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Pathophysiology of Bends and Decompression Sickness: An Overview With Emphasis on Treatment

Pathophysiology of Bends and Decompression Sickness: An Overview With Emphasis on Treatment 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. Cockett ATK, Nakamura RM: A new concept in the treatment of decompression sickness (dysbarism) . Lancet 1:1102-1103, 1964.Crossref 8. Cockett ATK, Nakamura RM, Franks JJ: Recent findings in the pathogenesis of decompression sickness (dysbarism) . Surgery 58:384-389, 1965. 9. Cockett ATK, Nakamura RM, Kado RT: Physiological factors in decompression sickness . Arch Environ Health 11:760-764, 1965.Crossref 10. Cockett ATK, Nakamura RM, Kado RT: The pathophysiology of decompression sickness–dysbarism. Proceedings of the XVIth International Astronautical Congress. Warsaw, Polish Scientific Pub, 1967, pp 185-189. 11. Cockett ATK, Pauley SM, Saunders JC, et al: Histopathological evidence for pulmonary emboli in experimental decompression sickness diagnosed by radioisotopic lung scanning . Aerosp Med 40:1357-1360, 1969. 12. Pauley SM, Cockett ATK: Role of lipids in decompression sickness . Aerosp Med 41:56-61, 1970. 13. Cockett ATK, Mangelson NL, Swanson L, et al: The diagnosis of experimental pulmonary aeroemboli following decompression by radioisotopic lung scanning . Am Surg 34:109-113, 1968. 14. Cockett ATK, Swanson LE, Kado RT: Location of pulmonary emboli following decompression by radioisotopic lung scanning . Rev Physiol Subaquatique 4:283-287, 1969. 15. Cockett ATK, Mangelson NL, Kado RT, et al: Radioisotopic color scanning of pulmonary aeroemboli in experimental decompression sickness: Dysbarism . Aerosp Med 39:1052-1054, 1968. 16. Hallenbeck JM, Bove AA, Elliott DH: Mechanisms underlying spinal cord damage in decompression sickness . Neurology 25:308-316, 1975.Crossref 17. Zweizig JR, Hanley J, Cockett ATK, et al: EEG Monitoring During the Treatment of Decompression Illness ("Bends"). Proceedings of the IEEE National Telemetry Conference, Washington, DC. Washington, DC, Institute of Electrical and Electronic Engineers, 1969, pp 195-198. 18. Cockett ATK, Zehl DN, Hanley J, et al: Effects of emboli on the neurocirculatory system in decompression sickness, in Trapp WG, Banister EW, Davision AJ, et al (eds): Proceedings of the Fifth International Hyperbaric Congress. Burnaby, BC, Canada, Simon Fraser University, 1974, pp 883-889. 19. Pauley SM, Saunders JC, Depenbusch FL, et al: Unusual experiences in the hyperbaric chamber, in Wada J, Iwa T (eds): Proceedings of the Fourth International Congress on Hyperbaric Medicine. Tokyo, Igaku Shoin Publishers Ltd, 1970, pp 495-499. 20. Philp RB, Gowdey CW, Prasad M: Changes in blood lipid concentration and cell counts following decompression sickness in rats and the influence of dietary lipid . Can J Physiol Pharmacol 45:1047-1059, 1967.Crossref 21. Cockett ATK, Pauley SM, Roberts AP: Advances in treatment of decompression sickness: An evaluation of heparin , in Fructus X (ed): Third International Congress on Hyperbaric and Underwater Physiology . 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Pathophysiology of Bends and Decompression Sickness: An Overview With Emphasis on Treatment

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1979.01370270066011
Publisher site
See Article on Publisher Site

Abstract

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. Cockett ATK, Nakamura RM: A new concept in the treatment of decompression sickness (dysbarism) . Lancet 1:1102-1103, 1964.Crossref 8. Cockett ATK, Nakamura RM, Franks JJ: Recent findings in the pathogenesis of decompression sickness (dysbarism) . Surgery 58:384-389, 1965. 9. Cockett ATK, Nakamura RM, Kado RT: Physiological factors in decompression sickness . Arch Environ Health 11:760-764, 1965.Crossref 10. Cockett ATK, Nakamura RM, Kado RT: The pathophysiology of decompression sickness–dysbarism. Proceedings of the XVIth International Astronautical Congress. Warsaw, Polish Scientific Pub, 1967, pp 185-189. 11. Cockett ATK, Pauley SM, Saunders JC, et al: Histopathological evidence for pulmonary emboli in experimental decompression sickness diagnosed by radioisotopic lung scanning . Aerosp Med 40:1357-1360, 1969. 12. Pauley SM, Cockett ATK: Role of lipids in decompression sickness . Aerosp Med 41:56-61, 1970. 13. Cockett ATK, Mangelson NL, Swanson L, et al: The diagnosis of experimental pulmonary aeroemboli following decompression by radioisotopic lung scanning . Am Surg 34:109-113, 1968. 14. Cockett ATK, Swanson LE, Kado RT: Location of pulmonary emboli following decompression by radioisotopic lung scanning . Rev Physiol Subaquatique 4:283-287, 1969. 15. Cockett ATK, Mangelson NL, Kado RT, et al: Radioisotopic color scanning of pulmonary aeroemboli in experimental decompression sickness: Dysbarism . Aerosp Med 39:1052-1054, 1968. 16. Hallenbeck JM, Bove AA, Elliott DH: Mechanisms underlying spinal cord damage in decompression sickness . Neurology 25:308-316, 1975.Crossref 17. Zweizig JR, Hanley J, Cockett ATK, et al: EEG Monitoring During the Treatment of Decompression Illness ("Bends"). Proceedings of the IEEE National Telemetry Conference, Washington, DC. Washington, DC, Institute of Electrical and Electronic Engineers, 1969, pp 195-198. 18. Cockett ATK, Zehl DN, Hanley J, et al: Effects of emboli on the neurocirculatory system in decompression sickness, in Trapp WG, Banister EW, Davision AJ, et al (eds): Proceedings of the Fifth International Hyperbaric Congress. Burnaby, BC, Canada, Simon Fraser University, 1974, pp 883-889. 19. Pauley SM, Saunders JC, Depenbusch FL, et al: Unusual experiences in the hyperbaric chamber, in Wada J, Iwa T (eds): Proceedings of the Fourth International Congress on Hyperbaric Medicine. Tokyo, Igaku Shoin Publishers Ltd, 1970, pp 495-499. 20. Philp RB, Gowdey CW, Prasad M: Changes in blood lipid concentration and cell counts following decompression sickness in rats and the influence of dietary lipid . Can J Physiol Pharmacol 45:1047-1059, 1967.Crossref 21. Cockett ATK, Pauley SM, Roberts AP: Advances in treatment of decompression sickness: An evaluation of heparin , in Fructus X (ed): Third International Congress on Hyperbaric and Underwater Physiology . 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.

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1979

References

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