UNCERTAINTY AFTER DIVING: Case Report and Recommendations #1.

A 53-YEAR-OLD MAN WAS DIVING at a resort in the South Pacific. He was doing approximately four dives per day; all his dives were on air, and all were within his computer’s no-decompression limits. In the evening on the third day, approximately three hours after his last dive and a half hour after dinner, he began to experience severe abdominal pain.

 The pain radiated to his back, just below his right shoulder blade. He vomited several times, felt weak and needed help walking. Concerned about the possibility of severe decompression sickness (DCS), his friends called a taxi and rode with him to the local hospital. Some things about this diver’s symptoms and recent history suggest DCS, and most doctors would include it on their list of differential diagnoses.

The evaluating physician in this case considered it, but he knew that other potential causes had to be eliminated first. After a cardiovascular emergency was ruled out, blood tests and ultrasound imaging of the diver’s abdomen revealed stones in the gallbladder that were causing acute inflammation. The diver underwent laparoscopic surgery and made a successful recovery.

SYMPTOMS OF DCS
Books and articles about DCS usually include an extensive list of signs and symptoms. It is important to remember that none of the signs and symptoms in any such list is exclusive to DCS. Here are examples of some of the most common symptoms of DCS:

• headache
• lightheadedness and/or dizziness
• nausea
• joint and/or muscle aches
• fatigue, lethargy and/or generalized weakness.

 
As you can see, these symptoms can apply to a wide range of medical conditions, not just DCS. This can make diagnosing DCS a challenge.

CONCLUSION
The signs and symptoms of DCS are not exclusive to that condition. However, when a person experiences signs or symptoms after diving, DCS is very often presumed to be the diagnosis. This is not all bad, because it encourages divers and dive staff to administer oxygen and ensure the injured diver gets prompt medical care. But it becomes a problem when divers refuse to accept alternative explanations and become fixated on the need for chamber therapy at the expense of other diagnostics and/or treatments that may be delayed.

In addition, the diversion of a nondiving-related emergency from appropriate medical treatment for an unnecessary recompression treatment, especially by air late at night, can introduce additional risks to the patient as well as the aircrew. There are many medical conditions much more serious than DCS for which timely treatment is critical. In the event of symptoms after diving, provide oxygen and get the injured diver to the closest medical facility.

Don’t hesitate to call EMS if the situation is serious, and feel free to call the DAN Emergency Hotline -for SOUTHERN AFRICA - +27 82 810 6010) at any time. Tell the doctor that the person was diving, and encourage him or her to contact DAN for consultation. But keep in mind that there are more dangerous ailments than DCS, some of which must be considered first.