Abstract • Current concepts in the pathophysiology of decompression sickness are reviewed. Mild, moderate, and severe forms of this syndrome resulting from gaseous and lipid emboli are described. Therapy is aimed at restoring or specifically treating each alteration. Plasma volume deficit is restored by colloidal re-expansion. Decompression sickness is partially treated when recompression alone is used. Blood lipid alterations are managed by use of antilipemic agents. Dextran is mentioned. Divers at depths of 61 m display changes in hematocrit, platelet, and blood lipid profiles. Cord paralysis may occur from bubbles in the vena cava. Retrograde migration blocks the venous circulation of the spinal cord. Ultrasonic devices can detect "silent" bubbles during decompression. Recompression, when available, is a lifesaving treatment for diving accidents involving saturation diving. Air embolism is discussed. Monitoring emboli by EEG and fundoscopy are reported. (Arch Surg 114:296-301, 1979) References 1. Behnke AR: Decompression sickness . Mil Med 117:257-271, 1955. 2. Spencer MP, Johansen DC, Campbell SO: Safe decompression with the Doppler ultrasonic blood bubble detector , in Lambertsen CS (ed): Underwater Physiology . Baltimore, Federation of American Societies for Experimental Biology, vol 5, 1976. 3. Cockett ATK, Pauley SM, Saunders JC, et al: Coexistence of lipid and gas emboli in experimental decompression sickness , in Lambertsen CJ (ed): Underwater Physiology . New York, Academic Press Inc, 1971, pp 245-250. 4. Philp RB, Gowdey CW: Experimental analysis of the relation between body fat and susceptibility to decompression sickness . Aerosp Med 35:351-354, 1964. 5. Cockett ATK, Nakamura RM, Franks JJ: Delayed shock in experimental dysbarism . Surg Forum 14:7-8, 1963. 6. Cockett ATK, Nakamura RM: New concepts in the pathophysiology of experimental dysbarism: Decompression sickness . Am Surg 30:447-451, 1964. 7. 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Paris, DOIN Editeurs, 1972, pp 156-160. 22. Cockett ATK, Saunders JC, Depenbusch FL, et al: Combined treatment in decompression sickness, in Wada J, Iwa T (eds): Proceedings of the Fourth International Congress on Hyperbaric Medicine. Tokyo, Igaku Shoin Publishers Ltd, 1970, pp 89-92.
Archives of Surgery – American Medical Association
Published: Mar 1, 1979
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