Last reviewed: 4 Nov 2023
Last updated: 14 Aug 2020
Summary
Definition
History and exam
Key diagnostic factors
- musculoskeletal pain
- numbness
- tingling
- paresthesia
- nonspecific constitutional symptoms
- muscular weakness
- paralysis
- rash
More key diagnostic factors
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
Other diagnostic factors
Risk factors
- diving or other activity involving increased atmospheric pressure (decompression illness)
- increasing depth and duration of dives (decompression illness)
- strenuous exercise during diving (decompression illness)
- rapid ascents (decompression illness)
- multiple ascents (decompression illness)
- missed safety stops (decompression illness)
- repetitive diving (decompression illness)
- altitude exposure (decompression illness)
- right-to-left shunt (decompression illness)
- dehydration (decompression illness)
- cold temperature (decompression illness)
- hot temperature (decompression illness)
- high body fat content (decompression illness)
- increasing age (decompression illness)
- menstruation (decompression illness)
- poor physical fitness (decompression illness)
- recent physical injury (decompression illness)
- carbon dioxide retention (decompression illness)
- failure to equilibrate pressure (barotrauma)
- breath-holding during ascent (barotrauma)
- lung disease (barotrauma)
- eustachian tube dysfunction (barotrauma)
- sinus ostia blockage (barotrauma)
- incorrect autoinflation (barotrauma)
- trapped gas in or near teeth (barotrauma)
- Fallopian canal dehiscence (barotrauma)
- deep diving (nitrogen narcosis)
More risk factors
Diagnostic investigations
1st investigations to order
- chest x-ray
- pure-tone audiometry
More 1st investigations to order
Investigations to consider
- tympanometry
- electronystagmography
- facial x-rays
- ECG
- echocardiography
- CBC
- blood glucose
- carboxyhemoglobin
- creatine kinase
- D-dimer
- CT of the head or spine
- CT of the sinuses
- CT of the chest
- MRI
- subclavian Doppler ultrasound
More investigations to consider
Treatment algorithm
ACUTE
decompression illness
barotrauma
nitrogen narcosis
Contributors
Authors
Oliver M. Firth, MBBs, BSc, MRCGP
Diving Physician & Director
Hyperdive, Ltd.
London
UK
Disclosures
OMF declares that he has no competing interests.
Acknowledgements
Dr Oliver M. Firth would like to gratefully acknowledge Dr John D. King, the previous contributor to this topic. JDK declares that he has 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.
Differentials
- Gas toxicity (decompression illness)
- Hypercapnia
- Hyperventilation
More DifferentialsGuidelines
- 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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