Decompression Sickness (The Bends): Symptoms, Causes, and Emergency Treatment

What Is Decompression Sickness (DCS)?

DCS occurs when dissolved inert gases (mainly nitrogen) form bubbles in tissues and blood due to rapid pressure reduction (fast ascent from dive, altitude exposure, caisson work).

Mechanism

• At depth, increased ambient pressure → more gas dissolves in tissues (Henry's law).
• Rapid ascent → supersaturation → bubble nucleation (like opening a soda).
• Bubbles cause mechanical damage, endothelial activation, coagulation, complement activation, ischemia.

Symptoms (Onset: usually <6 hrs, up to 24–48 hrs)

Emergency Treatment

1. 100% Oxygen immediately (non-rebreather mask) — accelerates nitrogen washout.
2. IV fluids (crystalloid) — maintain perfusion.
3. Rapid transport to hyperbaric facility.
4. Hyperbaric Oxygen Therapy (HBOT): US Navy Table 6 (2.8 ATA) or Table 5; recompresses bubbles, oxygenates ischemic tissues.
5. Do NOT give ENTONOX (50% N₂O) — expands bubbles.

Prevention

• Dive tables/computers: no-decompression limits, safety stops (3 min @ 5 m / 15 ft).
• Controlled ascent rate (<9–10 m/min / 30 ft/min).
• Adequate surface intervals; avoid flying/altitude >24 hrs after diving.
• Hydration, fitness, avoid alcohol/cold.

DCS is a medical emergency. Delayed recompression worsens outcomes. Call DAN ([phone]) or local EMS.

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Type	Manifestations
Type I (Mild)	Joint/muscle pain ("the bends"), fatigue, skin rash (cutis marmorata), lymphadenopathy
Type II (Serious)	Neurologic: numbness, weakness, paralysis, bladder/bowel dysfunction, confusion, ataxia, visual/hearing changes. Cardiopulmonary: "chokes" (cough, dyspnea, substernal pain), shock.