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Medical Author:

Scott D. Fell, DO, FAAEM

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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The nervous and musculoskeletal system are most often affected. If a diver is going to develop symptoms they will show within 48 hours in all cases. Ninety-five percent (95%) have symptoms within 6 hours, while 50% develop within the first hour of surfacing from a dive.

DCS is often categorized into two types. Type I indicating mild symptoms and Type II with neurologic and other serious symptoms.

Symptoms of the bends include the following:

• Pain in and around major joints with the shoulder and elbows being the most commonly affected in divers but any joint can be involved due to nitrogen being released into the joints and muscles.

• Extreme tiredness that is out of proportion to the activity just performed.

• Rashes that are red or marbled may occur. They can be very itchy also.
• It is rare to have skin findings with DCS

• Seen more commonly during decompression in hyperbaric chamber workers (see media photos).
• Very itchy reaction on the skin that is exposed to pressures of the dive (i.e. not covered up by a wet suit.)
• This is due to gas from the chamber dissolving into the skin and forming bubbles under the skin.
• The creeps do not occur in divers

• Rare but if it occurs can be very serious
• A burning pain in the chest that is usually worse with breathing in (inspiration).
• Other symptoms include cough, difficulty breathing, and cyanosis (blue lips and skin)
• Divers with the chokes can progress to shock rapidly

• The most common area affected in divers is the spinal cord.
• Symptoms classically include low back pain, "heaviness" of the legs, paralysis and/or numbness of the legs, and even loss of control of the sphincter (or valve) that controls urine and stool resulting in incontinence.
• Other symptoms may include fatigue, weak or numb upper extremities, chest or abdominal pains.
• DCS involving the brain can present with dizziness, confusion, decreased awareness, loss of consciousness, loss or limited vision and even difficulty with balance and/or walking.

The lymph glands can be swollen and painful.

Pain can occur at the head, neck, or torso. Pain at these sites versus the arms or legs carries a worse prognosis.

Occasionally someone with decompression illness may have symptoms suggesting an inner ear problem, such as a spinning sensation, deafness, ringing in the ears, or vomiting. This group of symptoms is called the "staggers."

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