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Dysbarism

Last reviewed: 12 Nov 2024
Last updated: 21 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • musculoskeletal pain
  • numbness
  • tingling
  • paresthesia
  • nonspecific constitutional symptoms
  • muscular weakness
  • paralysis
  • rash
Full details

Other diagnostic factors

  • headache
  • ear or sinus pain
  • dizziness or vertigo
  • nausea
  • vomiting
  • shortness of breath
  • tachypnea
  • difficulty in walking
  • reduced hearing
  • middle ear bleeding or tympanic membrane perforation
  • pruritus
  • reduced level of consciousness
  • crackles
  • wheezing
  • reduced breath sounds
  • subcutaneous emphysema
Full details

Risk factors

  • increasing depth and duration of dives (decompression illness)
  • breathing gas mixture
  • rapid ascents (decompression illness)
  • altitude exposure after diving (decompression illness)
  • thermal stress (decompression illness)
  • exercise stress (decompression illness)
  • patent foramen ovale (PFO) (decompression illness)
  • increasing age (decompression illness)
  • high body fat content (decompression illness)
  • dehydration (decompression illness)
  • breath hold diving
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • chest x-ray
  • ECG
  • echocardiography
Full details

Treatment algorithm

ACUTE

decompression sickness or arterial gas embolism

barotrauma

nitrogen narcosis

Contributors

Authors

Charlotte Sadler, MD

Program Director, Undersea and Hyperbaric Medicine Fellowship

Associate Professor of Clinical Emergency Medicine

University of California, San Diego

La Jolla

CA

Disclosures

CS has authored two chapters in UpToDate on diving medicine and fitness to dive, for which she receives royalties. She has also authored chapters on similar topics in CorePendium (online textbook) and Tintinalli's Emergency Medicine - these chapters are not reimbursed. She has previously received grant funding from the PADI Foundation to study COVID-19 in Divers.

Brian Snyder, MD

Clinical Professor of Emergency Medicine

Department of Emergency Medicine

University of California, San Diego

La Jolla

CA

Disclosures

BS has updated a number of book chapters as part of his role at the University for which he is not remunerated financially.

Casey Smith, MD

Fellow of Hyperbaric and Dive Medicine

Department of Emergency Medicine

University of California, San Diego

La Jolla

CA

Disclosures

A portion of CS's salary as Fellow of Hyperbaric and Dive Medicine was provided by the Diver Alert Network (DAN).

William Toppen, MD

Fellow of Hyperbaric and Dive Medicine

Department of Emergency Medicine

University of California, San Diego

La Jolla

CA

Disclosures

A portion of WT’s salary as Fellow of Hyperbaric and Dive Medicine was provided by the Diver Alert Network (DAN).

Acknowledgements

Dr Charlotte Sadler, Dr Brian Snyder, Dr Casey Smith, and Dr William Toppen would like to gratefully acknowledge Dr Oliver M. Firth and Dr John D. King, both previous contributors to this topic. OMF and JDK declare that they have no competing interests.

Peer reviewers

Avi Shupak, MD

Head Otoneurology Unit

Carmel and Lin Medical Centers

Haifa

Israel

Disclosures

AS declares that he has no competing interests.

John R. Fitz-Clarke, MD, PhD

Staff Hyperbaric Physician

Queen Elizabeth II Health Sciences Centre

Halifax

Nova Scotia

Canada

Disclosures

JRFC declares that he has no competing interests.

  • Dysbarism images
  • Differentials

    • Gas toxicity (decompression illness)
    • Hypercapnia
    • Hyperventilation
    More Differentials
  • Guidelines

    • US Navy diving manual, revision 7 with change A entered. Chapter 17: diagnosis and treatment of decompression sickness and arterial gas embolism
    • Pre-hospital management of decompression illness: expert review of key principles and controversies
    More Guidelines
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