Summary
Definição
História e exame físico
Principais fatores diagnósticos
- musculoskeletal pain
- numbness
- tingling
- paresthesia
- nonspecific constitutional symptoms
- muscular weakness
- paralysis
- rash
Outros fatores diagnósticos
- 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
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- clinical diagnosis
Investigações a serem consideradas
- chest x-ray
- ECG
- echocardiography
Algoritmo de tratamento
decompression sickness or arterial gas embolism
barotrauma
nitrogen narcosis
Colaboradores
Autores
Charlotte Sadler, MD
Program Director, Undersea and Hyperbaric Medicine Fellowship
Associate Professor of Clinical Emergency Medicine
University of California, San Diego
La Jolla
CA
利益声明
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
利益声明
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
利益声明
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
利益声明
A portion of WT’s salary as Fellow of Hyperbaric and Dive Medicine was provided by the Diver Alert Network (DAN).
鸣谢
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.
同行评议者
Avi Shupak, MD
Head Otoneurology Unit
Carmel and Lin Medical Centers
Haifa
Israel
利益声明
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
利益声明
JRFC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Mitchell SJ, Bennett MH, Moon RE. Decompression sickness and arterial gas embolism. N Engl J Med. 2022 Mar 31;386(13):1254-64. 摘要
US Navy. US Navy diving manual revision 7 with change A entered - chapter 17: diagnosis and treatment of decompression sickness and arterial gas embolism. Washington, DC: US Navy; 2018.全文
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Gas toxicity (decompression illness)
- Hypercapnia
- Hyperventilation
更多 鉴别诊断指南
- 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
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