Decompression Sickness

Decompression Sickness is a topic covered in the 5-Minute Emergency Consult.

To view the entire topic, please or purchase a subscription.

Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:

Emergency Central

-- The first section of this topic is shown below --

Basics

Description

Multisystemic disease process resulting from escape of inert gas bubbles (nitrogen) out of solution into body fluids and tissues

Etiology

Mechanism:
  • Pathophysiology:
    • Increases in ambient pressure cause increase in partial pressure of nitrogen inspired (as per Henry law, below).
    • Nitrogen accumulates in tissues in increasing concentrations the longer ambient pressures remain elevated.
    • Decompression sickness (DCS) results when ambient pressure keeping nitrogen in solution decreases too rapidly (on ascent), preventing gradual removal of excess body burden of nitrogen.
    • As the nitrogen removal gradient is overwhelmed, tissues become supersaturated and bubble formation occurs.
  • Henry law:
    • Amount of gas that will dissolve in a solution at a given temperature is directly proportional to partial pressure of that gas.
    • Increases in partial pressure result in larger amount of gas dissolved in tissue.
    • Decreases in partial pressure result in gas coming out of solution.
  • Bubbles are viewed as foreign material by body inciting inflammatory and coagulation responses
    • Leads to increased vascular permeability and decreased intravascular volume and hemoconcentration
  • Bubble location determines clinical effects:
    • Blood flow and lymphatic obstruction leading to ischemia, infarction, or lymphedema
    • Mechanical distention of tissues leading to pain
  • Risk factors for DCS:
    • Dive factors:
      • Greater depth
      • Longer bottom time
      • Multiple dives in a day
      • Rapid ascent
      • Cold water
    • Human factors:
      • Obesity
      • Intercurrent illness
      • Pulmonary disease
      • Dehydration
    • Proper use of dive tables and computers does not eliminate risk for DCS.
    • Predive vigorous exercise may reduce risk
  • 50% of patients develop symptoms in 1 hr, 90% develop symptoms within 6 hr.
  • Airplane flight following diving can precipitate DCS owing to lower cabin pressure.

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Decompression Sickness ID - 307696 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307696/all/Decompression_Sickness ER -