Decompression sickness, also called “the bends”, normally happens in individuals who actively engage in scuba diving, high-altitude flying, flying in commercial aircraft within 24 hours following the incident. Decompression sickness occurs relatively infrequently, however its effects can be extremely hazardous to health. Being aware of its effects and careful assessment of the victim can significantly result in lessening it’s morbidity.
Decompression sickness occurs when nitrogen bubbles become trapped inside the body. Nitrogen gasses typically accumulate in joint and muscle spaces that result in varying degrees of musculoskeletal pain, numbness and hyperesthesia. Moreover, the danger lies when these trapped bubbles become dislodged and become air emboli in the blood stream that can become a precursor to stroke, paralysis and death. Taking rapid assessment about the events preceding the symptoms is vital in treating decompression sickness. Recompression is very essential and necessary as soon as possible via a hyperbaric chamber to alleviate and correct the problem.
Assessment and Initial Management
To effectively identify decompression sickness, a detailed history must be obtained from the victim or someone associated with the individual who was present at the events. Evidence of rapid ascent, loss of air in the tank, buddy breathing, lack of sleep, recent alcohol intake, or flight within 24 hours following diving can suggest the possibility for decompression sickness.
Signs and symptoms include extremity and joint pain, hyperesthesia and numbness, loss of normal range of motion. Moreover, neurologic symptoms may be evident by mimicking those of spinal cord injury/stroke could highly indicate air embolus in the body. Cardiopulmonary arrest can very likely occur in severe cases. Because of the hypoxia being one of the primary complications of decompression sickness, very few individuals survive without prompt treatment. All cases can be effectively treated by recompression in a hyperbaric chamber to reverse the effects of decompression sickness.
Emergency clinical and medical management
A patent airway and sufficient ventilation must be properly established as described above and 100% oxygen must be immediately administered throughout transport and during the course of the treatment. A chest x-ray must also be obtained to identify aspiration and at least one intravenous line must be started with normal saline solution or lactated ringers as a precautionary measure for emergency medications to be promptly given when cardiac arrest occurs.
The cardiopulmonary as well as the neurologic systems must be constantly supported and monitored as well. If an air embolus is suspected, the head of the bed should be lowered to prevent any dislodged embolus to circulate in the systemic circulation. The victim’s wet clothes are removed and he/she must be kept warm to prevent hypothermia. Immediate transfer to the closest hyperbaric chamber is vital in order to prevent any existing complications from further worsening.
If transport necessitate flying (e.g. Rescue helicopter), low
altitude flight (below 1000 feet) is required. However, if the victim is conscious without any symptoms of neurologic deficits, he/she is permitted to be transported by ground ambulance or an appropriate emergency vehicle depending on the elicited symptoms. Throughout the treatment, the individual is continuously evaluated and changes are documented for any improvement or deterioration of the condition.