Page 24 - Journal of Special Operations Medicine - Spring 2015

resuscitation capability. At the very least, extra oxygen more likely with the vague chest pain possibly even be­
bottles should be carried on vehicles and at field aid sta­ ing “chokes,” with pneumothorax excluded on chest
tions, which may anticipate a prolonged evacuation time radiograph. A civilian advanced life support ambulance
for a DCS casualty. In the case of DCS Type I and dif­ arrived for the transfer to WHASC and the hyperbarics
ficult evacuation circumstances, consideration may be team was activated. Within 3 hours of initial arrival to
made by the senior medical provider on the ground (with the BAMC ED, the patient underwent recompression.
telemedicine consultation if possible) for treating the ca­ Ten minutes into the “dive,” the patient reported full
sualty with high­concentration oxygen alone. resolution of all symptoms. He was discharged follow­
ing the completion of the full Table 6. Upon follow­up
It was by pure happenstance that all physicians involved the next day, the patient was doing well with no residual
in the care of this casualty were also qualified flight sur­ symptoms. He was cleared by his unit flight surgeon and
geons. Most SOF medical officer positions require flight returned to flight status 5 days later.
surgeon training, which is invaluable for recognition
and care of DCS and other dysbarisms. Additionally, Discussion
flight surgeon evaluation and occasionally waiver sub­
mission are required to return an aviator or parachutist This patient was the first DCS case to present to the
to status following an episode of DCS. BAMC ED in recent memory. It is a reminder that DCS
or AGE should be considered for any aviator, parachut­
ist, or diver presenting to a medical provider following
Case Conclusion
exposure to changes in pressure. In this case, vague and
The differential diagnosis at the time of the patient’s nondebilitating symptoms heralded a concerning diag­
presentation included complex migraine, concerning nosis. SOF operations place personnel at higher risk for
intracranial pathology including stroke or bleeding, DCS and other dysbarisms.
hypoxia, viral illness, heat stress, dehydration, AGE/
DCS, pneumothorax, and psychiatric etiology. Hypoxia Disclaimer
was deemed unlikely with normal room air oxygen satu­
ration and no improvement with high­flow oxygen. In­ The view(s) expressed herein are those of the authors
tracranial pathology seemed dubious with no headache, and do not reflect the official policy or position of the
a completely normal and extensive neurologic examina­ US Army Medical Department, the US Army Office of
tion, and symptom development immediately following the Surgeon General, the Department of the Army and
chamber training. Heat stress and dehydration seemed Department of Defense, or the US Government.
doubtful based on his clinical presentation, and a bo­
lus of IV fluid did not improve his symptoms. Viral ill­ Disclosures
ness was felt to be unlikely, as the patient was afebrile
and had no progression of any other symptoms typical The authors have nothing to disclose.
of viral illness. Psychiatric etiology was improbable, as
the patient had a normal mental status examination, no References
previous psychiatric history, and it would be inconsis­
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was made by the ED physician team. It was specifically trouble and the rationale of its treatment. Sci Am. 1911;72
(Suppl 1868):270–271.
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7. US Navy Supervisor of Diving. US Navy Diving Manual SS521-
A posteroanterior/lateral chest radiograph was negative AG-PRO-010, Revision 6, Vol. 5. Washington, DC: US Naval
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14 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015