(Caisson Disease; Altitude Sickness; Dysbarism; The Bends; DCS)
Decompression sickness (DCS) occurs when the body is exposed to a sudden drop in surrounding pressure. DCS occurs most frequently during deep sea diving or when flying in a nonpressurized aircraft.
DCS is caused by the formation of gas bubbles in the blood and tissues. At normal altitudes, nitrogen and other gases are exhaled or dissolved in the blood and tissues. However, during severe changes in altitude and air pressure, nitrogen and other gases form gas bubbles. These bubbles block the flow of blood. This condition can be fatal if not treated quickly.
The only risk factor that increases your chance of getting DCS is a sudden reduction in pressure. This occurs as a result of:
The less severe type of DCS is called DCS I. It primarily results in inflammation of muscles, joints, and tendons, resulting in pain and swelling. This is commonly referred to as the bends. Although pain may occur anywhere in the body, it is most common in or near an arm or leg joint. The pain may become more severe over time. Itching, skin mottling, weakness, and fatigue also occur.
The more severe type of DCS is called DCS II. This results in more serious systemic effects, including neurological symptoms such as numbness and tingling. In the most severe form, numbness may lead to paralysis and even death. Other symptoms of DCS II include:
If an individual dives occupationally and has regular exposure to increased pressure, a mild, chronic case of the bends may occur without detection. Over time, this can result in deterioration of affected joints and bones.
The doctor will ask about your symptoms and medical history. A physical exam will be done. When DCS is suspected, treatment is often started immediately without any delay for examination or testing. Blood and other diagnostic tests are not usually helpful.
If you experience symptoms of DCS, it is extremely important to get treatment right away. In severe cases, delayed treatment may be fatal.
If you have DCS I, breathing 100% oxygen from a mask may be sufficient treatment. You should also be monitored carefully for other symptoms.
The treatment for DCS II is oxygen therapy in a hyperbaric chamber. This device works by gradually increasing and then decreasing air pressure around the body. This forces gas bubbles to dissolve. Oxygen should be administered through an oxygen mask during transport to a hyperbaric chamber.
Treatment should be given even if initial symptoms are mild or disappear. Proper treatment given quickly should cure all symptoms of DCS.
If you are diagnosed with DCS, follow your doctor's instructions.
DCS may be prevented by:
American College of Hyperbaric Medicine
Divers Alert Network
Undersea and Hyperbaric Medical Society
Capital Health Nova Scotia
Altitude-induced decompression sickness. Federal Aviation Administration website. Available at: http://www.faa.gov.... Accessed February 1, 2013.
Decompression illness: what is it and what is the treatment? Divers Alert Network website. Available at: http://www.diversa.... Accessed January 31, 2008.
Decompression sickness. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 18, 2012. Accessed February 1, 2013.
Last reviewed October 2012 by Peter Lucas, MD