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The CompliCaTions
The island with the medical clinic had no chamber, so it
was determined the diver should be promptly evacuated
to the U.S. Unfortunately, the island’s runway was not
lit, making flights after sunset impossible. The boat
was scheduled to make landfall at 10 p.m., so DAN
TravelAssist
®
arranged for an air ambulance to arrive on
the island at sunrise, approximately 7:15 a.m. the next
day. The aircraft would be pressurized to sea level for
transporting the diver.
On the way to the island, the diver’s strength and sensation
in his right arm returned to normal. He was still unable to
move his legs but was beginning to sense pain in his left leg.
He also became aware he was unable to urinate. The oxygen
supply lasted the expected two hours, and he went without
oxygen for more than six hours. The boat made landfall at
10:45 p.m., and the diver was transferred to the clinic in a
personal vehicle belonging to one of the clinic staff.
On examination the diver had no strength in either leg,
only painful sensation in the left leg and no sensation in
his right leg. He required a catheter to urinate. The doctor
diagnosed acute neurological decompression sickness
(DCS). He remained on oxygen through the night and
received fluids through an IV. Due to the clinic’s limited
supply of oxygen, they could provide only 6 liters per
minute instead of the recommended 10 to 15. The air
ambulance arrived at 7:30 a.m. and landed in the U.S.
with the diver three hours later. Upon arrival, he was
transferred by ambulance to the closest chamber, which
had been waiting for him since being notified by DAN the
day before. He entered the chamber at 11 a.m. The elapsed
time from the onset of symptoms to entering the chamber
was approximately 20 hours.
The patient was treated with an extended TT6 and
improved measurably. He received four additional TT6s
over the next two days and continued to improve. In the
following days he underwent five more, shorter treatments
(U.S. Navy Treatment Table 9s). He was discharged
with some residual loss of sensation in his legs as well
as persistent sexual dysfunction and inability to urinate.
Within one month the diver was able to urinate on his
own, and over the next three months all residual symptoms
completely resolved.
DisCUssion
Decompression illness (DCI), which includes both AGE and
DCS, is not always predictable with regard to when and to
whom it occurs. It can be equally difficult to predict with
regard to recovery. DCI should always be treated within as
short a time span as possible, but as these cases illustrate,
prompt treatment does not always guarantee a positive
outcome. Conversely, a significant delay does not guarantee a
negative outcome. The variables affecting final outcomes are
far too many to allow reliable projections. The importance
of administering oxygen promptly and seeking definitive
care as soon as possible cannot be overstated. Contact DAN
early in the process to obtain the assistance and guidance
we can provide. Research is ongoing, but the ability to make
dependable predictions about DCI is elusive.
AD
www.alertdiver.com
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