If you have symptoms after diving and worry you may be suffering from a diving-related medical problem, activate local emergency medical services or safely get yourself to the nearest emergency department. Call the DAN Emergency Hotline at +1-919-684-9111 if you want to discuss your symptoms with an expert in dive medicine.
Whether a DAN medic advises you to seek care or you decide on your own to do so, the best course of action is to go to the nearest hospital — not the closest hyperbaric chamber. Chambers are not generally equipped to receive patients directly; patients must be evaluated in an emergency department first. People with severe burns don’t seek out the closest burn center — they go directly to the hospital. Symptoms after diving warrant the same approach.
Making the diagnosis
In addition to establishing a thorough medical history and case history (including dive depths and times), the doctor will perform a neurological exam – a series of observations, questions and measurements used to evaluate motor strength and sensation all over the body, the function of the 12 cranial nerves, reflexes, balance, co-ordination and cognition. Impaired balance or co-ordination is relatively common in people with neurological decompression illness (DCI). Some of the specific evaluations used to detect impairments include the Romberg and sharpened Romberg tests, in which you will be asked to stand still with your eyes closed and your feet close together, the finger-to-nose test and the heel-to-shin test. The doctor may also carefully examine your gait for signs of unsteadiness and evaluate your ability to perform rapid, alternating movements.
Diagnosing diving-related medical conditions may be especially difficult since both DCS and AGE are clinical diagnoses. This means there are no definitive medical tests that can prove these conditions are present. The diagnosis is instead the result of a thorough history, identification of abnormalities during the physical exam, and data gathered from other tests and observations.
Remember that just because you were diving you are not necessarily suffering from a diving-specific medical problem. Many medical conditions can mimic the symptoms of DCI, which further complicates the process of making a diagnosis. Other possible explanations of symptoms that commonly occur after diving include food-borne illnesses like ciguatera, infectious diseases including viral and parasitic syndromes and, perhaps most notably, exertion or trauma that leads to muscle strains or joint pain.
To the chamber
Once a doctor has diagnosed DCI, the next stop is usually the chamber. Hyperbaric oxygen therapy involves the administration of 100 percent oxygen during compression in a hyperbaric chamber. The most-common hyperbaric treatment protocol used for DCS and AGE is the US Navy Treatment Table 6, which pressurizes the patient to a maximum depth of 60 feet and lasts at least four hours and 45 minutes. Both DCS and AGE warrant chamber therapy, but other diving-related medical conditions do not.
Physicians in the ER who manage patients with divingrelated illnesses are encouraged to call DAN for consultation and information about nearby dive-medicine specialists and hyperbaric chambers. As a patient, it is important to be your own advocate – ask your doctor to call DAN for consultation about your diagnosis and treatment.
Knowing how to handle a dive emergency — and what to anticipate should one occur — can help alleviate anxiety and empower you to be an active participant in the process.
This article was originally published in Scuba Diver North America #12.