ABCDE and call the National Diving Accident Helpline 07831 151 523 (in England and Wales) or 0345 408 6008 (Scotland) or Divers Alert Network (Worldwide) +191968491111.

  1. OXYGEN– this is the most effective management of decompression illness in the emergency department. It improves prognosis and is usually all patients need in terms of analgesia. ALL PATIENTS SHOULD BE STARTED ON HIGH FLOW OXYGEN AT 15L/MIN VIA A NON-REBREATHE MASK REGARDLESS OF THEIR OXYGEN SATURATIONS
  2. CHEST X-RAY – A good chest examination and CXR are very important to identify a possible pneumothorax or pulmonary oedema. Pneumothorax is a particular concern in divers because gas expands in the lungs as divers ascend, possibly causing an overexpansion.
    • Insert a chest drain if there is evidence of a pneumothorax.
  3. FLUIDS– oral if the patient is alert, not vomiting, and is passing urine. Have a very low threshold for giving IV fluids.
    • Insert a catheter if there is any suspicion the patient may be in retention

Things you shouldn’t do

  • Do not give Entonox under any circumstances to anyone who has recently dived as the nitrous oxide is highly soluble and will increase the inert gas load, making the symptoms of DCI worse. It can also expand within the air filled spaces of the body and cause barotrauma to the lungs, ears, sinuses or gut.
  • Do not give pain killers unless you have a very long transfer to a chamber, and only after discussion with a diving doctor. Oxygen is usually sufficient to control pain. NSAIDs are best avoided as they can exacerbate micro-haemorrhages caused by DCI (particularly in neurological DCI) which can lead to permanent sequelae. Opiates should also be avoided where possible as they can increase the risk of oxygen toxicity. Patients will be exposed to high partial pressures of oxygen during recompression therapy and so lowering their toxicity threshold can be dangerous and may increase their likelihood of a seizure.

Recompression Therapy

Recompression therapy is the definitive treatment of decompression illness and involves the patient being transferred to a dedicated facility. The patient is re-pressurised in a chamber breathing 100% oxygen at a high partial pressure.

There are 3 main effects of recompression therapy:

i. Bubble crushing: as per Boyle’s law, increasing pressure decreases the volume of bubbles

ii. Flushing out the nitrogen bubbles with oxygen

iii. Healing damaged tissue with hyperbaric oxygen

Learning Bite

The most important thing you can do for a diver in the emergency department is put them on high flow oxygen and call the National Diving Accident Helpline (or Divers Alert Network).

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