![]() Re-immersion pulmonary edema can occur, and its mechanism is similar to negative pressure pulmonary edema. Decompression illness is a term that encompasses both AGE and DCS.ĪGE can also occur outside the setting of diving, e.g., during central line placement, flushing, or removal. Stroke symptoms such as bilateral or unilateral motor or sensory changes, aphasia vertigo, ataxia, dysmetria, cortical blindnessĪGE and DCS are often hard to distinguish, and they are managed similarly. Shortness of breath, hemoptysis, crepitus AGE has even been documented following breath holding ascents of as little as one meter (e.g., in swimming pools). Unlike DCS, which requires sufficient time at depth to cause a high nitrogen load, AGE can occur anytime a diver breathes compressed gas, regardless of the depth or duration of the dive. When air entry is in sufficient quantity to overwhelm the pulmonary capillary network, systemic arterial air embolization ensues.Ĭlassically described in setting of submarine escape training, where participants breathe compressed air at depth and then perform rapid ascents while holding their breath. Beware: there are other diseases that can mimic decompression syndrome and barotrauma:Īrterial gas embolism (AGE) may mimic decompression syndromeĭefined as gas bubbles in the arterial system and occurs when change in atmospheric pressure is rapid enough to cause lung injury.ĭecreasing surrounding atmospheric pressure during ascent inversely expands lung volumes resulting in barotrauma and subsequent alveolar damage facilitating entry of air bubbles into the pulmonary venous circulation. Severe barotrauma can result in pneumothorax or tympanic membrane rupture. Lymphedema resulting from lymphatic obstructionīarotrauma to the ears, sinuses, and lungs presents with local pain or shortness of breath during the dive itself. Pulmonary manifestations, such as wheezing and shortness of breathīladder or bowel incontinence (due to spinal cord lesions) Symptoms of DCS (listed in decreasing order of overall prevalence): The onset of symptoms within 10 minutes is more suggestive of gas embolism, whereas DCS tends to present after 10 minutes. The median time to symptom/sign onset is 30 minutes and severe neurologic symptoms tend to present within 10 minutes.ĩ0% of patients will experience onset of some symptoms or signs within 3 hours, and nearly all experience symptoms or signs within 24 hours of emerging from the water. Time of onset and the specific symptoms/signs aid in establishing the diagnosis. Sinuses: Sinus pressure and pain may be observed in divers who dive with sinus congestion or when the effect of decongestants wears off during diving.Īre you sure your patient has decompression syndrome or barotrauma? What should you expect to find?ĭecompression syndrome is a clinical diagnosis. Symptoms of vertigo may be related to rupture of the round window or, in the acute setting, may reflect neurologic involvement of DCS. Otherwise, pain followed by hemorrhage, development of serous middle ear effusion, or tympanic membrane rupture may develop. Auto-insufflation involves forcing air up the Eustachian tube, typically by swallowing or by performing a Valsalva maneuver. As surrounding water pressure increases, a diver must be able to equalize the pressure in the middle ear by auto-insufflation. Middle ear: Injury is commonly seen in inexperienced divers who are not adept at equalizing middle ear pressures during descent. Holding one’s breath or performing a Valsalva maneuver during ascent may result in pulmonary barotrauma. Lungs: Injury arises from pulmonary overinflation due to decreasing surrounding atmospheric pressure during ascent (as described by Boyle’s law).
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