Decompression Illness (DCI)
We offer specialised Medical Care for Commercial and Recreational Scuba Divers suffering from or suspecting any level of Decompression Illness (DCI).
With our 24-hour Emergency Response System (EMS) in place, the Hyperbaric Therapy Treatment area within the Poseidonia Medical Centre employs fully trained Hyperbaric Physicians and Nurses, Certified Technicians and experienced ECHCO Chamber Operators and ECHM In-Chamber Medical Attendants.
Our Emergency Standby Response is throughout the year 24/7. We follow internationally recognised treatment profiles based on US Navy, Royal Navy, COMEX, UHMS and European Undersea & Baromedical Society (EUBS) protocols.
These Internationally acclaimed and recognised bodies set the benchmarks for Decompression Illness (DCI) and HBOT treatments globally. All protocols are applied to the Doctor’s recommendation depending on the severity of and the resolution to signs and symptoms. The patient will be given treatments ideally until all symptoms are completely resolved, symptoms have platitude or if necessary alternative treatments are necessary.
If you believe a diver to be suffering from Decompression Illness in Cyprus:
Contact the 24-hour emergency helpline on: +357-99-518837
Steps to Help a Diver until Medical Treatment Can be Administered
- Administer 100% Oxygen
- If the victim is conscious and able to tolerate, administer 1 litre of non-fizzy fluid (water) orally in small amounts
- Lay the victim down flat or if worried about vomiting place victim in recovery position Keep monitoring ABCs and record details as much as possible. Consider carrying out a 5-minute neurologic exam if you are suitably qualified
- Do not administer any painkilling drugs
- NEVER GIVE ENTONOX
- Do not ration any Oxygen Administration to try and make it last longer if Oxygen is administered then signs and symptoms of DCI may appear to resolve, however, it is still important to continue Oxygen therapy until advised otherwise by a Qualified Diving Physician.
- Decompression Illness has no definitive presentation or test to confirm its presence. Symptoms can be vague and subtle, and any area of the body can be involved. If at any time you are concerned about any signs or symptoms after diving call the 24-hour helpline on +357-99-518837.
Type I decompression sickness is the least severe form of DCS. It usually involves only pain in the body and is not immediately life-threatening.
However, the symptoms of Type I decompression sickness may be warning signs of more severe problems.
Overview Of Decompression Illness
The earliest descriptions of Decompression Illness (DCI) used the term “bends” for joint and/or skeletal pain, “chokes” for breathing problems and “staggers” for neurological problems. In 1960, Golding introduced the terms Type 1 for symptoms involving the skin, musculoskeletal system and/or lymphatic system and Type 2 for the more serious symptoms where the CNS was involved. However, neurological symptoms may develop after the initial presentation of Type 1 Decompression Sickness (DCS). For this reason, both Type 1 and 2 Decompression Sickness (DCS) have the same initial treatment protocol. In fact, symptoms may appear at any time between surfacing and 72 hours.
Due to the potential severity of Decompression Sickness (DCS), much research has gone into preventing and treating it. Prevention methods include scuba divers using dive tables and/or computers to limit their exposure to pressure and their ascent speed.
Decompression Sickness (DCS) commonly refers to a specific type of scuba diving hazard but may also result from other types of depressurisation events (snorkelling, free diving, etc.) Caisson disease is seen in workers decompressing from the watertight structures (caissons) used for working underwater in the construction of bridges, dams, the repair of ships, etc.
Flying in unpressurized aircraft, or sudden depressurization of an aircraft also causes Decompression Sickness (DCS), as does extra-vehicular activity (EVA) from spacecraft. EVA includes work done by an astronaut away from the Earth and outside a spacecraft like spacewalks, moonwalks, and repairs done in space. Astronauts on the International Space Station preparing for EVA remain at low atmospheric pressure, 10.2 psi (pounds per square inch or 0.70 bar) for eight hours before their spacewalk. During the EVA they breathe 100% O2 in their spacesuits which operate at 4.3 psi (0.30 bar).
For many other medical conditions, the therapeutic principle of HBOT lies in its ability to drastically increase the partial pressure of O2. Partial pressure refers to the pressure that the gas would have if it alone occupied the volume under consideration. The O2 partial pressures achievable using HBOT are much higher than those present while breathing pure O2 at normobaric (normal barometric pressure equivalent to that at sea level).
Another therapeutic effect is the increased oxygen transport capacity of the blood. Under normobaric conditions, O2 transport is limited by the O2 binding capacity of haemoglobin in the red blood cells (RBC’s). Haemoglobin (Hb, Hgb) is the iron-containing oxygen transport metalloprotein that transports O2 from the lungs to tissues all over the body. When it releases O2 (and other chemicals) it picks up the used O2 (carbon dioxide or CO2). Under normal pressures, very little O2 is transported by the blood plasma. Blood plasma comprises 55% of blood volume and is composed of 90% water. Blood cells are suspended in the blood plasma. However, plasma stimulated by HBOT can significantly increase O2 transport.
The incidence of DCS is considered rare at 2.8 cases per 10,000 dives. The risk is 2.6 times greater for males than females. DCS affects about 1,000 U.S. scuba divers per year. In the U.S., it is common for medical insurance not to cover treatment for DCS that is a result of recreational diving. A typical stay in a re-compression chamber can easily cost several thousand dollars, even before emergency transportation is included. Groups such as DAN offer insurance policies that specifically cover all aspects of treatment for DCS at rates of less than $100/year.
Symptoms of Decompression Illness usually develop more slowly than do those of air embolism and pulmonary barotrauma. Only half of the people with decompression sickness have symptoms within 1 hour of surfacing, but 90% have symptoms by 6 hours. Symptoms commonly begin gradually and take some time to reach their maximum effect. The first symptoms maybe
- Loss of appetite
- A vague feeling of illness
Type I decompression sickness (less severe)
The less severe type (or musculoskeletal form) of decompression sickness, often called the bends, typically causes pain. The pain usually occurs in the joints of the arms or legs, back, or muscles. Sometimes the location is hard to pinpoint. The pain may be mild or intermittent at first but may steadily grow stronger and become severe. The pain may be sharp or may be described as “deep” or “like something boring into the bone.” It is worse when moving.
Less common symptoms include itching, skin mottling, swollen lymph nodes, rash, and extreme fatigue. These symptoms do not threaten life but may precede more dangerous problems.
Type II decompression sickness (more severe)
The more severe type of decompression sickness most commonly results in neurologic symptoms, which range from mild numbness to paralysis and death. The spinal cord is especially vulnerable.
Symptoms of spinal cord involvement can include numbness, tingling, weakness, or a combination in the arms, legs, or both. Mild weakness or tingling may progress over hours to irreversible paralysis. Inability to urinate or inability to control urination or defecation may also occur. Pain in the abdomen and back also is common.
Symptoms of brain involvement, most of which are similar to those of air embolism, including
- Trouble speaking
- Double vision
- Loss of consciousness is rare.
Symptoms of inner ear involvement, such as severe vertigo, ringing in the ears, and hearing loss, occur when the nerves of the inner ear are affected.
Symptoms of lung involvement caused by gas bubbles that travel through the veins to the lungs produce cough, chest pain, and progressively worsening difficulty breathing (the chokes). Severe cases, which are rare, may result in shock and death.
Late effects of decompression sickness
Dysbaric osteonecrosis (sometimes called avascular bone necrosis) can be a late effect of decompression sickness or can occur in the absence of decompression sickness. It involves the destruction of bone tissue, especially in the shoulder and hip. Dysbaric osteonecrosis can produce persistent pain and severe disability. These injuries rarely occur among recreational divers but are more common among people who work in a compressed-air environment and divers who work in deep underwater habitats. There is often no specific initiating event the person can identify as the source of symptoms once they do appear.
These workers are exposed to high pressure for prolonged periods and may have an undetected case of the bends. Technical divers, who dive to greater depths than recreational divers, may be at higher risk than recreational divers. Dysbaric osteonecrosis usually produces no symptoms but if it occurs close to a joint it may gradually progress over months or years to severe, disabling arthritis. By the time severe joint damage has occurred, the only treatment may be a joint replacement.
Permanent neurologic problems, such as partial paralysis, usually result from delayed or inadequate treatment of spinal cord symptoms. However, sometimes the damage is too severe to correct, even with appropriate treatment. Repeated treatments with oxygen in a high-pressure chamber seem to help some people recover from spinal cord damage.
Causes of Decompression Sickness
The main cause of Decompression Sickness is the reduction in pressure due to the formation of bubbles and inert gases inside the tissues of the body. This condition happens when a person leaves an environment or moves from lower altitude to higher altitude.
The important causes of this disease are
- Departure from High-Pressure Environment
There are many regions, where this condition is very common. If a person leaves that pressure area, he may experience a reduction in atmospheric pressure. When Astronauts come out from space ship, they also experience a similar situation.
- Climb from Depth
This is the diver’s disease that affects the divers who breathe gas which has high pressure than surface pressure. The divers dive from greater depth and when they go for breath-holding, the risk of Decompression Sickness increases.
- Climb to Altitude
When suddenly an unpressurized Aircraft goes to the higher Altitude, decompression sickness is a common problem in this situation.
- Decompression Sickness and Aviation
This condition is mostly seen in Aeronauts and Aircraft Flights. The technology of Airplanes has become faster and the flights of planes are increased due to this reason the risk of Decompression Sickness is increased.
Diagnosis of Decompression Illness
Doctors recognise decompression sickness by the nature of the symptoms and their onset in relation to diving. Tests such as computed tomography (CT) or magnetic resonance imaging (MRI) sometimes show brain or spinal cord abnormalities but are not reliable. However, recompression therapy is begun before the results of a CT or MRI scan are available, except in cases in which the diagnosis is uncertain or the diver’s condition is stable. MRI is usually diagnostic of dysbaric osteonecrosis.
Normally, this condition can be detected if you notice the symptoms of the disease due to a drop in pressure within 24 hours of diving. If the symptoms remain for more than 6 hours than the Diagnosis methods mentioned previously like MRI and CT scans are used. This diagnosis is done to identify the presence of bubbles in the body.
Treatment For Decompression Illness
Here at Poseidonia Healthcare, the treatment we offer for Decompression Illness:
The optimal treatment is the use of a hyperbaric oxygen chamber, which is a high-pressure chamber in which the patient receives 100% oxygen. This treatment reverses the pressure changes that allowed gas bubbles to form in the bloodstream. The treatment drives nitrogen back into its liquid form so that it can be cleared more gradually from the body over a period of hours.
Type II decompression sickness is the most serious and can be immediately life-threatening. The main effect is on the nervous system.
When nitrogen bubbles affect the nervous system they can cause problems throughout the body. This type of DCS normally shows as tingling, numbness, respiratory problems and unconsciousness.
Symptoms can spread quickly and if left untreated can lead to paralysis or even death.
Medical professionals with oxygen may treat minor cases of DCI; in time, the excess nitrogen in the body will naturally off-gas. More serious situations, including rapid uncontrolled ascents from significant depth, usually require re-pressurization in a hyperbaric oxygen chamber.
Immediate on the scene treatment consists of oxygen therapy and basic first aid. This should be followed as quickly as possible by recompression treatment in a recompression chamber. When treating decompression sickness, the delay in beginning recompression treatment can be the biggest single cause of residual effects.
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