Page 38 - 2026 SMOG

DECOMPRESSION SICKNESS
History
• Recent history of SCUBA diving
• Hypobaric chamber training
• High altitude parachutist training/operations >18,000 ft (HALO, HAHO)
• High altitude exposure
Signs and Symptoms
• The Bends (Type 1)
˚ Pain in the joints, muscles, and related tissues. Initially mild and/or intermittent, it can
become deep, gnawing, and eventually severe.
˚ Pain tends to be progressive and becomes worse during ascent
˚ Larger joints, such as the knees and shoulders, are most frequently affected. The hands,
wrists, and ankles are also commonly involved
˚ Unusual, generalized fatigue, headache, malaise (constitutional bends)
• Skin Manifestations (Type 1)
˚ Paresthesia: tingling, itching, and cold and warm sensations
˚ A mottled red rash might appear on the skin
˚ Rarely, a welt might appear along with a burning sensation
˚ Bubbles might develop just under the skin and cause localized swelling
˚ Affected regions with excess fat beneath the skin, soreness, and abnormal fluid accumulation
might be present for 1 or 2 days
• Chokes (Type 2)
˚ Symptoms occurring in the thorax are caused in part by innumerable small bubbles that
block smaller pulmonary vessels.
˚ Burning sensation under the sternum
˚ As the condition progresses, a stabbing pain is felt, chest tightness occurs, and inhalation
becomes rapid and markedly difficult
˚ Uncontrollable desire to cough. Cough is ineffective and nonproductive
˚ Difficulty taking a deep breath may trigger uncontrollable coughing
Cyanosis
˚
• CNS (Type 2)
˚ The brain or spinal cord is affected by nitrogen bubble formation
˚ Visual disturbance (lights are flashing/flickering when they are steady)
˚ From dull to severe headache
˚ Partial paralysis/one-sided numbness and tingling
˚ Loss of orientation, and Inability to hear or speak
˚ Inner ear disturbances (vestibular DCS): vertigo, nausea, vomiting. More likely associated
with diving than altitude exposure
Treatment
• If DCS occurs while in flight, descend to a lower altitude or to the ground level.
• Place the patient on 100% O (for denitrogenating)
2
• Monitor vital signs and conduct a Neuro exam. Note any changes
• Minimize any reactor movement
• Start IV. Manage circulatory collapse with IV fluids (LR or NS)
(continues)

30 • MEDICAL