A guest post by Dr Clair Ashford, Diving and Hyperbaric Physician at the DDRC.
Decompression illness is technically described as a disease of compressed gas divers, aviators, astronauts and caisson workers where gas bubbles form in tissues and/or the blood during or after a decrease in environmental pressure.
However, in ED the main reason you will see it is with divers. They have bubbles of nitrogen in places where they shouldn’t be. They need oxygen – to help the nitrogen clear from the system – and usually recompression as treatment. So, before we get to the technical stuff… please put them on high flow oxygen and call us ASAP.
It can present with pretty much any clinical picture (see below – How does DCI Manifest?). Call us if you are not sure. Diagnosis is clinical and we often speak to the diver to get a history of the dive as there aren’t many diving docs.
We may ask you to do a very thorough neurological examination. Yes, this involves tendon hammers and neurotips, but we do appreciate that these are sparse in an ED. As we are nearby we can see stable patients easily at our unit or come into Derriford ED.
Do not give Entonox (50% nitrous oxide/50% oxygen) under any circumstances to anyone who has recently dived as the nitrous oxide is highly soluble and will increase the inert gas load, making the symptoms of DCI worse. It can also expand within the air filled spaces of the body and cause barotrauma to the lungs, ears, sinuses or gut. Do not give pain killers unless you have a very long transfer to a chamber, and only after discussion with a diving doctor.
Lastly, we might send divers to you and ask for your help assessing whether they have a pneumothorax following a dive. We will ask for your help in deciding this with imaging as you see fit. If they do have a confirmed Ptx with significant DCI symptoms and need recompression, then we may ask for your assistance with a suitable chest drain before transfer.
We are your local Hyperbaric Medical Centre and are very close by:
As already stated…Decompression illness is a technically described as a disease of compressed gas divers, aviators, astronauts and caisson workers where gas bubbles form in tissues and/or the blood during or after a decrease in environmental pressure.
Most divers will come up bubbling.
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