Dysbarism Clinical Presentation

Updated: Jun 15, 2018
  • Author: Stephen A Pulley, DO, MS, FACOEP; Chief Editor: Joe Alcock, MD, MS  more...
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Presentation

History

Any symptom or sign that appears during or following a dive is pressure-related until proven otherwise based on diagnostic or therapeutic recompression. Specifics about the dive should be elicited as follows:

  • Location - Ocean, lake, river, quarry, or cave

  • Timing - Time dives occurred, length of dives, surface intervals, safety stops, and type of timing used (eg, watch with tables, dive computer) (The diver's logbook or dive computer, along with all of his or her dive equipment, should accompany the diver each step of the way.)

  • Activities - Over the 72 hours prior to the dive (especially flying) and after the dive (including how transported)

  • Depth - Deepest point, approximate time spent at that depth, and rate of ascent

  • Work - Currents, distance swam, water temperature, and primary activity (eg, wreck diving, artifact recovery)

  • Gases and equipment - Compressed air, rebreathing equipment, and mixed gases

  • Problems - Violation of no-decompression limit dive tables, equipment, entanglement, dizziness, and marine bites or stings

  • Condition - Physical condition before, during, and after the dive (eg, fatigue, alcohol ingestion, fever, vertigo, nausea, overexertion, pulled muscles)

  • First aid received - Oxygen, positioning, medications, and fluids

  • Eyes or face - Hemorrhage and numbness

  • Ears - Pain, hearing loss, tinnitus, bloody discharge, and vertigo

  • Nose or sinuses - Pressure or pain associated with sinus locations, bloody nasal discharge, and numbness in infraorbital nerve distribution

  • Mouth - Dental pain

  • Neck - Edema, crackling, and hoarseness

  • Pulmonary - Dyspnea, hemoptysis, and chest pain

  • Gastrointestinal - Bloating, cramps, and pain

  • Musculoskeletal - Symptoms probably related to DCS

  • Skin - Rash or marks

  • Neurologic - Seizure, unconsciousness, confusion, headache, visual disturbance, paresis, and paresthesia (more likely related to DCS)

Next:

Physical Examination

Physical examination findings may include any of the following:

  • Distress secondary to pain

  • Eyes or face - Subconjunctival or scleral hemorrhage or edema, periorbital edema, nystagmus, facial petechiae, and red ring

  • Ears - Tympanic hemorrhage or perforation, hemotympanum, external canal blood, cerumen, mass, lack of mobility on pneumatoscopy, and evidence of sensorineural hearing loss

  • Nose or sinuses - Pain over sinuses with percussion or epistaxis

  • Mouth - Tooth tenderness to percussion

  • Neck - Subcutaneous emphysema, vocal changes, and neck vein distention

  • Pulmonary - Respiratory distress, decreased breath sounds, hyperresonance, and tracheal shift

  • Gastrointestinal - Distention

  • Skin - Subcutaneous emphysema

  • Neurologic - Unconsciousness, changes in mental status, blindness, hemiplegia, paresis, and paresthesia

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