Decompression Illness: Causes and Treatments

Written by Medicover Team and Medically Reviewed by Dr Sateesh Pydi , General Medicine

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Decompression illness (DCI) is a term that encompasses various medical conditions arising from the reduction in ambient pressure surrounding a person, usually after scuba diving. These conditions are chiefly associated with the formation of gas bubbles in the blood or tissues due to rapid decompression.

What are the Causes of Decompression Illness?

Decompression illness occurs when dissolved gases, primarily nitrogen, come out of solution and form bubbles in the body. This phenomenon is often a result of a diver ascending too rapidly and not allowing sufficient time for the inert gases absorbed under pressure to be safely expelled from the body through respiration.

Acute decompression illness is a condition where symptoms develop suddenly when a diver ascends too rapidly from a deep dive, causing nitrogen bubbles to form in the blood, potentially blocking blood flow and harming tissues. This can lead to various symptoms like joint pain, dizziness, chest pain, or neurological problems such as paralysis.

The Role of Nitrogen in Decompression Illness

While diving, increased pressure allows for more nitrogen to dissolve into the body's tissues. If ascent occurs too quickly, the rapid decrease in pressure can lead to nitrogen coming out of solution too rapidly, forming bubbles in the bloodstream and tissues. This is akin to the fizz that forms in a soda bottle when opened quickly. These bubbles can cause a range of physiological disturbances, leading to decompression sickness, also known as "the bends".

When Should You See a Doctor for Decompression Illness?

Immediate consultation with an emergency care doctor or diving medicine specialist is necessary, as decompression illness can become life-threatening.

Any unusual symptoms after diving
Severe joint pain or muscle weakness
Difficulty breathing or chest pain
Confusion, dizziness, or neurological symptoms
Persistent fatigue or unusual discomfort after diving

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What are the Types of Decompression Illness?

Decompression illness is broadly classified into two types: Decompression Sickness (DCS) and Arterial Gas Embolism (AGE).

Decompression Sickness (DCS)

DCS, commonly referred to as "the bends", manifests when nitrogen bubbles form in tissues and blood. This can occur in various parts of the body, leading to joint and limb pain, dizziness, fatigue, and in severe cases, neurological symptoms.

Arterial Gas Embolism (AGE)

AGE occurs when gas bubbles enter the arterial system, which can happen if a diver holds their breath during ascent, causing lung over-expansion and the release of gas bubbles into the bloodstream. This can lead to serious complications such as stroke-like symptoms, unconsciousness, or even death.

What are the Symptoms and Signs of Decompression Illness?

Symptoms of decompression illness can vary widely depending on the severity and location of the bubbles. Common symptoms include:

Joint and muscle pain
Fatigue
Dizziness or vertigo
Skin rash
Difficulty breathing
Neurological manifestations such as confusion, visual disturbances, or paralysis

It is crucial for divers to recognize these symptoms early, as timely treatment is essential to prevent long-term damage or fatality.

Signs of Decompression Illness

Typical Signs of Decompression Illness are as follows:

Joint Discomfort: Commonly known as "the bends," this discomfort typically impacts the joints and muscles post-dive. It can span from mild unease to severe, immobilizing pain.
Sensation of Dizziness or Vertigo: A sense of instability, dizziness, or imbalance might arise, especially if nitrogen bubbles affect the brain.
Feeling Nauseous and Vomiting: The presence of bubbles in the bloodstream can lead to these symptoms, disrupting normal bodily functions.
Chest Pain or Difficulty in Breathing: Pain or breathing challenges could signify that bubbles are impacting the lungs, potentially resulting in pulmonary DCI.
Tingling Sensations or Paralysis: Nitrogen bubbles influencing the spinal cord can provoke neurological issues like tingling, weakness, or paralysis.
State of Confusion or Cognitive Decline: Brain-affected nitrogen bubbles may induce confusion, memory lapses, or cognitive difficulties.
Fatigue: A pervasive sense of extreme exhaustion or weakness post-dive might indicate potential decompression concerns.

How is the diagnosis of Decompression Illness?

Diagnosis of decompression illness is typically based on the patient's symptoms and history of recent diving activity. A thorough physical examination is conducted, focusing on neurological function and respiratory status. In some cases, imaging studies such as MRI may be used to assess the extent of injury, particularly in severe cases with neurological involvement.

Additional tests such as blood investigations and chest imaging may be performed to evaluate complications and rule out other conditions. Early recognition and prompt diagnosis are crucial to initiate timely treatment and prevent long-term complications.

What are the Treatments of Decompression Illness?

The primary treatment for decompression illness is hyperbaric oxygen therapy. This involves placing the patient in a hyperbaric chamber where they breathe 100% oxygen at increased atmospheric pressure. This treatment helps reduce the size of nitrogen bubbles and facilitates their elimination from the body.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy is effective because it increases the amount of oxygen in the blood, promoting healing and reducing edema in affected tissues. The increased pressure helps to dissolve nitrogen bubbles, alleviating symptoms and preventing further complications.

Supportive Care and Monitoring

In addition to hyperbaric therapy, supportive care is vital. Patients should be monitored for respiratory and cardiovascular stability, and pain management should be addressed. Hydration is also important, as it helps in the natural elimination of nitrogen through urination.

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How can be Preventive Strategies for Decompression Illness?

Preventing decompression illness is paramount for divers. The following strategies are recommended:

Adhering to Safe Diving Practices

Divers should follow established dive tables or dive computers to manage ascent rates and decompression stops. Avoiding excessive exertion during and after dives is also advisable, as it can increase the risk of bubble formation.

Pre-dive Planning and Education

Comprehensive pre-dive planning, including understanding dive profiles and limits, is essential. Divers should be educated on the risks of nitrogen narcosis and the importance of slow ascents and safety stops.

Fitness and Health Considerations

Maintaining physical fitness and addressing any underlying health issues can reduce the risk of DCI. Divers should avoid diving with a cold or congestion, as this can impede the equalization of pressure in air spaces.