Resumo
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor musculoesquelética
- dormência
- formigamento
- parestesia
- sintomas constitucionais inespecíficos
- fraqueza muscular
- paralisia
- erupção cutânea
Other diagnostic factors
- cefaleia
- dor sinusal ou na orelha
- tontura ou vertigem
- náuseas
- vômitos
- dispneia
- taquipneia
- dificuldade de andar
- audição reduzida
- sangramento na orelha média ou perfuração da membrana timpânica
- prurido
- nível de consciência reduzido
- estertores
- sibilância
- murmúrios vesiculares reduzidos
- enfisema subcutâneo
Risk factors
- aumento da profundidade e duração dos mergulhos (doença da descompressão)
- mistura de gases respiráveis
- subidas rápidas (doença da descompressão)
- exposição à altitude após mergulho (doença da descompressão)
- estresse térmico (doença da descompressão)
- estresse por exercício (doença da descompressão)
- forame oval patente (FOP) (doença da descompressão)
- idade avançada (doença da descompressão)
- alto conteúdo de gordura corporal (doença da descompressão)
- desidratação (doença da descompressão)
- mergulho em apneia
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- radiografia torácica
- eletrocardiograma (ECG)
- ecocardiografia
Treatment algorithm
doença da descompressão ou embolia gasosa arterial
barotrauma
narcose por nitrogênio
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.
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.
References
Key articles
Mitchell SJ, Bennett MH, Moon RE. Decompression sickness and arterial gas embolism. N Engl J Med. 2022 Mar 31;386(13):1254-64. Abstract
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.Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Toxicidade gasosa (doença da descompressão)
- Hipercapnia
- Hiperventilação
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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