Cited Passage
CHAPTER 17 — Diagnosis and Treatment of Decompression Sickness and Arterial Gas Embolism 17 -11
symptoms. Pain should not be treated with drugs in an effort to make the patient
more comfortable. The pain may be the only way to localize the problem and
monitor the progress of treatment.
17 - 4.2.2 Cutaneous (Skin) Symptoms. The most common skin manifestation of
decompression sickness is itching. Itching by itself is generally transient and does
not require recompression. Faint skin rashes may be present in conjunction with
itching. These rashes also are tran sient and do not require recompression. Mottling
or marbling of the skin, known as cutis marmorata (marbling), may precede a
symptom of serious decompression sickness and shall be treated by recompression
as Type II decompression sickness. This condition starts as intense itching,
progresses to redness, and then gives way to a patchy, dark-bluish discoloration of
the skin. The skin may feel thickened. In some cases the rash may be raised.
17 - 4.2.3 Lymphatic Symptoms. Lymphatic obstruction may occur, creating localized
pain in involved lymph nodes and swelling of the tissues drained by these nodes.
Recompression may provide prompt relief from pain. The swelling, however, may
take longer to resolve completely and may still be present at the completion of
treatment.
17-4.3 Treatment of Type I Decompression Sickness. Type I Decompression Sickness
is treated in accordance with Figure 17-2 . If a full neurological exam is not
completed before initial recompression, treat as Type II DCS.
Symptoms of musculoskeletal pain that have shown absolutely no change after the
second oxygen breathing period at 60 feet may be due to orthopedic injury rather
than decompression sickness. If, after reviewing the patient’s history, the Diving
Medical Officer feels that the pain can be related to specific orthopedic trauma or
injury, a Treatment Table 5 may be completed. If a Diving Medical Officer is not
consulted, Treatment Table 6 shall be used.
17-4.4 Symptoms of Type II Decompression Sickness. In the early stages, symptoms of
Type II decompression sickness may not be obvious and the stricken diver may
consider them inconsequential. The diver may feel fatigued or weak and attribute
the condition to overexertion. Even as weak ness becomes more severe the diver
may not seek treatment until walking, hearing, or urinating becomes difficult.
Initial denial of DCS is common. For this reason, symptoms must be recognized
during the post-dive period and treated before they become too severe. Type II,
or serious, symptoms are divided into three categories: neurological, inner ear
(staggers), and cardiopulmonary (chokes). Type I symptoms may or may not be
present at the same time.
17 - 4.4.1 Neurological Symptoms. These symptoms may be the result of involvement of
any level of the nervous system. Numbness, paresthesias (a tingling, pricking,
creeping, “pins and needles,” or “electric” sensation on the skin), decreased
sensation to touch, muscle weakness, paralysis, mental status changes, or motor
performance alterations are the most common symptoms. Disturbances of higher
brain function may result in personality changes, amnesia, bizarre behavior,
lightheadedness, lack of coordina tion, and tremors. Lower spinal cord involvement