Decompression Sickness: Current Recommendations

Decompression sickness (DCS, "bends") is the clinical condition triggered by generation of bubbles in tissues or blood due to supersaturation of inert gas during or after a reduction in ambient pressure. The condition can occur in association with compressed gas diving, compressed air ("caisson") work or rapid decompression to high altitude or reduced cabin pressure such as extravehicular activity (EVA) in space suits. It can also be triggered by mild reduction in ambient pressure such as during commercial aircraft flight after scuba diving. Its manifestations range from joint or muscle pain, lymphedema and skin rash to severe neurological abnormalities and cardiorespiratory collapse. Immediate evaluation should include a history of the diving/altitude event and timing of symptom onset, in addition to a careful neurological exam. Immediate treatment should include oxygen administration and appropriate resuscitation with oral or intravenous fluids; definitive treatment of DCS consists of hyperbaric oxygen. While residual manifestations may persist in severe instances, in most cases appropriate treatment results in good outcome.