonary and nervous systems and is often accompanied by hypovolemic shock. The symptoms may be delayed until about 36 hours. Patients may have back pain, paralysis, loss of sensation, bladder problems, headaches, visual disturbances, dizziness, alterations in mental status, vomiting, vertigo, nonproductive cough, breathing difficulty, increased heart rate and postural hypotension. ^[1]

Diagnosis

The patient’s history is a valuable tool to determine probable reason for the symptoms. Physical examination is done to assess the condition. In reviewing differential diagnoses, laboratory studies that may help include chest x-ray, CT scan, MRI, blood chemistries, ECG and oxygen saturation test. ^[1]

Treatment

Emergency treatment should be aimed at maintaining blood pressure. If trauma is suspected, the patient should be immobilized at once. The patient is by and large given oxygen usually through hyperbaric oxygen chamber. Fluids may also be given. If needed, intubation and chest tube thoracostomy are performed. ^{[1] [4]}

References:

1.      http://emedicine.medscape.com/article/769717-overview

2.      http://scuba.about.com/od/divemedicinesafety/a/dcs.htm

http://www.diversalertnetwork.org/medical/articles/Decompression_Illness_What_Is_It_and_What_Is_The_Treatment

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Hyperbaric Oxygen Therapy (HBOT):

Recommendation: Strongly in favor (HBOT is used routinely to treat Decompression sickness)

Grade of Evidence: High quality of evidence

* www.gradeworkinggroup.org