Diver’s disease or decompression sickness has been the downfall of many divers in the past because its causes were not sufficiently researched and known. With the knowledge that exists today and highly modern technology, diver’s sickness can be defeated and prevented.
What is diver’s disease?
The colloquial term diver’s disease is used for a health condition that is much more meaningful under the term decompression sickness. Diver’s illness or decompression sickness is not unique to divers. It can also be fatal when exiting into an airless space, as in outer space. Other names for diver’s disease are compressed air disease or caisson disease. It is only since the middle of the 20th century that the causative factors leading to diver’s sickness have been known. The name caisson disease goes back to so-called caissons, with which caisson workers were lowered into the depth of waters and pulled up again. In medicine, diver’s disease is considered a trauma.
Causes
The causes in diving sickness are due to the fact that after being at a certain depth, there is an anesthesia-like trauma in the neurological area due to surfacing. When people dive and reach an enormous diving depth, the nitrogen in the compressed air is pressed into individual tissues of the body. If the water pressure decreases during the ascent, the gases rise abruptly into the brain because they cannot be exhaled through the lungs, resulting in diver’s sickness. This process takes place in diver’s sickness when there is a hasty ascent.
Symptoms, complaints and signs
Diver’s disease is divided into two classes according to the severity of symptoms. In type I, only mild symptoms develop; pain in the joints and muscles is typical. Due to the occlusion of small blood vessels (microemboli), the skin on the face, ears, upper body, and arms begins to itch, and skin spots resembling insect bites (diver’s fleas) develop. The formation of edema is possible. Air may accumulate in the subcutis, which is clearly visible by deformities. On palpation, these air accumulations crackle or crunch. Type II of the disease shows, in addition to the symptoms of type I, other severe symptoms that can become life-threatening. The central nervous system is affected and neurological deficits occur. Paralysis and sensory disturbances are possible. Nitrogen bubbles in the vessels or in the organ itself can cut off oxygen supply to the brain and heart. Clouding of consciousness may occur, leading to unconsciousness and respiratory arrest. Other symptoms include severe headaches, chest pain, cardiovascular problems and dizziness. Shortness of breath occurs and the patient has the feeling of suffocating. Coordination disorders develop and the ability to speak is impaired. In severe cases, necrosis of tissue and bone may occur. If left untreated, the disease can lead to death.
Diagnosis and course
If divers ascend too quickly from a great depth and after a long dive, the microbubbles in the tissues not only lead to a state of intoxication but, in the case of diver’s disease, can also destroy individual tissue regions in which they were stored. In the case of diver’s disease, affected individuals may lose their orientation and even consciousness, which often contributed to drowning in the past. Symptoms typical of a course of diver’s disease include pain in joints and muscles, edema, persistent itching, fatigue and loss of strength, disturbances in skin perception and coordination, nausea, vomiting, loss of hearing and vision, and, after loss of consciousness, a cessation of breathing. In diver’s disease, there are mild and severe, fatal courses. Diagnosis of diver’s disease focuses particularly on how the affected person feels.
Complications
Depending on the type of diver’s disease, different complications and late effects may occur. In type 1 diver’s disease, there is pain in the arm and leg muscles and in the joints.Under certain circumstances, these are associated with restricted movement and incorrect posture, which can result in joint damage and subsequently premature joint wear. Type 2 of diver’s disease almost always causes serious complications that can also be life-threatening. When nitrogen bubbles clog blood vessels, the central nervous system, heart and lungs take significant damage. The supply to the brain may also be blocked, resulting in rapid irreversible damage. Typical secondary symptoms include speech disorders, paralysis, damage to the inner ear, pain and unconsciousness. As a complication of diver’s disease, gas embolism may occur in the lungs, resulting in death of lung tissue and eventual organ failure. Furthermore, symptoms of a stroke may occur. Incorrectly performed first aid measures can cause serious complications. Medical treatment is always associated with the risk that administered medications may cause side effects and interactions or that an allergic reaction may occur.
When should you go to the doctor?
If divers have pain in the muscles, bones or joints, they need a medical examination. Itching in the upper body area, changes in the usual appearance of the skin, and swelling are signs of a health condition. A visit to the doctor is necessary, because in severe cases complications can occur. Disturbances of sensibility, air accumulation in the organism as well as loss of memory are alarm signals of the organism. Characteristic of the diver’s disease are crackling sounds as soon as light pressure is applied from the outside to the swellings of the body. If a noise is perceived, a doctor should be consulted as soon as possible. If unconsciousness or cessation of breathing occurs, an ambulance must be alerted. Intensive medical treatment is required as the person’s demise is imminent. Until the arrival of the emergency physician, first aid measures must be carried out by persons present. If headaches, dizziness, restrictions in breathing and changes in speech occur immediately after a dive or during ascent, a medical examination is required. Internal weakness, general malaise, and loss of physical ability should be presented to a physician. Discomfort in the chest as well as disturbances in coordination are further signs of an irregularity. If the complaints are noticed in people coming from a vacuum, a visit to the doctor is also necessary.
Treatment and therapy
In order to alleviate the discomfort associated with diver’s disease and reduce the risks of a fatal course and extensive late effects, immediate treatment is required. If the condition of the person affected by diving sickness is acutely life-threatening (unconsciousness, respiratory arrest), emergency care must be given (artificial respiration, stable lateral position). As a further therapeutic measure, a stay of varying length in a so-called pressure chamber is initiated. The purpose of this is to allow the gas bubbles trapped in the tissue to slowly escape again by adjusting the pressure. In the pressure chamber, patients are subjected to overpressure. During this time, they remain in direct contact with the physician via radio, so that targeted observation can be carried out and further hazards can be ruled out. The hyperbaric chamber causes the organism to gradually adapt to the pressure conditions prevailing on the surface of the earth. The untreated diver’s disease should not be underestimated also in connection with the possible late effects. These affect in particular the bone and lung tissue.
Prevention
In order to prevent diver’s illness, it is important to carry functional control and indicator instruments with you when diving. Risk factors for diver’s illness increase the longer and deeper the dive. The entire diving venture should also be adapted to the given physical conditions in order to prevent decompression sickness. Divers should not overestimate themselves in order to minimize the risks of decompression sickness. When surfacing, divers should not be left alone and it is imperative that they adhere to the appropriate decompression times in order to prevent diver’s illness.
Aftercare
Successful, completed treatment of diver’s disease requires complete elimination of the gas bubbles in the body. Depending on the severity of the disease, permanent damage cannot be ruled out. Once treatment of a mild to moderate disease is complete, no further follow-up is necessary. The affected person is free of symptoms and signs. In the case of severe disease with permanent damage or disability, appropriate follow-up treatments must be initiated. Special care should be taken if the affected person wishes to dive again. In this case, a specially trained diving physician should be consulted. This doctor will decide if and when diving is possible again. Depending on the severity of the illness, this varies from a few days to several months. Since the affected person has a history of diving, a relapse or further illness cannot be ruled out if diving is resumed. Not infrequently, this is more serious than the first illness. In the future, diving must be more conservative than before, which includes strict adherence to the generally known diving rules. No decompression dives or extremely deep dives, as the risk of recurrence of the disease is much higher. Diving with oxygen-enriched mixture (nitrox) and dive computer in air mode instead of normal air mixture. Avoiding frequently repeated dives with short surface intervals. Avoiding any physical exertion before, after and during the dive.
What you can do yourself
Before each dive, check that the general state of health is optimal for the undertaking. In case of the slightest inconvenience or health impairment, the dive should be canceled or postponed. Existing fears, inner insecurities or a weakening of the organism can lead to considerable consequences during diving. Therefore, in the area of self-help, an early and critical control of one’s own well-being is necessary. An overestimation of one’s own competencies can lead to life-threatening developments. A diving project should never be carried out alone. A partner is needed so that help can be provided immediately in case of emerging irregularities. Emergency signals should be defined together in advance. A good consultation belongs to the necessary measures before a diving start besides the examination of the equipment. Health issues should also be addressed. Past experiences should be shared with the partner. Each diver must know and respect his or her own physical limits. As soon as problems or health disturbances occur during the dive, the diving partner must be informed accordingly and the dive must be terminated as quickly as possible without hectic. It is often sufficient to check the depth reached in time so that no impairment occurs. The ascent must not be made too quickly. Care must be taken so that irreversible damage does not develop.
