Rapid reduction in ambient pressure, during ascent, causes dissolved gases to come out of
solution and form bubbles of nitrogen, the oxygen is rapidly metabolized in the tissues.

Gas bubbles can: 
– obstruct small blood vessels
– cause changes in blood chemistry
– stretch and damage tissues

Symptoms present within 12 hours.
– 80% within 1 hour of surfacing.
– 95% within 4 hours of surfacing.

TYPE I  – musculoskeletal limb pain
BENDS = periarticular pain in arms & legs (arms > legs)
pain relieved by direct pressure
pain can be mild, “Niggles,” to severe
skin/lymphatic involvement = pruritus, marbling, rashes

TYPE II – neurological
pain in areas other than the extremities
CNS changes = cord involvement or cerebral
spinal cord DCS = most common form of DCS in divers
paresthesia s – ascending numbness – paraplegia
urinary retention – fecal incontinence – priapism

Cerebral DCS:
classic CVA symptoms
pulmonary manifestations – “CHOKES”
occurs within minutes of surfacing
substernal chest pain – cough – dyspnea
can progress to respiratory failure and shock
labyrinthine or inner ear DCS – “STAGGERS”
vertigo – nausea/vomiting – tinnitus – hearing loss – nystagmus
100% oxygen (helps to wash out nitrogen)
IV fluid therapy with crystalloid (hemoconcentration)
diazepam or phenergan for vertigo – nausea – vomiting
should not dive for 6 months after DCS & not until full evaluation

to reduce the size of the bubbles
to promote reabsorption
prevent further bubble production

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