Decompression sickness (the “bends”) is a painful condition that results from a too-rapid change from a high- to low-pressure environment (decompression). Most victims are scuba divers who ascend too quickly from water deeper than 30' (9.1 m) and pilots and passengers of unpressurized aircraft who ascend too quickly to high altitudes.
Decompression sickness results from an abrupt change in air or water pressure that causes nitrogen to spill out of tissues faster than it can be diffused through respiration. It causes gas bubbles to form in blood and body tissues, which produce excruciating joint and muscle pain, neurologic and respiratory distress, and skin changes.
Symptoms usually appear during or within 30 minutes of rapid decompression, although they may be delayed up to 24 hours. Typically, decompression sickness results in:
❑ “the bends,” deep and usually constant joint and muscle pain so severe that it may be incapacitating
❑ transitory neurologic disturbances, such as difficult urination (from bladder paralysis), hemiplegia, deafness, visual disturbances, dizziness, aphasia, paresthesia and hyperesthesia of the legs, unsteady gait and, possibly, coma
❑ respiratory distress (known as the “chokes”), which includes chest pain, retrosternal burning, and a cough that may become paroxysmal and uncontrollable.
Such symptoms may persist for days and result in dyspnea, cyanosis, fainting and, occasionally, shock. Other symptoms include decreased temperature, pallor, itching, burning, mottled skin, fatigue and, in some patients, tachypnea.
Treatment consists of recompression and oxygen administration, followed by gradual decompression. In recompression, which takes place in a hyperbaric chamber (not available in all hospitals), air pressure is increased to 2.8 absolute atmospheric pressure over 1 to 2 minutes. This rapid rise in pressure reduces the size of the circulating nitrogen bubbles and relieves pain and other clinical effects. During recompression, intermittent oxygen administration, with periodic maximal exhalations, promotes gas bubble diffusion. After symptoms subside and diffusion is complete, a slow decrease of air pressure in the chamber allows for gradual, safe decompression.
Supportive measures include fluid replacement in hypovolemic shock and, sometimes, corticosteroids to reduce the risk of spinal edema. Opioids are contraindicated because they further depress impaired respiration.
❑ To avoid oxygen toxicity during recompression, tell the patient to alternate breathing oxygen for 5 minutes with breathing air for 5 minutes.
❑ During oxygen administration, make sure all electrical equipment is grounded. Prohibit smoking, the use of electric appliances such as razors, and the use of blankets made of wool or other materials that produce static electricity in the patient’s room.
❑ If the patient with bladder paralysis needs catheterization, monitor intake and output.
❑ To prevent decompression sickness, advise divers and pilots to follow the U.S. Navy’s ascent guidelines.
Review other book chapters online related to Decompression sickness:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
What do you think about the features of this website?
Take our user survey and have your say:
Next articles: Tools & Services:
Medical Articles:
Treatment
Special considerations
Book Source Details
More About Decompression sickness
More Medical Textbooks Online about Decompression sickness
Medical Books Excerpts
More About This Book:
Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Surveys relating to Decompression sickness
Rate This Website
Medical Tools & Articles:
Forums & Message Boards
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
