Examination

As with any unwell patient, the patient should be assessed using an ABCDE approach.

Once the patient is stable, the most important aspects of a decompression illness examination are:

• Chest examination: a thorough chest examination, pulse oximetry and a chest x-ray are helpful in looking for any pulmonary barotrauma, subcutaneous emphysema and subsequent tension pneumothorax. It can also help with assessing for immersion pulmonary oedema, another relatively common problem in divers caused by the fluid shifts which occur during immersion. Immersion pulmonary oedema is discussed in more detail later on.
• Neurological examination: a full neurological examination including a thorough assessment of power, reflexes and sensation (sharp/ blunt, soft touch, vibration) as well as co-ordination, balance (gait, Rombergs, Unterbergers) and cranial nerves is very helpful for a diving physician to then be able to monitor progress after recompression treatment. It may not always be necessary to be quite so thorough in an emergency setting.
• Joint examination: musculoskeletal DCI usually causes a deep unremitting joint pain which is unchanged on movement and palpation.
• Skin examination: cutaneous DCI presents with cutis marmorata, a mottled appearance of the skin possibly associated with pruritis.