ICU · environmental

Acute Decompression Illness — Comprehensive ICU Management (Diving Emergencies)

Also known as Decompression illness (DCI) · Decompression sickness (DCS) · The bends · Arterial gas embolism (AGE) · Pulmonary barotrauma · The chokes (pulmonary DCS) · The staggers (vestibular DCS) · Skin bends · Recompression therapy · Hyperbaric oxygen (HBO) · US Navy Treatment Table 6 · Dysbarism

Acute decompression illness (DCI) — the umbrella term for the two dysbaric injuries of ascent: decompression sickness (DCS, 'the bends') and arterial gas embolism (AGE). Both arise from bubbles formed when ambient pressure falls. DCS is driven by inert-gas (nitrogen) supersaturation during/after ascent — in-situ bubbles in tissues and blood — classically Type 1 (musculoskeletal joint pain 'the bends', skin itching/mottling 'skin bends', lymphatic) and Type 2 (neurological — spinal cord is the MOST SERIOUS form with paralysis, paraesthesia, bladder/bowel dysfunction; pulmonary 'the chokes' — cough, dyspnoea, substernal chest pain; vestibular 'the staggers' — vertigo, nystagmus, nausea). AGE is pulmonary barotrauma of ascent — breath-holding or too-rapid ascent over-expands alveoli → alveolar rupture → gas enters pulmonary veins → left heart → systemic arteries (brain most often) → stroke-like presentation during or within minutes of surfacing. Risk is increased by depth, bottom time, repetitive dives, rapid ascent, cold, exertion, dehydration, and a patent foramen ovale (paradoxical embolisation). Onset: AGE within minutes; DCS usually within minutes-to-hours, 98% within 24 h. Management is identical for both: 100% oxygen immediately (denitrogenates tissues and accelerates bubble resolution), IV isotonic glucose-free fluids (correct immersion diuresis and dehydration, avoid hypovolaemia), and DEFINITIVE recompression therapy — hyperbaric oxygen, most commonly US Navy Treatment Table 6 (100% oxygen at 2.8 ATA), which shrinks bubbles by Boyle's law (to ~one-third of surface volume), oxygenates ischaemic tissue, reduces oedema, and denitrogenates. Retrieve to the nearest hyperbaric chamber urgently — call the Divers Alert Network (DAN) 24-hour hotline. Delay to recompression worsens outcome — recompress as soon as feasible.