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Decompression Sickness, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Multisystemic disease process resulting from escape of inert gas bubbles (nitrogen) out of solution into body fluids and tissues 

Etiology

Mechanism: 
  • Pathophysiology:

    • Increases in ambie...

Diagnosis

Signs and Symptoms

  • Cutaneous:

    • Scarlatiniform, erysipeloid, or mottled rash:

      • Mottling (Cutis marmorata) often indicates more severe disease

    • Peau d’orange appearance owing to lymphatic obstruction

  • ...

Treatment

Pre-Hospital

  • Cautions:

    • Recognize DCS:

      • Postdive extremity pain often attributed to muscle strain

      • Serious neurologic complaints often minimized because diver does not consider DCS

    • If air evacuation...

Follow-Up

Disposition

Admission Criteria

Refer all patients with suspected or diagnosed DCS for hyperbaric therapy. 

Discharge Criteria

  • Stable patients with mild symptoms may be discharged posthyperbaric ...

Pearls and Pitfalls

  • Difficult to distinguish musculoskeletal DCS from musculoskeletal pain

  • Significant fatigue may be the only symptom of DCS

  • Even minor symptoms or resolving symptoms suspected of being...

Additional Reading

  • Bennett  MH, Lehm  JP, Mitchell  SJ, et al. Recompression and adjunctive therapy for decompression illness. Cochrane Database Syst Rev.  2012;5:CD005277. doi:10.1002/14651858.C...

Codes

ICD9

993.3 Caisson disease 

ICD10

T70.3XXA Caisson disease [decompression sickness], initial encounter 

SNOMED

  • 89684003 Bends

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