Is a medical condition caused by dissolved gases emerging from tissue and blood as bubbles inside the body tissues after a rapid ascend to the surface from a deep dive.

Our body can sustain pressure upto ATA 2.5 times level of N2 in our body with out having effects of having DCS, Upto depth of 15 meters. with out having the effects of bubble formation

It can present delayed upto 48 hrs from the dive

Flying after Diving

Diving with in NDL (No decompression Limit is based on the factor of N2, how much our body can tolerate the levels of N2 with out having the effects of DCS, Based on T1/2 of Tissue saturation)
Single Dives: minimum preflight surface interval of 12 hrs is suggested
Multiple dives in a day: Surface interval of 18 hrs is suggested
Diving with Decompression stops
Had Deco Dive > 24 hrs.
Violated all the rules of diving >48 hrs watch out for the DCS

Safety Stop

Safety stop of 3 min at depth of 5 meters mandatory for depths deeper than 30 meters

Emergency Decompression

NDL is exceeding no more than 5 minutes- 8 minutes of decompression stop at 5 meters

NDL is exceeding more than 5 minutes – 15 minutes of safety stop required at 5 meters, (air supply permits)

should be out of water for 24 hours,

if couldn’t do the required time period , dive computer locks for 48 hours – for safety Diving

avoid depth more than 30 meters
ascend no more than 18 meters /minutes, or watch your dive computer beeping
falling in pressure groups W or X – surface interval of 1 hr mandatory
Falling into pressure groups of Y or Z – 3 hours SI mandatory
follow the dive computer – more conservative computer

How to avoid DCS

Avoid heavy activity before your dive, don’t swim before diving
Proper wet suit to protect form cold
Drink water and juices
Maintain your Buoyancy
Avoid Heavy Current and exertion under water
Don’t hold your breath during ascending
Avoid hot shower after diving and hot weather
avoid Gym activity for 1 day after diving- late onset of DCS can occur in heavy Gym activity

Decompression Sickness (DCS):

Depend upon Individual susceptibility and physique

Not necessary the sign and symptoms present in the line of order, can start from any systems given below

Musculoskeletal system – Muscle and Joints

Joint or muscle pain
Reduced range of motion
Unusual sound in joints when moved

Skin

Itching
Rash, blotches, and/or marbling
Lumps or swelling

Gastrointestinal effects

Nausea or vomiting
Abdominal cramps
Diarrhea

Heart and Lungs

Coughing
Bloody or frothy sputum
Chest pain
Painful breathing
Rapid breathing or shortness of breath
Decrease in blood pressure

Neurological effects

Cerebrum, cerebellum, spinal cord, inner ear, and nervous system)
EFFECTS ON BRAIN: –
Mental confusion or memory loss
Headache
Lack of coordination
Tremors
Visual disturbance
Involuntary eye movement
Dizziness or vertigo
Hearing loss
Unconsciousness/ leading to Death- severe DCS
EFFECTS ON NERVES OF LIMBS: –
Numbness or reduced sensation
Feeling of being stuck by pins and needles
EFFECTS ON SPINAL CORD:-
Urinary incontinence or the inability to void
Partial or full paralysis of lower limbs

Decompression Illness (DCI)/ Arterial Gas Embolism (AGE):

As air in the diver’s lungs expands on ascent, increasing volume proportionally to keep the pressure equal to the surrounding pressure (Boyle’s law in action), the expanded gas must be able to escape. This is achieved by continuously breathing or breathing out during an ascent. If the maximum volume of the lungs is reached by holding your breath on ascent, the lungs get over-pressurized and may start to tear or rupture.

Arterial gas embolism, abbreviated as AGE, occurs if air escapes through tears in lung alveoli and goes into the bloodstream (pulmonary capillaries). Air can enter tissue or the bloodstream, which may lead to serious injury or death. Over-pressurizing can easily happen: Even ascending 1 to 1.5 meters/3 to 5 feet with full lungs can give rise to lung injuries. Especially in shallow water, the pressure drop (respiratory volume increase) per ascended 1 meter/3 feet is greatest as you get closer to the surface.

Although these symptoms are comparable to those of DCS, AGE symptoms are rapid and dramatic, whereas DCS symptoms are somewhat delayed. Symptoms occur during and immediately after surfacing.

It may be difficult, in many cases, to differentiate between the types of DCI when evaluating a victim in the field. The overriding concern is that a general diagnosis of DCI be made and that the appropriate first aid treatment is given.

Any Sign and symptoms starting immediately after the dive should be considered DCI

Signs and Symptoms

It Usually effects by formation of large gas bubbles which will obstruct the flow of blood to parts of the body. Synonym – AGE – arterial Gas embolism, These can cause varied presentations, not necessary in the order given in here.

EFFECTS OF BUBBLES ON OUR SYSTEMS

Medical Terminology –

NO. 1. Air embolism to brain: rupture of air bubbles in the lung arteries carry gas bubble thru carotids to the brain, causing block in the arteries supplying blood to brain, leading to sudden loss of consciousness and death

No. 2. Mediastinal Emphysema- rupture of air bubble from the lung towards the heart side,

No. 3. Subcutaneous “crackling” when touched – Surgical Emphysema

No. 4. Tension Pneumothorax – rupture of Air bubble between the Lung and chest wall, cause leak with a flap closing and opening with each breath, air accumulating and increasing with each breath taken

comparison of symptoms	EMBOLISM/DCI	DCS
ONSET OF SYMPTOMS	Usually with in 5 minutes of surfacing	Tend to be delayed
Most common symptoms	Sudden unconsciousness	Pain in joints & Fatigue
Location of Symptoms	one side of the body/ paralyzed	both sides of the body(Joints)
Changes of symptoms	May improve as a result of first aid	Usually no change or worsening of the condition
Use computer between your EARS.	Follow Dive computers	Most common cause- DIVER ERROR

Follow Rules and principles of Diving, plan dive appropriately

Treatment

The early management of AGE and DCS is the same. Although a diver with severe DCS or AGE requires urgent re-compression for definitive treatment, it is essential that they be stabilized at the nearest medical facility before transportation to a chamber. Early oxygen first aid is important and may reduce symptoms substantially, but this should not change the treatment plan.

Symptoms of AGE and serious DCS often clear after initial oxygen breathing, but they may reappear later. Because of this, always contact your country’s diving emergency services or a dive physician in cases of suspected DCS or AGE—even if the symptoms and signs appear to have resolved.

First Aid for DCI- Diver is Conscious

The emergency response to all cases of DCI, including Type I and Type II DCS and Barotrauma, is the same:

Remove the victim to a safe area where emergency first aid can be administered
Administer 100% O2
Conduct the Rapid (Field) Neurological Exam
Activate the EMS system and follow instructions
Protect against hypothermia and, if possible, remove wet clothing and replace with dry clothes or covering
Encourage the diver to rest and to remain calm and still
Protect the diver from excessive heat
Provide fluids for re-hydration

Diver Semiconscious or Unconscious

If unconscious, place the diver in the lateral recumbent (recovery) position. Lay them on their left side, with the upper leg bent at the knee. The body should be horizontal or, if a backboard is available, the head can be lowered approximately 30º below horizontal plane. (This may help reduce bubble migration to the brain.) Ensure that the airway is open.
Perform CPR if required
Provide 100% oxygen
Activate EMS

Hyperbaric Chamber

Hyperbaric chamber is available with Dr Soliman Fakeeh Hospital and Marine Coat guards.

its based on your profile of diving, to max depth a diver had dived based on your SPG and Dive computer log

Diver will be placed in chamber where there will be continuous supply of 100 percent oxygen and taken to a pressure based on the SPG or Dive Computer, intermittent refresh air with air breaks with normal air for 5 min.

Hyperbaric treatment

Dark blue are the air breaks which is given for 5 min

Light blue is the time you spend under 100 percent oxygen. usually they have PaO2 up to 1.6, any chances of oxygen toxicity is managed with the emergency team ready at that point.

This helps removes nitrogen from our body at much faster rate

This may last for 4 to 8 hours depend upon your depth profile