St. Patrick's Hospital Medical Center
Lopez Jaena St. Batangas City

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Email: info@philippinehyperbarics.com

 
 


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Decompression Illness ( DCI ) 

" The Bends "

         Decompression illness refers to the conditions Decompression sickness ( DCS ) and / or Arterial gas embolism( AGE ) and all of their clinical presentations and manifestations.

         Decompression sickness (DCS) is the most common condition that divers are familiar with. It results from gas coming out of solution in the bodily fluids and tissues when a diver ascends too quickly. This occurs because the decreasing pressure that results when moving from the deep to shallower levels lowers the solubility of gas in liquid - resulting in the gas turning into bubbles.

       Joint pain is the most common complaint in DCS, especially in the elbow, shoulder, hip and knee which if severe enough can make the patient bend over in pain , hence the term " bends " or the diver got " bent" . The gas bubbles can cause blockage of blood vessels causing ischemia ( lack of oxygen ) and infarction (damage) of tissues beyond the obstruction.

       Other symptoms are the mottled appearance of the skin and even edema or swelling in the involved area. More severe cases may involve the brain, the spinal cord, or the cardiopulmonary system. Neurologic manifestations may include sensory deficits, hemiplegia, paraplegia, paresthesias, and peripheral neuropathies. These mean that patients may feel a range of symptoms like itchiness, numbness, weakness to outright paralysis. Balance and coordination may also be affected. Possible cardiopulmonary effects include massive pulmonary gas emboli or myocardial infarction( heart attack ).

      The expansion of gas in the lungs may lead to alveolar rupture, also known as "Pulmonary Overinflation Syndrome," which may, in turn, result in arterial gas embolism (AGE). Which can present as breathing difficulties to convulsions to unconsciousness.

      Decompression sickness is treated with recompression in a chamber to 60 FSW or deeper, associated with hyperbaric oxygen breathing. In the US, this therapy is usually guided by a Navy Treatment Table. These tables are very effective, especially when recompression is begun promptly.

The Bubble and The Pressure

    On the earth's surface, the human body is exposed to an ambient pressure which is the result of the combined partial pressures of all the gases in the earth's atmosphere. At sea level, the force of this pressure is described as 1 atmosphere absolute (ATA). When diving, as the diver goes deeper the pressure increases forcing more gas to dissolve in the bodily fluids and tissues. Upon ascent, the atmospheric pressure decreases so there will be less pressure forcing the gas into solution. Rapid ascent may lead the gas to form bubbles causing decompression sickness (DCS) or alveolar rupture ("Pulmonary Overinflation Syndrome" )  with resultant bubbles in the arterial circulation (arterial gas embolism-AGE )

The Treatment

      Because of recreational scuba diving's increasing popularity, it has become the most common type of hyperbaric exposure. This then lead to the emergence of an increase interest in diving medicine as a specialty. For divers being afflicted with decompression illness or the bends, Hyperbaric oxygen (HBOT) therapy has become the treatment of choice. HBOT, aside from treating decompression sickness, however, is also being recognized as the definitive therapy for a growing number of disorders, including  AGE, Carbon monoxide poisoning, clostridial infections, crush injuries, diabetic leg ulcers, skin graft failures, refractory osteomyelitis, thermal burns, necrotizing soft tissue infections, and osteoradionecrosis.

     It is incumbent on divers, dive professionals and resort staff to be familiar with the symptoms of decompression Illness ( DCI ) as well as the procedures necessary to obtain  immediate and appropriate medical management for the victims. Recognizing the presence of DCI; access to a reliable hyperbaric facility compliant with international standards which is manned by appropriately trained personnel and a diving physician is important  because the hyperbaric chamber is now widely recognized as effective in reversing the sometimes-deadly changes that take place with decompression illness.

Batangas Hyperbaric Medicine & Wound Healing Center 2002. All rights reserved.