Neurological Injury from Undersea Diving Decompression Sickness Caisson Disease

1. NEUROLOGICAL INJURY
FROM UNDERSEA DIVING
BY: E. WAYNE MASSEY
SUMMARIZED BY: ADE WIJAYA, MD
(AUGUST 2017)

2. OUTLINE
• EPIDEMIOLOGY
• CLINICAL MANIFESTATION
• CLASSIFICATION
- DECOMPRESSION SICKNESS (CAISSON DISEASE)
TYPE I & II
- ARTERIAL GAS EMBOLISM
- DIVING-RELATED ILLNESSES
• DIAGNOSTIC STUDIES
• MANAGEMENT

3. EPIDEMIOLOGY

4. CLINICAL MANIFESTATION

5. CLASSIFICATION
• DECOMPRESSION SICKNESS (CAISSON
DISEASE)
- TYPE 1
- TYPE 2
• ARTERIAL GAS EMBOLISM
• DIVING-RELATED ILNESSES

6. DECOMPRESSION SICKNESS
(CAISSON DISEASE)
DECOMPRESSION SICKNESS OCCURS WHEN INERT GAS TAKEN UP DURING A DIVE
COMES OUT OF SOLUTION, FORMING BUBBLES
DUE TO RAPID PRESSURE GRADIENT
DOSE RELATED (AMOUNT OF BUBBLES)

7. DECOMPRESSION SICKNESS TYPE I
• MILD
• NON-NEUROLOGICAL
• SKIN ITCHING
• JOINTS AND / OR LIMBS PAIN

8. DECOMPRESSION SICKNESS TYPE II
• SERIOUS; NEUROLOGICAL
• WEAKNESS,
• LOSS OF SENSATION,
• ATAXIA,
• VERTIGO,
• DISTURBANCE OF CONSCIOUSNESS AND MENTATION,
• DISTURBANCE OF VISION,
• DISTURBANCE OF BOWEL AND BLADDER CONTROL

9. ARTERIAL GAS EMBOLISM
• RESULTS WHEN A DIVER ASCENDS WITHOUT VENTING AIR FROM THE LUNGS
• BOYLE’S LAW:  PRESSURE   VOLUME
• LUNG RUPTURE  PNEUMOTHORAX, SUBCUTANEOUS EMPHYSEMA,
PNEUMOPERICARDIUM
• SYMPTOMS: PAIN, RESPIRATORY DISTRESS, COUGH, HEMOPTYSIS,
UNCONSCIOUSNESS, CONVULSION, APHASIA, HEMIPARESIS, CORTICAL BLIND,
QUADRIPLEGIA, RESPIRATORY AND CARDIAC ARREST
• MAYBE ASSOCIATED WITH PATENT FORAMEN OVALE, OBSTRUCTIVE PULMONARY
DISEASES, ASTHMA

10. DIVING-RELATED ILLNESSES
• PULMONARY DYSFUNCTION (OBSTRUCTIVE PULMONARY DISEASES, ASTHMA,
PNEUMOTHORAX)
• PREEXISTING NEUROLOGICAL DISEASES (SEIZURES, SYNCOPE, NEUROPATHY,
MYOPATHY, HEAD INJURY, ETC)
• CARDIAC ARRHYTHMIAS
• ALTERED MENTAL CAPACITY

11. DIAGNOSTIC STUDIES
• HISTORY AND PHYSICAL EXAMINATION
• ECHOCARDIOGRAPHY
• NEUROPSYCHOLOGICAL EXAMINATION
• NEUROIMAGING
• ELECTROPHYSIOLOGICAL STUDIES

12. MANAGEMENT
• DEFINITIVE TREATMENT: HYPERBARIC OXYGEN THERAPY (TIME FROM ONSET
DEPENDENT)
• FIELD MANAGEMENT:
- PROMPT RECOGNITION
- OXYGEN THERAPY
- RESCUCITATION
- TRANSPORTATION
• REHABILITATION

13. SUMMARY
• DIVING INJURY CAN CAUSE NEUROLOGICAL IMPAIRMENTS
• CLASSIFIED INTO: DECOMPRESSION SICKNESS TYPE I & II (CAISSON DISEASE),
ARTERIAL GAS EMBOLISM, AND DIVING-RELATED ILLNESSES
• DEFINITIVE TREATMENT: RECOMPRESSION WITH HYPERBARIC OXYGEN
CHAMBERS (TIME FROM ONSET DEPENDENT)