Decompression Sickness is NOT Self-Limited and Requires Immediate Active Treatment
No, decompression sickness (DCS) is definitively not a self-limited disease—untreated DCS shows progressive worsening rather than spontaneous resolution, and without recompression therapy, severe cases can be fatal. 1
Why DCS Requires Active Intervention
Progressive Pathophysiology Without Treatment
- DCS results from dissolved inert gas forming bubbles in tissues and blood vessels during or after ascent, causing mechanical tissue disruption, vascular occlusion, platelet activation, endothelial dysfunction, and capillary leakage 1, 2
- The natural history demonstrates progressive worsening rather than spontaneous resolution, with recurrent episodes typically more severe than the initial incident, indicating cumulative tissue damage 1
- This is fundamentally different from self-limited conditions that resolve without intervention
Life-Threatening Potential
- Severe DCS with neurological manifestations (motor weakness, ataxia, altered mental status) or pulmonary involvement (chest tightness, cough, dyspnea, hypotension) can be fatal if recompression therapy is not administered 1
- Arterial gas embolism, which may occur alongside DCS, can present with sudden neurological deficits, convulsions, or sudden death from coronary embolism 1
- DCS is explicitly described as "a life-threatening condition if left untreated" 3
Essential Treatment Protocol
Immediate First Aid
- High-flow 100% oxygen administration is recommended as first aid for all cases and can be definitive treatment for most altitude DCS 2
- Isotonic, glucose-free fluids are recommended for prevention and treatment of hypovolemia 2
- Horizontal body position should be maintained during transport 4
Definitive Management
- Hyperbaric oxygen recompression is the definitive treatment for DCS and should be performed as soon as possible 5
- The standard protocol is 100% oxygen breathing at 2.82 atmospheres absolute (U.S. Navy Treatment Table 6 or equivalent) 2
- Additional treatments (generally no more than one to two) are used for residual manifestations until clinical stability; some severe cases may require more treatments 2
Critical Clinical Timing
Symptom Window
- Symptoms typically develop within 24 hours of surfacing, with the diagnosis being primarily clinical based on timing of symptom onset after ascent 1
- Symptoms may appear up to 24 hours after decompression, requiring continued monitoring during this entire period 4
Prognosis Depends on Rapid Treatment
- Prognosis is variable but improved by rapid recompression therapy, with prompt hyperbaric treatment recommended for all cases 1
- Early recognition and prompt administration of high-flow oxygen with referral to the nearest hyperbaric chamber for recompression is the optimal treatment protocol 3
Common Pitfall to Avoid
The most dangerous error is assuming mild symptoms will resolve spontaneously—even minor complaints after diving warrant serious consideration of decompression illness, as every dive carries risk and could result in DCS, barotrauma, and/or death 5. Contact a center specialized in diving and hyperbaric medicine immediately when DCS is suspected 5.