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Sections Decompression Sickness
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Media Gallery
- References
Diagnostic Considerations
Diagnostic considerations include the following:
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General - Dehydration, electrolyte imbalance, viral syndrome, exhaustion
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Mental status - Psychosis, hypoxia
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Eyes - Ophthalmic migraine, CNS lesion
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Ears - Tympanic membrane rupture, otitis media, external canal occlusion, round window rupture
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Pulmonary - Bronchospasm
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Cardiac - Pneumopericardium, supraventricular tachycardia
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Gastrointestinal - Enteritis, motion sickness, viral food poisoning
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Genitourinary - Urinary tract infection, prostatism, anticholinergic effect
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Neurologic - Radiculopathy, neurapraxia, hypoxia, round window rupture, alternobaric vertigo
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Musculoskeletal - Sprain, strain, fracture, fatigue, acute arthritis, herniated disk
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Skin - Dermatitis, allergic reaction, envenomation, contusion, arterial occlusion
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Toxicology - Carbon monoxide poisoning, marine life envenomation, substance abuse, medication adverse effects
As emphasized above, symptoms that occur following scuba diving may be due to decompression sickness (DCS). Many times, the only way to assist with this determination is a trial hyperbaric oxygen (HBO) recompression. However, some have symptoms temporally linked to diving that ultimately are determined to be nondiving-related issues. The take-home point is to consider DCS as a possibility but not to exclude others, especially if symptoms are atypical and the dive profile would not normally be expected to cause a problem.
Differential Diagnoses
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Heat exhaustion
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Illustration of Dalton gas law. As an individual descends, the total pressure of breathing air increases and the partial pressures of the individual components have to increase proportionally. Nitrogen at higher partial pressures alters the electrical properties of cerebral cellular membranes, causing an anesthetic effect. Oxygen at higher partial pressures can cause CNS oxygen toxicity.
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Illustration of Henry gas law. If nitrogen is added to a bottle, it diffuses into and equilibrates with the fluid. With a sudden release of pressure (decreased), such as when an individual ascends rapidly, a lag occurs before nitrogen can diffuse back to the nonfluid space. This delay causes nitrogen to bubble while still in the fluid.
Tables
Stephen A Pulley, DO, MS, FACOEP Clinical Professor, Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine; Attending Physician, Suburban Community Hospital; Costin Scholar, Midwestern University; EMS Physician, Montgomery County (PA)
Stephen A Pulley, DO, MS, FACOEP is a member of the following medical societies: American College of Osteopathic Emergency Physicians, American Osteopathic Association
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
James Steven Walker, DO, MS Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association
Disclosure: Nothing to disclose.
Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center
Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.
Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Medical Association of Georgia
Disclosure: Nothing to disclose.
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Sections Decompression Sickness
- Overview
- Presentation
- DDx
- Workup
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