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dull ache in his right shoulder and numbness in his right
leg. When he began to have difficulty walking, he asked
his wife to make the drive back to the scuba shop. After
a few minutes in the car, the diver’s right arm started
feeling cold. He checked to make sure the cold sensation
was not because of the damp, long-sleeved rash guard
he was wearing or the cold air blowing from the air
conditioner. He then noticed that the cold sensation had
turned to numbness and slight tingling that progressed
down his right arm and leg.
They pulled over the vehicle and set up their DAN®
oxygen unit, and the diver began breathing from the
demand valve. They also set up the nonrebreather
mask in case the diver lost consciousness. Once the
diver was breathing 100 percent oxygen, his wife called
DAN. The DAN medic assessed the situation and
directed them to the nearest emergency room.
Fortunately, the diver’s symptoms subsided after
approximately 45 minutes of breathing pure oxygen.
When he reached the hospital, there was no more
numbness or tingling in his arm, and he could walk
normally again. Although his symptoms were gone,
he was admitted to the emergency room for further
analysis. When the diver arrived, he was put on a
nonrebreather mask with a flow rate of 15 liters per
minute. The emergency room doctor was in contact
with DAN medics, who provided contact information
for multiple hyperbaric medical specialists in the area
for further consultation.
The diver continued to breathe pure oxygen
for about two hours, and his symptoms never
returned. He underwent multiple tests, including an
electrocardiogram, MRI, CT scan and chest X-rays, all
of which were unremarkable. The doctor monitored
the diver for three and a half hours before releasing
him. In total, the diver breathed 100 percent oxygen for
approximately five hours, with the exception of during
testing and necessary breaks.
The doctors ultimately determined this may have
been a case of decompression sickness (DCS) that
resolved before the diver was admitted to the hospital.
The diver’s report of mild unilateral upper- and lower-
extremity paresthesia that were resolved by surface-
supplied oxygen suggests central nervous system DCS.
The general recommendation in such cases is to treat
with hyperbaric oxygen therapy (HBOT) regardless of
symptom resolution. In this case, after extensive testing
and prolonged monitoring, the physician was confident
HBOT was not necessary.
DISCUSSION
This incident is a good example of how being a prepared
diver and having an emergency action plan can prove
fortunate. The diver ensured he was properly hydrated,
well fed and sufficiently rested throughout his weekend
of diving. Although the reported dive profiles were
within the diver’s computer limits, with slow ascents
and adequate surface interval time between dives,
he still recognized and acknowledged the signs and
symptoms of neurological DCS. If the diver had ignored
the symptoms and waited longer to seek professional
medical attention, his eventual recovery might not have
been so swift and/or complete.
In many cases, divers choose to neglect DCS
symptoms or attribute them to a separate cause such as
heavy lifting, a tight wetsuit or overexertion. The diver
contemplated the numbness and tingling sensation in
his extremities, astutely recognized these symptoms
and took immediate action. He acknowledged that
there are risks associated with scuba diving and was
adequately prepared with an emergency oxygen
unit with various types of breathing apparatus. Both
the diver and his buddy were trained in how to use
the emergency oxygen and how to determine when
medical intervention is necessary.
The diver’s doctor advised him to discontinue
repetitive deep dives, consult a neurologist for other
possible explanations for his symptoms, get screened
for a patent foramen ovale (PFO) and wait 30 days
before returning to diving. The diver has returned
to diving since the incident and has not experienced
further problems.
This incident can serve to remind all divers of
the importance of self-awareness and having an
emergency action plan. It is crucial to be mindful when
considering symptoms, to have an immediate oxygen
supply available and to seek professional medical
attention promptly when necessary.
AD
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“This incident is a good example of how
being a prepared diver and having an emergency
action plan can prove fortunate.”