Decompression sickness - Revision history

DMartinPAC: /* Prognosis */

2025-10-22T15:44:41Z

Prognosis

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	==Prognosis==		==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>		*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		**These include impaired urination, defecation, and sexual function

	==See Also==		==See Also==

DMartinPAC: /* Management */

2025-10-22T15:43:34Z

Management

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	*If due to high altitude aviation or hypobarics		*If due to high altitude aviation or hypobarics
	**Descend to ground level ASAP		**Descend to ground level ASAP
	*~~Contact Divers Alert Network (DAN) Emergency Hotline at 1-919-684-2948<ref>~~https://~~www.diversalertnetwork~~.org/medical/ ~~Accessed 11/15/2018</ref>~~		*Many divers carry insurance covering diving accidents and related medical problems, including costs of transfer for hyperbarics, through the [https://dan.org/health-medicine/medical-services/ Divers Alert Network] - a worldwide, non-profit cooperative dedicated to dive safety. Coverage for transfer costs may require DAN arrange the transfer. Expert consultation over the phone, similar to Poison Control, may also be available. Whether or not you can confirm the patient has such coverage, and unless your facility has hyperbaric treatment available in-house, you should consider contacting them:
	**~~Similar function as to poison control~~		**'''Divers Alert Network 24/7 hotline - +1-919-684-9111'''
	*If patient requires transport to another facility, consider ground transport, air transport at max of 1000 ft, or air transport with pressurization capability		*If patient requires transport to another facility, consider ground transport, air transport at max of 1000 ft, or air transport with pressurization capability
	**[[O2]] with tight fitting mask during flight		**[[O2]] with tight fitting mask during flight

Rossdonaldson1: /* Workup */

2024-10-02T19:01:04Z

Workup

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	**CBC		**CBC
	**Chem10		**Chem10
	**Lactate		**[[Lactate]]
	**PT/PTT		**PT/PTT
	**VBG (or ABG)		**[[VBG]] (or [[ABG]])
	**Ethanol level		**Ethanol level
	**Consider UDT		**Consider [[UDT]]

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* Type II (Serious DCS) */

2024-10-02T19:00:11Z

Type II (Serious DCS)

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	*Pulmonary "chokes"		*Pulmonary "chokes"
	**[[Cough]], [[hemoptysis]], [[dyspnea]], substernal [[chest pain]]		**[[Cough]], [[hemoptysis]], [[dyspnea]], substernal [[chest pain]]

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

	==Management==		==Management==

Rossdonaldson1: /* Type III (Type II + gas embolism) */

2024-10-02T18:59:50Z

Type III (Type II + gas embolism)

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	*[[Vertigo]] and balance disturbance		*[[Vertigo]] and balance disturbance
	*Ear pain and fullness		*Ear pain and fullness

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

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Type I (Pain only DCS) */

2024-10-02T18:59:25Z

Type I (Pain only DCS)

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	*Pain may be reduced by BP cuff inflation over the joint to 150-200 mmHg		*Pain may be reduced by BP cuff inflation over the joint to 150-200 mmHg

	===Type I (Pain only DCS)===		====Type I (Pain only DCS)====
	*Involves the [[arthralgia\|joints]] and extremities, with constitutional symptoms		*Involves the [[arthralgia\|joints]] and extremities, with constitutional symptoms
	*Usually only single joint is involved, most commonly:		*Usually only single joint is involved, most commonly:
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	**Cutis marmorata - marbling rash, purplish-bluish discoloration, otherwise common and normal in infants		**Cutis marmorata - marbling rash, purplish-bluish discoloration, otherwise common and normal in infants
	**Pitting edema, peripheral swelling from lymphatic blockage		**Pitting edema, peripheral swelling from lymphatic blockage

			====Type II (Serious DCS)====
			*Some consider multiple joint involvement qualifies as Type II
			*Spinal cord involvement
			**Ascending [[weakness\|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") involvement
			**[[Vertigo]], [[hearing loss]], [[tinnitus]]
			***Differentiated from inner ear barotrauma which usually occurs on descent
			*Pulmonary "chokes"
			**[[Cough]], [[hemoptysis]], [[dyspnea]], substernal [[chest pain]]

	==Management==		==Management==

Rossdonaldson1: /* Type II (Serious DCS) */

2024-10-02T18:58:59Z

Type II (Serious DCS)

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 *[[Vertigo]] and balance disturbance
 *Ear pain and fullness
 ==Type III (Type II + [[Arterial gas embolism|gas embolism]])==

Rossdonaldson1: /* Diagnosis */

2024-10-02T18:58:44Z

Diagnosis

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 '''Decompression sickness is a clinical diagnosis'''
 *Pain may be reduced by BP cuff inflation over the joint to 150-200 mmHg
 ==Management==

Rossdonaldson1: /* Type I (Pain only DCS) */

2024-10-02T18:58:19Z

Type I (Pain only DCS)

@@ Línea 57: / Línea 57: @@
 *[[Vertigo]] and balance disturbance
 *Ear pain and fullness
 ==Type II (Serious DCS)==

Rossdonaldson1: /* Evauluation */

2024-10-02T18:57:23Z

Evauluation

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	{{Scuba diving DDX}}		{{Scuba diving DDX}}

	==~~Evauluation~~==		==Evaluation==
	===Workup===		===Workup===
	*In patients that are ambiguous or decompensated, consider additional workup without delaying definitive treatment		*In patients that are ambiguous or decompensated, consider additional workup without delaying definitive treatment