Decompression illness symptoms not to ignore after diving

Each year DAN receives thousands of emergency and information calls. Most calls are basic fitness-for-diving questions, but many calls involve a diver with symptoms after diving. These symptoms may herald the occurrence of Decompression Illness (DCI) in a diver.

What to look for

The obvious question for divers is this: "Which symptoms should I be concerned about after a dive?" Clearly, not every ache and pain after diving indicates DCl. Many times an increase in exertion can result in muscle or joint soreness, stiffness and general discomfort.

Most symptoms probably will require a physician to evaluate the diver. It will require a medical practitioner with diving medical knowledge to do an assessment and to diagnose if DCI is possible after studying a diver’s dive profiles and previous medical history – including acute and chronic illness and injury.
The following symptoms and situations are some of the more common scenarios. Often the symptoms occurred many hours after a dive. Should you or a dive buddy experience any of these symptoms, we advise you to call DAN or act immediately.

Post-dive Pain

Pain is the most common first symptom reported to DAN in cases of DCl. Depending on the level of discomfort, the diver may need to see a physician immediately. For divers, non-DCl pain is more common than DCI-related pain. Non-DCI pain often resolves by the next morning without treatment after the diver has rested. As a result of this, many divers have adopted a “wait and see” attitude. This works against the diver who is actually experiencing mild DCI or the beginnings of a more serious pressure-related injury.

The Warning Signs

Over the years, DAN has identified characteristics that can serve as warning signs to help guide divers and dive professionals. DCI pain can occur within minutes – or hours – after a dive. Usually the pain is constant, it does not change with movement. It may start in a hand or wrist and expand to the forearm or shoulder. Divers most often describe the pain as a different sort of pain than they have previously experienced. Gradual symptom onset can mislead divers; seeking relief, they may self-medicate with non-steroidal medications like aspirin or ibuprofen, and these are not effective for DCI.

Paraesthesia

This symptom is better known to divers as numbness, tingling, so called “pins and needles” feelings or altered skin sensations. It also frequently occurs in combination with pain.
Paraesthesia is more subtle than pain. A diver may only sense a change in touch to the skin. This is a good reason to seek DAN or medical advice about their symptoms. Divers can describe only the symptoms they are aware of; they may be unaware of the loss of sensation on their backs or a more serious symptom such as weakness in one or both legs. While weakness is more serious than a mild tingling sensation, it can go undetected without a medical evaluation.

Anxiety with hyperventilation (rapid breathing) can cause tingling in both hands and both feet and with serious anxiety can lead to loss of consciousness while a diver is still in the water.

Divers should not take a “wait and see” attitude about paraesthesia.

Balance Problems

Balance and walking difficulties represent a very serious side effect of DCl that require immediate medical attention. There may be other reasons for having balance or walking difficulties, such as middle ear barotrauma or head injuries. Walking difficulties may be a sign of weakness and paraesthesia in the legs.

Rash

Rashes can be caused by a large variety of things, such as allergy, various marine organisms, chemicals in the water, among others. However, rashes can also be associated with DCI and can be a useful warning signal. Recently, increasing numbers of divers who have reported mottled rashes after diving have been diagnosed with a Patent Foramen Ovale (PFO). A PFO can increase the likelihood of serious decompression illness. Such a rash may disappear with oxygen breathing but divers are well advised to call a DAN’s Hotline to get prompt advice.

Respiratory Difficulties

Difficulty breathing after a dive can represent a number of medical issues, not just barotrauma. Many things can happen during a dive that will produce breathing difficulties or even barotrauma. Respiratory symptoms are especially important for divers because they represent numerous potential injuries and complications for the lung.

Breathing difficulty is not a common DCI symptom, but can occur in conjunction with other symptoms. It is because the lungs are vital to gas exchange and circulation that divers should call for assistance immediately if they have sustained an injury or if a medical condition has been intensified by diving.
Besides shortness of breath, injured divers often complain of chest pain, chest burning and chest pressure. This may indicate something else to a medical professional who factors in medical history and the circumstances of the dive. Don’t take chances: call DAN or get a medical facility involved.

Get Treatment, Even After Oxygen

Divers have reported the recurrence of serious symptoms when they received no follow-up treatment after first aid. Symptoms may have partially or even fully resolved after receiving oxygen only to recur or worsen when oxygen provision was ceased prematurely and/or there was no further treatment (e.g. in situations where transport to a recompression facility will take some time, DAN AP often advises divers to breathe oxygen constantly for 4 to 5 hours). It is important to stay on oxygen until told to stop by a diving physician. Oxygen is the first step in the healing process after a pressure-related dive injury. A decompression injury usually requires further treatment in the form of recompression therapy. While oxygen is the correct first aid treatment and may initially help, it is not the definitive treatment for DCI.

Act!

Don’t waste time with possible self-diagnosis or by getting a consensus among your dive buddies. While serious cases are relatively infrequent, quick thinking and action by those involved can have a positive effect on the outcome of injured divers.

Recommendations

• Call early if you have symptoms.• Boost your knowledge of what to look for through courses and careful observation.
• Know that divers can be fooled by symptoms.
• Oxygen first aid should be commenced as soon as possible and continued until a dive medical physician advises otherwise.  

This is not a complete list of DCI symptoms. Divers should be especially concerned when symptoms come on shortly after a dive, especially those occurring within the first hour.  
www.danap.org/emergency.php
For complete article visit: www.danap.org/symptoms.ph

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