A little knowledge about decompression sickness (DCS) can help you with a fast response to the emergency room. One of the most common problems in the management of dive accidents is delay in seeking help. If you are worried you may be suffering from a diving-related medical problem, don’t hesitate and take action.
The chamber of Bonaire is not equipped to receive patients directly; patients must be evaluated in an ER firstMedical staff is available at the hospital of Kralendijk to provide recommendations about the need for medical care. If you experience symptoms after diving, get to the emergency room.
A discussion of medical history and recent diving history is essential for diagnosing DCI.
The doctor will ask about your medical history and conduct a physical exam. Provide as much information as you can about your symptoms and dives. Be prepared to tell the doctor the number of dives you made over the past few days, the depths and times of the most recent dives, the maximum depth of the deepest dive in the series and the gases you breathed. Also, make sure to mention any rapid ascents, omitted decompression or other problems.
Bring your dive computer with you; it can provide information such as dive profiles and ascent rates that may be of interest to the doctor.
The Physical and Neurological Exams
For a patient who was diving, the most important parts of the physical exam are the assessments of the ears, lungs, heart, skin and neurological function.
The doctor will check your ears for signs of barotrauma, such as visible damage to the eardrums and blood or other fluid in the middle ears. He will listen to your lungs and heart for abnormal sounds and will examine your skin for any rashes that might be suggestive of DCS.
The exam is a series of observations, questions and measurements used to evaluate motor strength and sensation all over the body, the function of the 12 cranial nerves, reflexes, balance, coordination and cognition. Impaired balance or coordination is relatively common in people with neurological decompression illness (DCI).
Making the Diagnosis
When it comes to diving-related medical conditions, diagnosis may be especially difficult since both forms of DCI — DCS (or “the bends”) and arterial gas embolism (AGE) — are clinical diagnoses. This means there are no definitive medical tests that can prove these conditions are present. The diagnosis is instead the result of a thorough history, identification of abnormalities during the physical exam and data gathered from other tests and observations.
Your doctor may also may order a chest Xray or CT-scan to check for problems with your lungs, including such conditions as pneumothorax (a collection of air in the space around the lungs) or evidence that air has leaked outside the lung into other areas such as the mediastinum (the area around the heart) or in subcutaneous (under the skin) spaces. In addition, a chest X-ray can identify fluid in the lungs that may suggest cardiac problems, immersion pulmonary edema or water aspiration.