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Thread: DCS Fact Sheet for Emergency Personell

  1. #1
    RBW Member dreamdive has disabled reputation dreamdive's Avatar
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    DCS Fact Sheet for Emergency Personell

    Anecdotally in the past, I have heard that the time from ER to Chamber can be extremely long. A friend of mine recently suffered his first but serious DCS hit. As DCS is thankfully relatively rare, it appears that EMS and ER personnel are not very well versed in "First Aid" of DCS and the need for early decompression in a chamber for serious hits.

    Here is a "DCS Fact Sheet for the Emergency Room" that hopefully facilitates recognition and prompt treatment. The phone number is for the US. Feel free to modify this document for your special needs. A PDF format is given at the end of it.

    Take a picture of it with your phone, since you most likely have that with you.

    __________________________________________________ _____________

    Attention ER Physicians:
    Decompression Sickness Treatment Protocol

    First line treatment: 100% Oxygen
    Definitive treatment: Recompression in a Decompression Chamber

    Time is of the essence!

    An injured diver should be assessed for any non-DCS life threatening problems and treated accordingly. If the diver is stable and the clinical diagnosis of DCS is made, transfer to a decompression chamber should be arranged. Divers Alert Network (919-684-9111) will help identify a suitable chamber.

    Keeping a ‘bent’ diver in your ER longer than to rule-out whether he/she is stable to enter a decompression chamber may be a disservice. If you do not have a chamber on-site and need to arrange for transfer to a chamber, please initiate ASAP.

    The sooner a ‘bent’ diver gets to a decompression chamber the sooner his/her symptoms abate. Delay in treatment may result in irreversible damage or longer and repeated chamber treatments.

    Pathophysiology of DCS:

    Nitrogen bubbles absorbed during a dive are coming out of solution too fast and cause symptoms of DCS.

    · Joint Pain
    · Marbling of the skin
    · Vertigo, Dizziness,
    · Weakness, Paralysis
    · Unusual behavior, Severe fatigue

    Symptoms may improve with oxygen but may progress nevertheless!

    Treatment of a DCS patient:

    If not already, place the patient on 100% O2 with a non-rebreather. This will create a concentration gradient favoring the elimination of remaining nitrogen bubbles. If the patient is not breathing adequately, assist ventilation.

    Assess and treat non-DCS problems first.

    Keep the injured patient in a horizontal position. Do not place them head-down.

    Once the diagnosis of DCS is made and the patient is stable, arrange for treatment in a decompression chamber. Call DAN at 919-684-9111 to determine the nearest staffed chamber available for treatment.

    The patient needs to be recompressed in a chamber to decrease the size of nitrogen bubbles. Hyperbaric oxygen also delivers oxygen to tissues distal to occluded areas or edema caused by nitrogen bubbles, thus preventing distal ischemia.

    Additional web-information.
    1. The Four R&#39s of Managing a DCI Injury ? DAN | Divers Alert Network ? Medical Dive Article
    2. Decompression Illness: What Is It and What Is The Treatment? ? DAN | Divers Alert Network ? Medical Dive Article

    By Claudia L. Roussos MD

    dcs ER fact sheet.pdf
    __________________________________________________ __________

    To place this in context, here is Mr. F's story:

    Mr. F is a 45-year old healthy diver who never got bent before. He has logged multiple deep dives to 300 ft. OC and CCR. He has been an instructor for many years and started diving as a teen.

    On this particular day, Mr F. was finishing up teaching an entry-level rebreather course. Part of the course requirement is to complete 10 minutes of deco. Prior to surfacing, Mr. F pulled the anchor off the wreck.

    Soon after taking off his gear, he knew “something” was wrong. He started feeling weakness and numbness in his legs and immediately asked for oxygen. Following boat protocol, EMS was notified to meet them on the dock for transport to the emergency room.

    Once inside the ambulance, Mr. F requested to be placed back on oxygen. Since the EMS personnel were not perceiving Mr. F in any respiratory distress, they did not see the necessity. Mr. F was reassured that he is getting plenty of oxygen from breathing air. Mr. F kept insisting and explaining that he is suffering from decompression sickness and that oxygen is absolutely vital. Mr. F finally received oxygen during his ambulance ride to the nearest emergency room.

    This ER was part of regional trauma center but without a decompression chamber. Mr. F encountered the same difficulty and this time demanding to be placed on oxygen. The treating physician was given the history and Mr. F’s assessment that he is suffering from severe DCS. He provided the physician with the number for DAN and that he needs to be transferred to a decompression chamber immediately.

    Mr. F’s symptoms did not improve with oxygen but immediately worsened without it. His legs were getting more numb and week as he spent the next five hours in that ER. Mr. F insisted that he needed to be treated in a decompression chamber. Finally, he was transferred to another facility’s ER but one that had a chamber. He would spend another 1.5 hour in that ER prior to finally seeing the inside of a decompression chamber.

    Over the next few days, it took seven chamber rides to restore Mr. F to baseline.
    Last edited by dreamdive; 1st November 2014 at 15:29. Reason: upload attachement

  2. #2
    David Carden cardysnr is on a distinguished road cardysnr is on a distinguished road cardysnr's Avatar
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    Re: DCS Fact Sheet for Emergency Personell


    Hopefully never need it but really useful :D


  3. #3
    RBW Member dreamdive has disabled reputation dreamdive's Avatar
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    Re: DCS Fact Sheet for Emergency Personell


    Given the severity of the “hit” and not being able to account for it, Mr. F had himself checked out by an interventional cardiologist who is also well-versed in diving.

    The echocardiogram revealed that Mr. F had a PFO. After various discussions, soul searching and given that diving is part of Mr. F’s profession, Mr. F underwent closure of his PFO.

    It is speculated that during the pulling of the anchor, Mr. F invariable was "bearing down" thus caused his right heart pressure to be greater than his left. This could allow bubbles to enter the left side of his circulation leading accounting for his neurologic DCS.

    This one had a good turn out.

    I came across this report though that was disturbing:

    "A recent bulletin in DiveStyle, a South African Diving Magazine, challenged the standard recommendation to injured divers "to go to the nearest emergency room before being referred to a recompression chamber", by presenting the outcome of a lawsuit (see below).

    American Keith Rawson, a paralysed scuba diver who suffered DCI when he returned to the surface too quickly, has been awarded $31,3 m by a US jury. After the dive, off Pensacola in north west florida, Rawson claimed doctors at the Baptist Hospital in Pensacola caused his legs to become paralysed by sending him first to the emergency room instead of a hyperbaric chamber. The doctors argued that their decision saved Rawson's life and that his legs would still have been paralysed even if he had gone into the hyperbaric chamber. The jurors nevertheless handed down the award, a record verdict in that county. Rawson's legal battle has involved two court cases, drawn out over five years. in 1995, a $7,88m verdict in his favour was reversed because his attorney made derogatory remarks about the defence experts who gave evidence for the hospital. In 1997, a verdict in favour of the hospital was dismissed because the court was held to have improperly allowed the late addition of evidence from a defence expert."

  4. #4
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    Re: DCS Fact Sheet for Emergency Personell

    Good info Claudia

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