Emergency Medicine

Environmental Emergencies 209

SPORTS-DIVING ACCIDENTS

It is most commonly associated with sports-diving accidents with scuba (self-
contained underwater breathing apparatus) diving.

Decompression illness

Decompression illness (DCI) occurs when inert nitrogen gas forms bubbles
within the venous and lymphatic systems, or body tissues, rather than being
eliminated by the lungs.

DIAGNOSIS

1 Symptoms may occur within minutes of surfacing or up to 48 hours after
diving. It is important to look for and treat any patient who presents within
hours of a dive as DCI until proven otherwise.

2 Clinical manifestations include:
(i) Mild
(a) joint pain, ranging from a dull ache to the crippling ‘bends’.
Pain usually commences in large joints such as the elbow or
shoulder and may migrate
(b) unusual fatigue and malaise
(c) skin itching, marbling (cutis marmorata), scarlatiniform
rashes, painful lymphadenopathy and local oedema.
(ii) Serious
(a) cardiopulmonary:

• ‘the chokes’: retrosternal or pleuritic chest pain, dyspnoea,
  cough and haemoptysis


• may be associated with myocardial infarction, hypotension
  and cardiac arrhythmia, and progress to respiratory failure
  (b) central nervous system:


• ‘the staggers’: labyrinthine damage with deafness, tinnitus,
  nystagmus, vertigo and nausea


• motor and sensory loss with hemiplegia and paraplegia


• personality disorder, seizures and urinary retention.

3 Gain i.v. access and take blood for FBC, U&Es, LFTs, blood sugar level,
troponin and CK. The peak CK can be a marker for the severity of acute gas
embolism.

4 Perform an ECG and request a CXR in patients with cardiopulmonary
symptoms.

MANAGEMENT

1 Give the patient 100% oxygen by tight-fitting face mask with reservoir bag.
Manage the patient in the supine or left lateral position.

2 Commence normal saline rehydration, avoiding glucose-containing
solutions as they may exacerbate CNS injury.