Neurological decompression sickness treated without recompression.

Abstract

The conventional treatment of type II decompression sickness is immediate recompression, which shrinks any intravascular gas bubble and causes it to go back into solution. There is now evidence which requires reappraisal of the concept that a simple intravascular gas bubble is the major pathological factor in type II decompression sickness. After fatal decompression multiple systemic and pulmonary fat emboli have been found in dogs and in man (Clay, 1963). The composition of these fat emboli indicate that they are of metabolic origin. An absolute thrombocytopenia and a hyperliproteinaemia have been described in severe decompression sickness (Pauley and Cockett, 1970). Wells at al. (1971) found that in rapidly decompressed dogs erythrocyte and platelet aggregations occur, which do not appear to nucleate on gas bubbles. In type II decompression sickness the lesion would therefore appear to be a stable lipid/platelet embolus, and so rational medical therapy should be aimed at improving perfusion distal to the embolus and its destruction. Case ReportA 34-year-old man who was a professional diver had suffered three previous decompression accidents, one Investigations on admission were: haemoglobin, 1641 g/100 ml; packed cell volume, 48% mm3; platelets, 100,000/1; total plasma lipids, 1,030 mg/100 ml; plasma lipoproteins, 230 mg/100 ml; arterial pH, 7-32; Po,, 75 mm Hg; Pco2 51 mg Hg; HCO3, 22-0 mEq/l.The patient was treated initially with pentazocine 100 mg intramuscularly and 100% oxygen; 500 ml dextran 40 in saline were infused in 15 minutes; heparin 12,500 IU and frusemide 40 mg was given intravenously. Then he was given a second drip of 500 ml mannitol followed by 500 ml 20% fructose, which sobered him, and 500 ml 8-4% sodium bicarbonate solution. His bronchoconstriction and arterial hypoxaemia persisted, and he was given intravenous aminophylline 500 mg followed by 250 mg four-hourly. After this there was a steady rise in arterial Po2 and a fall in Pco2 (chart). The next day his electrocardiogram showed evidence of

Alphonse Jaminet on caisson disease: 1871—a commentary

“…Treatment for decompression sickness today requires recompression according to established tables, but Jaminet's prescription of rest, avoidance of hypotension, and fluid replacement are excellent principles for the resuscitation of a decompression sickness casualty far from the recompression chamber. There are case reports of recovery from serious decompression sickness using very similar treatment in recent times [2].…”