Ver el código de «Decompression sickness»

==Background==
*Also known as the bends
*Dissolved Nitrogen and occasionally helium come out of solution and form bubbles in blood and tissue

==Clinical Features==
*Symptom typically start soon after surfacing
**42% in 1 hr, 60% in 3 hr, and 98% in 24 hr<ref>Navy Department. US Navy Diving Manual. Revision 6. Vol 5: Diving Medicine and Recompression Chamber Operations. NAVSEA 0910-LP-106-0957. Washington, DC: Naval Sea Systems Command, 2008. </ref>
**CNS cases present more rapidly – 56% within 10 mins<ref>Francis TJ, et al. Central nervous system decompression sickness: latency of 1070 human cases. Undersea Biomed Res. 1988; 15:403–417.</ref>
**Some symptoms can be delayed for days<ref>Freiberger JJ, et al. The relative risk of decompression sickness during and after air travel following diving. Aviat Space Environ Med. 2002; 73:980–984.</ref>

===Type I (Pain only DCS)===
*Involves the joints, extremities, skin (livedo reticularis/cutis marmorata), and constitutional symptoms
*Usually only single joint is involved
===Type II (Serious DCS)===
*Spinal cord involvement
**Ascending paralysis
**Signs often cannot be traced to single location in the cord (may have skip lesions)
***Limb weakness, paresthesias, or paralysis
***Urinary retention, fecal incontinence, or priapism
*Vestibular ("staggers") involvment
**Vertigo, hearing loss, tinnitus
***Differentiated from inner ear barotrauma which usually occurs on descent
*Pulmonary "chokes"
**Cough, hemoptysis, dyspnea, substernal chest pain

===Type III (Type II + [[Arterial gas embolism|gas embolism]])===
*Variety of stroke symptoms/signs
**May spontaneously resolve

==Differential Diagnosis==
{{Scuba diving DDX}}

==Workup==
'''Decompression sickness is a clinical diagnosis'''
*In patients that are ambiguous or decompensated, consider additional w/u without delaying definitive treatment
*Other considerations
*#Fingerstick
*#CBC
*#Chem10
*#Lactate
*#PT/PTT
*#VBG (or ABG)
*#Ethanol level
*#Consider UDT

==Management==
'''Treatment based almost solely on case reports and series'''
*ABCs/BLS/ACLS
*100% NRB regardless of SpO2
*Keep supine, Trendelenburg not recommended<ref>Moon RE, ry sl. Guidelines for treatment of decompression illness. Aviat Space Environ Med. 1997; 68:234–243.</ref>
*Hyperbaric oxygen
**Effective even in delayed cases
**Do not wait for recompression, but if delayed presentation, may recompress up to 14 days after symptom onset<ref>Marx et al. Rosen's Emergency Medicine - Concepts and Clinical Practice. 8th Ed. 2013. Ch 143. Pg. 1925.</ref><ref>Edmonds C et al. Diving and Subaquatic Medicine, Fifth Edition. 2015. Decompression Sickness: Treatments. Pg 173.</ref>
*Contact Divers Alert Medicine (DAN) at 1-800-446-2671
**Similar function as to poison control
*Consider adjuncts
**Lidocaine
**Perfluorocarbon emulsions

==Disposition==
*Hyperbaric chamber and admission

==Prognosis==
*One study showed at an average of 6.1 yrs, almost 50% of patients had impairments<ref>Vann RD, et al. Decompression illness. Lancet. 2011; 377(9760):153-164.</ref>
**These include impaired urination, defication, and sexual function

==See Also==
*[[Scuba diving emergencies]]
*[[Arterial gas embolism]]

==External Links==

==Sources==
<references/>

[[Category:Environ]]