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: