Decompression sickness (DCS), also known as the bends, is an illness brought about by a sudden pressure change. The nickname came about because the sufferer tends to bend due to the great pain caused by the disease. Back in the days, mine workers suffered continuously from it at the end of their working day when they reached the surface after being submerged deep in the mines for many hours. At the beginning of SCUBA diving days, many divers experienced paralysis and other conditions that were recognized only after years of researches as DCS. Symptoms in divers have a more serious presentation as the underwater pressure is greater.
What is DCS in regarding to SCUBA diving?
DCS is a disease comes from the nitrogen bubbles that accumulate the bloodstream by breathing compressed gas under high pressure while under water. The air we breathe underwater from compressed cylinders travels from the lungs to the bloodstream forming tiny bubbles in the blood due to the high pressure. If we rise too fast these bubbles may expand before our body has time to release them. These bubbles do not cause harm while we are underwater but can cause serious damage if we do not follow gas releasing and safety precautions. How to avoid DCS? Before mentioning the prevention, we should note that there are no standard causes of DCS as it may come from many internal and external reasons such as: Fatigue, dehydration, certain health conditions, excessive sweating before a dive, or ascending faster than the accepted rate. The accepted rate is between 10 and 18 meters per minute, not taking into consideration the safety or decompression stops required for deep diving, observing diving profiles that are fluctuating rapidly or not following the diving computer safety limits and procedures during the dive, hard work, massage, hot showers, running or working out after the dive. To avoid DCS you should avoid the causes mentioned above before, during and after the dive, follow safe diving profiles that start with the deepest dive first, follow your training limits, take your safety or decompression stops seriously and be a good diver. Also avoid high altitudes after the dive such as flying before your body is clear from the nitrogen bubbles. Typically wait twelve to eighteen hours after the dive or more as recommended by your dive computer or divemaster. E,g; the picture below shows Dan`s post diving flying limits
What are the signs and symptoms of DCS?
DCS symptoms present post dive, not during the dive, and sometimes can take up to 48 hours to appear, and as stated by www.diversalertnetwork.org/ (DAN). DCS can be classified into type 1 and type 2, depending on the case in hand. Find below the screenshots from DAN website attached
How does the treatment work and what are the right steps to consider when DCS symptoms are recognized? We conducted a workshop affiliated with Dahab specialized hospital where the CEO Dr Maged answered numerous questions regarding DCS and the recompression chamber methodology. Here are some important questions and answers that most divers are curious to know about: Q: what is the idea behind the recompression chamber?A: it is a chamber that provides high-pressure conditions similar to a diving environment. It has two rooms; the first room is the main one. It is bigger in size and can accommodate up to 6 patients at the same time. The second room is minor and its importance is to balance the pressure inside the chamber so the physician may visit the patient to provide assistance or perform an assessment. It contains multiple breathing masks that can provide the specific concentration of oxygen required by each patient individually. Every patient receives the gas necessary for healing DCS, which ranges from the air, 21 per cent oxygen, to 100 per cent oxygen. It also contains a control panel where the nurses and physicians monitor the patient via cameras and microphones while controlling the pressure inside the chamber.
Basically, the treatment requires placing the patient back in diving conditions, in regards to the pressure, and then gradually reduces the depth, or the pressure, using the correct procedures of decompression stops, safety stops and breathing gas that will expel the nitrogen bubbles from the bloodstream out through the lungs by the patient’s own breathing. The chamber uses a high-pressure environment combined with oxygen delivery to assist the patient’s body in releasing potentially harmful nitrogen bubbles.
Q: what are the bases to consider as the right way of treating the DCS patient: A: Based on the patient`s conditions, whether the symptoms are related to DCS type I or II, the physician decides what depth he should place the patient in. Usually, most conditions are applied to a depth of 60 Ft. (18 M) – 2.8 ATA – then he decides which diving table to apply. Diving tables used are the NAVY tables 5 or 6 as it pushed the limits up to 1.6 partial pressure of O2.
Q: what are the first and main steps to take as a physician to treat a DCS patient?
A: 1- Diagnoses and assessment of the pre, during and post-diving circumstances.
2- Chest X-ray to make sure that the patient’s chest can handle the pressure.
3- Arterial blood gases analysis (ABG).
4- Deciding which NAVY diving table to apply based on the case in hand.
Q: How long does it take from the beginning until the patient gets in the chamber?
A: Maximum of 1 hour
Q- How much does the chamber itself cost? And how much is it for the diving patients?
A: The chamber costs 4.5 to 12 million Egyptian pounds (226,000 to 677,966 USD) and for the patients, it is 400 to 500 Euro per hour.
Q: would the recompression chamber be used for non-diving related issues?
A: Sure thing, as it always good to push oxygen into your body tissues for both medical and nonmedical reasons such as
- Diabetic foot cases
- Nervous system related issues
- Keep a youthful look
- Or just cleaning sessions for divers or pilots as well as any individual who works in pressure related jobs.