Fisherman develops spinal DCS after IWR attempt for joint pain DCS


Mikel ZubimendiMikel Zubimendi
The diver is a 29-year-old selfish harvester, hookah diver. He was treated for paraplegia, three years ago. He is now collecting razor clams (ensis macha).

On his fourth day of diving, he did three dives to about 18-meter depth, one to one and a half hours each, between 11 am and 4 pm. He did not do any deco or safety stops. Instead, he tried to maintain a slow ascent. Fifteen minutes after his last dive, while in the boat, he started feeling a pain in his right elbow. He did in-water recompression to 8 meters for ten minutes, and 30 minutes at 3 meters, while breathing air. Forty minutes after the recompression, when he already was at his house, he got pain in his both knees and decided to admit to a local hospital.

On admission, the pain in his knees was the six on a scale of zero to 10.* The strength of his lower limbs was three on the scale of 0 to 5, knee flexor three and knee extensor 4.# The patient received 1000 ml of Ringer's lactate for rehydration. His chest X-ray and ECG were normal, and his skin had no signs of skin bend. On first aid surface oxygen, his symptoms started to decrease. He was recompressed on USN TT5. Pain diminished three minutes after reaching the recompression depth and completely resolved within 15 minutes. Upon completion of treatment, his strength was normal.

Pain scale: 0 – no pain, 10 – worst possible pain

#MRC Muscle Strength Scale 0 - 5
0 – No contraction
I - Flicker or trace of contraction
2 - Active movement, with gravity eliminated
3 - The active movement against gravity
4 - The active movement against gravity and resistance
5 - Normal strength

Reported by Dr Maximiliano Fuentealba Candia, Arauco, Chile