A scuba diver ascends and experiences truncal constriction (a feeling of tight around the chest) and ascending paralysis. What is the diagnosis and initial treatment?

A scuba diver ascends and experiences truncal constriction (a feeling of tight around the chest) and ascending paralysis. What is the diagnosis and initial treatment?

• A. Decompression sickness Type 1 — 100% oxygen; IV fluids; Recompression therapy (hyperbaric oxygen); Lidocaine
• B. Decompression sickness Type 2 — 100% oxygen; IV fluids; Recompression therapy (hyperbaric oxygen); Lidocaine
• C. Acute myocardial infarction — aspirin; nitroglycerin; morphine; oxygen
• D. Pulmonary edema — diuretics; oxygen; nitrates; fluids

Answer: (B)

Rapid ascent after scuba diving can trap nitrogen bubbles in tissues and vessels. When those bubbles involve the nervous system or lungs, the situation becomes decompression sickness type 2, which fits this patient’s neurologic symptom (ascending paralysis) and chest–torso sensation (truncal constriction). The best initial approach is to treat those bubbles as quickly as possible. Start with 100% oxygen right away to maximize nitrogen washout and improve oxygen delivery to tissues. Secure IV access and give aggressive IV fluids to support perfusion and help prevent second-order effects of bubble formation. Arrange emergent recompression therapy in a hyperbaric chamber; the increased pressure reduces bubble size and helps re-dissolve nitrogen, reversing the pathophysiology driving symptoms. Lidocaine may be used if arrhythmias occur due to gas emboli or systemic effects, but it’s not the primary treatment. The key steps are high-flow oxygen, fluids, and prompt hyperbaric recompression.

Rapid ascent after scuba diving can trap nitrogen bubbles in tissues and vessels. When those bubbles involve the nervous system or lungs, the situation becomes decompression sickness type 2, which fits this patient’s neurologic symptom (ascending paralysis) and chest–torso sensation (truncal constriction).

The best initial approach is to treat those bubbles as quickly as possible. Start with 100% oxygen right away to maximize nitrogen washout and improve oxygen delivery to tissues. Secure IV access and give aggressive IV fluids to support perfusion and help prevent second-order effects of bubble formation. Arrange emergent recompression therapy in a hyperbaric chamber; the increased pressure reduces bubble size and helps re-dissolve nitrogen, reversing the pathophysiology driving symptoms.

Lidocaine may be used if arrhythmias occur due to gas emboli or systemic effects, but it’s not the primary treatment. The key steps are high-flow oxygen, fluids, and prompt hyperbaric recompression.