What is the emergency treatment for Decompression Sickness (DCS)?

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Last updated: February 20, 2025 • View editorial policy

From the Guidelines

The emergency treatment for decompression sickness is immediate recompression in a hyperbaric chamber with 100% oxygen administration. This is based on the principle of reducing the size of gas bubbles in the body and increasing the dissolution of gas into the blood, allowing for its elimination through respiration, as supported by the use of hyperbaric oxygen therapy (HBOT) in treating patients with ischemic neurological symptoms secondary to air embolism or decompression sickness 1.

Steps to manage decompression sickness include:

  • Remove the patient from the water if still submerged
  • Administer 100% oxygen via a non-rebreather mask
  • Keep the patient lying flat and still to prevent further bubble formation
  • Transport the patient to the nearest hyperbaric facility as quickly as possible
  • Begin hyperbaric oxygen therapy, typically at 2.8-3.0 atmospheres absolute (ATA) for 4-6 hours
  • Provide intravenous fluids to combat dehydration

Additional considerations:

  • Do not allow the patient to fly or ascend to higher altitudes, as this can worsen symptoms
  • Administer aspirin (325 mg) to reduce platelet aggregation, unless contraindicated
  • Consider administering steroids to reduce inflammation if there's evidence of spinal cord involvement

The high oxygen concentration in HBOT helps oxygenate tissues and reduces inflammation, which is crucial in preventing long-term complications or permanent tissue damage in decompression sickness. Although the provided study 1 discusses the use of HBOT in the context of acute ischemic stroke, the principles of HBOT in treating decompression sickness are relevant and supported by the emergency treatment guidelines. Prompt treatment is essential to improve outcomes and reduce morbidity and mortality in patients with decompression sickness.

From the Research

Emergency Treatment for Decompression Sickness (DCS)

The emergency treatment for Decompression Sickness (DCS) involves several key steps, including:

  • Basic life support and advanced life support if necessary 2
  • Horizontal positioning of the victim 2
  • Administration of 100% normobaric oxygen via face mask or endotracheal tube 3, 2, 4, 5, 6
  • Rehydration with isotonic, glucose-free fluids 4
  • Rapid transportation to the nearest emergency department/hyperbaric facility for definitive treatment 3, 2, 4, 5, 6

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy is a critical component of DCS treatment, involving:

  • Recompression therapy combined with hyperbaric oxygen breathing 3
  • 100% O2 breathing at 2.82 atmospheres absolute (U.S.Navy Treatment Table 6 or equivalent) 4
  • Additional treatments (generally no more than one to two) for residual manifestations until clinical stability 4

Supportive Therapy

Supportive therapy for severe decompression-related injuries is mandatory after first-aid treatment has been given, including:

  • 100% normobaric oxygen breathing 3
  • Oral or i.v. fluids (crystalloids or dextrose saline) 3
  • Flat position on the back 3
  • Organization of appropriate means of transportation to the nearest hyperbaric center 3

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.