6-5
inspiration), tachypnea, cough, irritability, or loss of consciousness; pain in the hip, abdomen, thorax, pelvis
or spine.
Objective: Signs
Using Basic Tools: Perform a complete dive history and neurological exam per the example in the appendix.
Numbness, pain, weakness or paralysis of limbs, diminished or absent reflexes, decreased cognitive function,
poor coordination, ataxia, hearing loss, vomiting, tachypnea, coughing; unconsciousness. Auscultation of
crackles in lung fields.
Using Advanced Tools: CXR to rule out pneumothorax.
Assessment:
Differential Diagnosis: Arterial gas embolism, myocardial infarction, trauma, pulmonary embolus and
many others.
Plan:
Treatment
Primary
- 100% oxygen immediately.
- Hyperbaric oxygen (HBO) recompression therapy as soon as possible. Refer to Figure 6-1 and treatment
tables in this chapter. - Complete neurological exam prior to recompression if symptoms allow. Otherwise, perform exam at
depth. - Pregnancy test for all women of childbearing age. If patient is pregnant, benefit of recompression
treatment needs to outweigh risks to unborn child (possible: retrolental fibroplasia, in utero death, birth
defects). - If transportation to HBO chamber is necessary, transport supine and fly below 1000 ft or pressurize the
cabin to below 1000 ft. If transporting on land, avoid mountain areas if possible (exacerbates DCS
symptoms). Use fluid instead of air in bulbs on Foley, ET tube, etc. to reduce risk of rupture with
pressure changes. - Ensure patient remains well hydrated. Fully conscious patients may be given fluids by mouth. 1-2 L
of water, juice or non-carbonated drink, over the course of a Treatment Table 5 or 6, is usually sufficient.
Stuporous or unconscious patients should always be given IV fluids (normal saline at a rate of 75-125
cc/hr). If the patient is obviously dehydrated, an initial 1L bolus of normal saline may be given (for an
otherwise healthy patient). No Ringer’s lactate until patient is urinating. Keep fluids running so urine is
clear and > 30 cc/hour. Catheterize patients unable to urinate. Keep patient warm and have them avoid
exertion during recompression. - Surface if ACLS is needed and can be administered. Operational chambers are not usually equipped or
approved for ACLS treatment. Follow algorithm at end of this section (Figure 6-1) for no improvement
or deteriortion. If it appears that the patient has died in the chamber, a qualified medical person who may
examine and pronounce someone dead must be consulted prior to aborting the recompression treatment.
If treatment is aborted, chamber should surface as early as possible ensuring the inside tender does not
get DCS.
Alternate: Submarine escape pod may be used if no hyperbaric chamber is available. 100% oxygen.
Primitive: 100% oxygen. In-water recompression (extremely risky; follow “In Water Recompression” instruc-
tions in Navy Dive Manual, Revision 4).
Patient Education
General: Recompression and hyperbaric oxygen is the treatment of choice for DCS.
It is strongly recommended that pregnant women should not dive. Patient should not fly within 72 hours of
recompression treatment.
Diet: Continue taking in clear fluids. Urine should be clear and of adequate volume (30 cc/hr). Eat solid