Decompression Illness / DCI / The Bends

The treatment of Decompression Illness (DCI) is normally classified as an Emergency Referral due to the importance of obtaining qualified advice and the appropriate therapy as quickly as possible.

You may not consider your case to be an Emergency and be reluctant to bother us for advice. This attitude may delay urgently required treatment, which we can give you at our centre.

Who do I call for Advice ? Call London Hyperbaric Medicine on (+44) 020 8539 1222 if you are within easy striking distance of London or the Royal Navy Helpline on 07831 151 523 (24 hours)

Decompression Illness

Causes	The direct cause is due to bubble formation and growth within body organs and tissues. Mainly seen in divers but can be seen in high altitude pilots or astronauts as well as persons working in compressed air environments. The exact mechanisms are not fully understood but rapid ascents from depth or sudden decompression as well as incorrect decompression procedures do seem to be a cause. Effects differ from person to person but varying predisposing factors are thought to heavily contribute to DCI even with correct procedures. Breath holding and air trapping in the lungs during ascent or decompression may also lead to DCI as well as some heart defects.
Sources	Breathing compressed gases under pressure
Signs & Symptoms	Altered consciousness, balance and coordination problems, memory problems, headache, nausea and vomiting, vertigo, numbness and tingling, joint pain, unusual fatigue, paralysis, skin rashes, difficulty walking/standing, muscular weakness, difficulty urinating, difficulty breathing
HBO/recompression in the case of decompression illness/ sickness	Breathing oxygen under pressure allows the inert gas bubbles to 'offgas' and be removed from the body much quicker. HBO will also reduce swelling caused by bubble damage as well as oxygenate hypoxic tissues. The pressure will also shrink the size of the bubbles.
Pre hospital treatment	Ensure safe rescue, ABCs, High flow oxygen (preferably by demand valve), oral fluids such as water or isotonic sports drinks, Gain I.V. access (medical professional), I.V. fluids if safe (medical professional) Pain killing drugs or analgesic gases should not be given
Referral Criteria for Hyperbaric Oxygen Therapy/ Recompression	As the symptoms for DCI are so diverse, any symptom that cannot be readily explained after diving or other hyperbaric exposure should be assumed to be DCI until proven otherwise. Any symptoms that are suspected to have been caused by DCI should be treated in a hyperbaric chamber. Many believe that DCI can only be treated whilst in the acute phase (no longer than 7-10 days after symptom onset)
Duration of treatment	Standard treatment usually involves an initial session of Hyperbaric Oxygen Therapy of between 2 and 7 hours duration at pressures of between 2.8 and 4 ATA. Patients are then reassessed and further treatment is given if necessary until all symptoms have resolved or they reach a plateau (stay the same)
Aim of treatment	Reversal of symptoms and prevention of permanent damage tissues and organs, reduction of possible long-term effects.

Please do not contact us by e-mail if you think you may be suffering from Decompression Illness.

Our Duty Hyperbaric Doctor is always available to answer your questions should you be in any doubt about the severity or urgency of your particular case. Alternatively you may like to call one of our Duty Hyperbaric Supervisors who are also experienced divers.