Cited Passage
17-12 U.S. Navy Diving Manual — Volume 5
can cause disruption of urinary function. Some of these signs may be subtle and
can be overlooked or dismissed by the stricken diver as being of no consequence.
The occurrence of any neurological symptom after a dive is abnormal and should
be considered a symptom of Type II decompression sickness or arterial gas embo -
lism, unless another specific cause can be found. Normal fatigue is not uncommon
after long dives and, by itself, is not usually treated as decompression sickness. If
the fatigue is unusually severe, a complete neurological examination is indicated to
ensure there is no other neurological involvement.
17 - 4.4.2 Inner Ear Symptoms (“Staggers”). The symptoms of inner ear decompression
sickness include: tinnitus (ringing in the ears), hearing loss, vertigo, dizziness,
nausea, and vomiting. Inner ear decom pression sickness has occurred most often
in helium-oxygen diving and during decompression when the diver switched
from breathing helium-oxygen to air. Inner ear decompression sickness should be
differentiated from inner ear barotrauma, since the treatments are different. The
“Staggers” has been used as another name for inner ear decompression sickness
because of the afflicted diver’s difficulty in walking due to vestibular system
dysfunction. However, symptoms of imbalance may also be due to neurological
decompression sickness involving the cerebellum. Typically, rapid involuntary eye
movement (nystagmus) is not present in cerebellar decompression sickness.
17 - 4.4.3 Cardiopulmonary Symptoms (“Chokes”). If profuse intravascular bubbling
occurs, symptoms of chokes may develop due to congestion of the lung circulation.
Chokes may start as chest pain aggravated by inspiration and/or as an irritating
cough. Increased breathing rate is usually observed. Symptoms of increasing lung
congestion may progress to complete circulatory collapse, loss of consciousness,
and death if recompression is not insti tuted immediately. Careful examination for
signs of pneumothorax should be performed on patients presenting with shortness
of breath. Recompression is not indicated for pneumothorax if no other signs of
DCS or AGE are present.
17 - 4.4.4 Differentiating Between Type II DCS and AGE. Many of the symptoms of Type II
decompression sickness are the same as those of arterial gas embolism, although
the time course is generally different. (AGE usually occurs within 10 minutes
of surfacing.) Since the initial treatment of these two conditions is the same and
since subsequent treatment conditions are based on the response of the patient
to treatment, treatment should not be delayed unneces sarily in order to make the
diagnosis.
17-4.5 Treatment of Type II Decompression Sickness. Type II Decompression Sickness
is treated with initial compression to 60 fsw in accordance with Figure 17-1 . If
symptoms are improved within the first oxygen breathing period, then treatment
is continued on a Treatment Table 6 . If severe symptoms (e.g. paralysis, major
weakness, memory loss, altered consciousness) are unchanged or worsen within
the first 20 minutes at 60 fsw, assess the patient during descent and compress to
depth of relief (or significant improvement), not to exceed to 165 fsw. Treat on
Treatment Table 6A . To limit recurrence, severe Type II symptoms warrant full
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