Management of decompression sickness

If resuscitation is required in a person with decompression sickness, it should follow standard advanced life support protocols (see flowcharts developed by the Australian Resuscitation Council).

Immediate referral for recompression therapy using hyperbaric oxygen is the treatment of choice for any form of suspected decompression sickness or arterial gas embolism. Time to starting recompression within a hyperbaric chamber is critical; while there are some reports of clinical improvement in symptoms in divers presenting for recompression after 24 hours, the efficacy of hyperbaric therapy diminishes over time.

Note: Refer divers with any form of decompression sickness immediately for hyperbaric oxygen therapy.

While there are no randomised controlled clinical trials of hyperbaric oxygen therapy, clinical experience and expert consensus strongly support its role in decompression sickness and arterial gas embolism. Increasing the ambient pressure reduces bubble volume and facilitates diffusion of the gas from any bubbles into solution within the surrounding tissues, to be eliminated via the lungs.

For advice on hyperbaric treatment, contact the Diving Emergency Service (telephone 1800 088 200 within Australia).

Note: Advice on hyperbaric treatment can be obtained from the Diving Emergency Service (telephone 1800 088 200 within Australia).

While awaiting transfer to a hyperbaric unit:

nurse the patient in the horizontal position (not head up or head down)
administer high-flow oxygen (achieve as close to 100% oxygen saturation as possible)
rehydrate with intravenous fluids, titrating to clinical response (pulse rate, blood pressure, urine output and mucosal moistness).

The use of adjuvant drugs such as aspirin, glucocorticoids and lidocaine is controversial, and advice should be sought from a specialist hyperbaric service before these are given.