Page 21 - Journal of Special Operations Medicine - Spring 2015

Decompression Sickness
Following Altitude-Chamber Training

Nicholas M. Studer, MD, EMT-P;
John R. Hughes, MD, FACEP; Joseph Puskar, MD, FAAFP

ABSTRACT

Decompression sickness (DCS) is one of several dysba­ medication or supplements, and had no other significant
risms (medical conditions resulting from a change in family or social history.
atmospheric pressure) that can be encountered by the
Special Operations Forces (SOF) medical provider. DCS Background
can present with several different manifestations. The
authors present the case of a 23­year­old Airman who DCS was first noted in 1841 by French geologist and
presented with vague neurologic symptoms following mining engineer Jacque Triger. To mine coal in the
altitude­chamber training. They discuss the care of ca­ water­logged ground near the Loire river of France,
sualties with DCS and its implications for SOF. Triger developed steel boxes called caissons that were
pressurized with compressed air and used an airlock.
Keywords: decompression sickness, Type II DCS, dysbarism, Sunk into the ground for mining, he noted several min­
gas embolism, hyperbaric oxygen, altitude chamber, de- ers with joint pains after working at 2.3atm for over 4
mand valve, Oxylator , hypoxia, hypobaric hours. These cases apparently resolved without compli­
®
cation. The following years saw the rapid spread of the
Triger process in excavation and a resultant increase in
cases of DCS. 1
Introduction
DCS can be encountered by the SOF medical pro­ In 1873, Andrew Smith, physician in charge at the con­
vider and have several different manifestations. The struction of the Brooklyn Bridge, described 110 serious
authors present a case and discuss treatment and SOF cases of DCS, including three deaths. He was the first
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considerations. to describe the poorly understood process as “Caisson’s
disease.” Workers there were among the first to describe
it as “the bends,” from the stooped posture affected
Case Presentation
workers would take. The mechanism of DCS remained
A 23­year­old male Air Force trainee presented to the unclear, and Smith believed that vascular congestion
Brooke Army Medical Center (BAMC) Emergency De­ was the cause. Recompression had been described as
partment (ED) complaining of difficulty concentrating potentially curative, but it was not implemented dur­
48 hours following altitude­chamber training, which in­ ing Smith’s tenure. In 1890, E.W. Moir used recom­
cluded a rapid decompression phase of 5,000 to 25,000 pression routinely for the treatment of DCS during the
feet. The patient reported that he felt vaguely “cloudy.” construction of the Hudson River Tunnel (now the Up­
He had difficulty describing his sense of mental confu­ town Hudson Tubes). By 1910, it was accepted that the
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sion to ED staff. While he was able to make it through formation of nitrogen bubbles in the blood and tissues
his classes earlier in the day, he reported feeling “just were the cause of DCS, and J.S. Haldane had developed
not right.” He stated that he had not felt the same since the first decompression protocol for Royal Navy divers.
he removed his oxygen mask for hypoxia training at al­ In 1915, the first US Navy dive tables were published.
titude. He delayed presenting to the medical system be­ In the 1930s, the US Navy Submarine Escape Unit
cause he hoped the symptoms would abate. The patient recognized air­gas embolism as a separate entity from
also noted intermittent, precordial, sharp chest pain that DCS and began to use supplemental oxygen in treat­
was 2/10 in intensity when present, but denied shortness ment. As military aviation advanced during the 1920s
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of breath, nausea, limb pain, decreased coordination, or and 1930s, flight surgeons noted similar presentations
skin irritation. Past medical/surgical history included in aircrew flying at high altitudes. It was quickly deter­
a right clavicle repair in 2005. He was not taking any mined that DCS affected personnel who experienced a

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