Decompression sickness

Decompression sickness may occur if a sufficient volume of inert gas has dissolved in the tissues during diving and the release of ambient pressure during ascent is so rapid that tissue gas tension exceeds the local tissue pressure sufficiently to allow bubbles to form.

The occurrence of symptoms is related to the number of bubbles formed, their location, and the presence of predisposing factors. Bubbles mechanically injure tissues by distortion, tearing, or the production of ischemia as a result of vessel compression. Bubbles within the circulation activate the coagulation, kininogen, and complement systems, leukocytes, and thrombocytes, leading to non-mechanical tissue injury. On rare occasions uncontrolled bubble formation leads to the fatal consequences of diffuse massive arterial air embolization known as the 'blow-up' syndrome. Symptoms of decompression sickness are classified as type I, which includes musculoskeletal pain, cutaneous manifestations, and constitutional symptoms (fatigue, anorexia, malaise), or type II, which includes central nervous system and cardiorespiratory involvement (Riyeia...l9§4; Moon 1993) (Table...?.). Type I symptoms may rapidly progress to type II illness which is more serious, particularly when symptoms occur close to surfacing.

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Table 2 Frequency of the most common signs and symptoms of decompression sickness (935 cases)

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