page_title: Decompression sickness
section_title: Treatment
hierarchical_section_title: Decompression sickness / Treatment
caption_attribution_description: The decompression chamber at the Neutral Buoyancy Lab.
context_page_description: Decompression sickness describes a condition arising from dissolved gases coming out of solution into bubbles inside the body on depressurisation. DCS most commonly refers to problems arising from underwater diving decompression, but may be experienced in other depressurisation events such as emerging from a caisson, flying in an unpressurised aircraft at high altitude, and extravehicular activity from spacecraft. DCS and arterial gas embolism are collectively referred to as decompression illness.
  Since bubbles can form in or migrate to any part of the body, DCS can produce many symptoms, and its effects may vary from joint pain and rashes to paralysis and death. Individual susceptibility can vary from day to day, and different individuals under the same conditions may be affected differently or not at all. The classification of types of DCS by its symptoms has evolved since its original description over a hundred years ago. The severity of symptoms varies from barely noticeable to rapidly fatal.
  Risk of DCS caused by diving can be managed through proper decompression procedures and contracting it is now uncommon.
context_section_description: All cases of decompression sickness should be treated initially with 100% oxygen until hyperbaric oxygen therapy (100% oxygen delivered in a high-pressure chamber) can be provided. Mild cases of the "bends" and some skin symptoms may disappear during descent from high altitude; however, it is recommended that these cases still be evaluated. Neurological symptoms, pulmonary symptoms, and mottled or marbled skin lesions should be treated with hyperbaric oxygen therapy if seen within 10 to 14 days of development.
  Recompression on air was shown to be an effective treatment for minor DCS symptoms by Keays in 1909. Evidence of the effectiveness of recompression therapy utilizing oxygen was first shown by Yarbrough and Behnke, and has since become the standard of care for treatment of DCS. Recompression is normally carried out in a recompression chamber. At a dive site, a riskier alternative is in-water recompression.
  Oxygen first aid has been used as an emergency treatment for diving injuries for years. If given within the first four hours of surfacing, it increases the success of recompression therapy as well as decreasing the number of recompression treatments required. Most fully closed-circuit rebreathers can deliver sustained high concentrations of oxygen-rich breathing gas and could be used as a means of supplying oxygen if dedicated equipment is not available.
  It is beneficial to give fluids, as this helps reduce dehydration. It is no longer recommended to administer aspirin, unless advised to do so by medical personnel, as analgesics may mask symptoms. People should be made comfortable and placed in the supine position (horizontal), or the recovery position if vomiting occurs. In the past, both the Trendelenburg position and the left lateral decubitus position (Durant's maneuver) have been suggested as beneficial where air emboli are suspected, but are no longer recommended for extended periods, owing to concerns regarding cerebral edema.
  The duration of recompression treatment depends on the severity of symptoms, the dive history, the type of recompression therapy used and the patient's response to the treatment. One of the more frequently used treatment schedules is the US Navy Table 6, which provides hyperbaric oxygen therapy with a maximum pressure equivalent to 60 feet (18 m) of seawater for a total time under pressure of 288 minutes, of which 240 minutes are on oxygen and the balance are air breaks to minimise the possibility of oxygen toxicity.
  A multiplace chamber is the preferred facility for treatment of decompression sickness as it allows direct physical access to the patient by medical personnel, but monoplace chambers are more widely available and should be used for treatment if a multiplace chamber is not available or transportation would cause significant delay in treatment, as the interval between onset of symptoms and recompression is important to the quality of recovery. It may be necessary to modify the optimum treatment schedule to allow use of a monoplace chamber, but this is usually better than delaying treatment. A US Navy treatment table 5 can be safely performed without air breaks if a built-in breathing system is not available. In most cases the patient can be adequately treated in a monoplace chamber at the receiving hospital.
caption: The recompression chamber at the Neutral Buoyancy Lab.
exif: {"Image Make": "NIKON CORPORATION", "Image Model": "NIKON D80", "Image Orientation": "Horizontal (normal)", "Image XResolution": "300", "Image YResolution": "300", "Image ResolutionUnit": "Pixels/Inch", "Image Software": "Ver.1.01", "Image DateTime": "2008:03:17 12:56:00", "Image YCbCrPositioning": "Co-sited", "Image ExifOffset": "216", "Thumbnail Compression": "JPEG (old-style)", "Thumbnail XResolution": "300", "Thumbnail YResolution": "300", "Thumbnail ResolutionUnit": "Pixels/Inch", "Thumbnail JPEGInterchangeFormat": "27816", "Thumbnail JPEGInterchangeFormatLength": "8969", "Thumbnail YCbCrPositioning": "Co-sited", "EXIF ExposureTime": "1/20", "EXIF FNumber": "53/10", "EXIF ExposureProgram": "Shutter Priority", "EXIF ISOSpeedRatings": "400", "EXIF ExifVersion": "0221", "EXIF DateTimeOriginal": "2008:03:17 12:56:00", "EXIF DateTimeDigitized": "2008:03:17 12:56:00", "EXIF ComponentsConfiguration": "YCbCr", "EXIF CompressedBitsPerPixel": "4", "EXIF ExposureBiasValue": "0", "EXIF MaxApertureValue": "47/10", "EXIF MeteringMode": "Pattern", "EXIF LightSource": "Unknown", "EXIF Flash": "Flash did not fire", "EXIF FocalLength": "62", "EXIF SubSecTime": "50", "EXIF SubSecTimeOriginal": "50", "EXIF SubSecTimeDigitized": "50", "EXIF FlashPixVersion": "0100", "EXIF ColorSpace": "sRGB", "EXIF ExifImageWidth": "3872", "EXIF ExifImageLength": "2592", "Interoperability InteroperabilityIndex": "R98", "Interoperability InteroperabilityVersion": "[48, 49, 48, 48]", "EXIF InteroperabilityOffset": "27678", "EXIF SensingMethod": "One-chip color area", "EXIF FileSource": "Digital Camera", "EXIF SceneType": "Directly Photographed", "EXIF CVAPattern": "[0, 2, 0, 2, 1, 2, 0, 1]", "EXIF CustomRendered": "Normal", "EXIF ExposureMode": "Auto Exposure", "EXIF WhiteBalance": "Auto", "EXIF DigitalZoomRatio": "1", "EXIF FocalLengthIn35mmFilm": "93", "EXIF SceneCaptureType": "Standard", "EXIF GainControl": "Low gain up", "EXIF Contrast": "Normal", "EXIF Saturation": "Hard", "EXIF Sharpness": "Hard", "EXIF SubjectDistanceRange": "0"}