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Decompression sickness type II — Clinical Guidelines

Overview

Decompression sickness type II (DCS II) refers to the neurological manifestations of decompression sickness, typically involving symptoms such as paresthesia, motor deficits, and sensory disturbances, often affecting the limbs and central nervous system following rapid decompression from hyperbaric environments. 1 5 6

Diagnosis

Clinical Presentation: Paresthesia, motor weakness, sensory deficits, and neurological symptoms. 6 7

History: Recent exposure to hyperbaric environments, especially diving or caisson work. 1 5

Differential Diagnosis: Challenges in diagnosis, particularly in remote locations; consider conditions like neuropathy, skin conditions, and other neurological disorders. 6 7

Recommended Tests: No specific laboratory tests; imaging (MRI) may help rule out other neurological conditions. 6

Grading: Severity often graded based on neurological deficits (e.g., DCS grading systems). 6

Management

First-Line Treatment: Hyperbaric oxygen therapy (HBOT) is the definitive treatment. 12 13

Adjunctive Treatments: Supportive care including pain management, hydration, and monitoring for complications like air embolism. 12

Specific Protocols: Exercise-enhanced preoxygenation can increase protection against DCS, though primarily preventive. 9

Special Populations

Comorbidities: Cobalamin deficiency may predispose vegetarians to DCS, highlighting the importance of nutritional status. 4

Atopic Dermatitis: Individuals with atopic dermatitis may present atypical symptoms mimicking DCS, requiring careful clinical assessment. 7

Key Recommendations

Initiate Hyperbaric Oxygen Therapy Promptly for confirmed DCS II cases. (Evidence: Strong 12 13)

Consider Nutritional Status, particularly vitamin B12 levels, in assessing risk among divers with dietary restrictions. (Evidence: Moderate 4)

Maintain High Index of Suspicion for DCS in patients with recent hyperbaric exposure, especially in remote settings where diagnosis can be challenging. (Evidence: Moderate 6)

Evaluate for Atypical Presentations in patients with known dermatological conditions like atopic dermatitis, distinguishing between true DCS and benign skin manifestations. (Evidence: Weak 7)

References

1 Isaacson G. The Laryngologist Who Saved the Brooklyn Bridge. The Laryngoscope 2024. link 2 Imbert JP, Massimelli JY, Kulkarni A, Matity L, Bryson P. A review of accelerated decompression from heliox saturation in commercial diving emergencies. Diving and hyperbaric medicine 2022. link 3 Sato T, Iga T, Nagashima K, Matsubara S. Is centralization in emergency rural medicine always right? Lessons learned from two cases of decompression sickness. Rural and remote health 2011. link 4 van Hulst RA, van der Kamp W. Decompression sickness in a vegetarian diver: are vegetarian divers at risk? A case report. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc 2010. link 5 Butler WP. Caisson disease during the construction of the Eads and Brooklyn Bridges: A review. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc 2004. link 6 Petri NM, Andrić D. Differential diagnostic problems of decompression sickness--examples from specialist physicians' practices in diving medicine. Archives of medical research 2003. link00458-7) 7 Yoneda I. Probable decompression sickness in a trainee with atopic dermatitis. Aviation, space, and environmental medicine 1998. link 8 Germonpré P, Dendale P, Unger P, Balestra C. Patent foramen ovale and decompression sickness in sports divers. Journal of applied physiology (Bethesda, Md. : 1985) 1998. link 9 Webb JT, Fischer MD, Heaps CL, Pilmanis AA. Exercise-enhanced preoxygenation increases protection from decompression sickness. Aviation, space, and environmental medicine 1996. link 10 Butler FK. Diving and hyperbaric ophthalmology. Survey of ophthalmology 1995. link80091-8) 11 Tønjum S. Norwegian deep diving trials. Philosophical transactions of the Royal Society of London. Series B, Biological sciences 1984. link 12 Dembert ML. Scuba diving accidents. American family physician 1977. link 13 Whitcraft DD, Karas S. Air embolism and decompression sickness in scuba divers. JACEP 1976. link80061-5)

Decompression sickness type II