{"id":1982,"date":"2020-07-09T16:07:11","date_gmt":"2020-07-09T20:07:11","guid":{"rendered":"http:\/\/wordpress.world.dan.org\/?post_type=dan_health_resources&#038;p=1982"},"modified":"2022-06-21T15:39:00","modified_gmt":"2022-06-21T19:39:00","slug":"diagnosing-decompression-sickness","status":"publish","type":"dan_health_resources","link":"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/decompression-sickness\/diagnosing-decompression-sickness\/","title":{"rendered":"Chapitre 3 : Diagnostic de l'accident de d\u00e9compression"},"content":{"rendered":"<p class=\"has-medium-font-size\"><em><strong>\u201cWhile DCS is commonly thought of as a bubble disease, bubbles are probably only the gateway to a complex array of consequences and effects.\u201d<\/strong><\/em><\/p>\n\n\n\n<p>DCS may develop when a diver\u2019s degree of supersaturation is so high (or, stated another way, if the elimination gradient is so steep) that a controlled transfer of inert gases from the body\u2019s tissues to the bloodstream \u2014 and then from the bloodstream to the lungs and the lungs to the environment \u2014 is not possible. If that removal process is inadequate, inert gases will come out of solution and form bubbles that can distort tissues, obstruct blood flow, cause mechanical damage (to the joints, for example) and\/or trigger a cascade of biochemical responses.<\/p>\n\n\n\n<p>Bien que l'on sache beaucoup de choses sur la SCD, les m\u00e9canismes de l'insulte sont encore en cours d'\u00e9tude. Et bien que la DCS soit g\u00e9n\u00e9ralement consid\u00e9r\u00e9e comme une maladie \u00e0 bulles, les bulles ne sont probablement que la porte d'entr\u00e9e d'un ensemble complexe de cons\u00e9quences et d'effets.<\/p>\n\n\n\n<p>In this chapter, you\u2019ll learn about:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"#dcs-symptoms\">Signes et sympt\u00f4mes du SCD<\/a><\/li><li><a href=\"#diff-dx\">Differential Diagnosis of DCS<\/a><\/li><\/ul>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/skin-mottling-DAN-256x230-1.jpg\" alt=\"\" class=\"wp-image-11941\" width=\"290\" height=\"261\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/skin-mottling-DAN-256x230-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/skin-mottling-DAN-256x230-1-13x12.jpg 13w\" sizes=\"auto, (max-width: 290px) 100vw, 290px\" \/><figcaption>Ce type de marbrure de la peau est caract\u00e9ristique de la cutis marmorata, une affection qui peut signaler le d\u00e9veloppement probable de sympt\u00f4mes plus graves du type 2.<\/figcaption><\/figure><\/div>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"dcs-symptoms\">Signes et sympt\u00f4mes du SCD<\/h2>\n\n\n\n<p>The collective insult to the body\u2019s systems can produce symptomatic DCS. The condition\u2019s primary effects may be evident in the tissues that are directly insulted. Its secondary effects can compromise the function of a broad range of tissues, further jeopardizing the diver\u2019s health.<\/p>\n\n\n\n<p>The ability to recognize the signs, or objective evidence, and the symptoms, or subjective perceptions, of DCS \u2014 and to differentiate them from signs and symptoms less likely to be associated with DCS \u2014 is important. A variety of classification systems have been established for DCS. One common approach is to describe cases as Type 1 or Type 2.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Type 1 DCS<\/h3>\n\n\n\n<p>Type 1 DCS is usually characterized by musculoskeletal pain and mild cutaneous, or skin, symptoms. Common Type 1 skin manifestations include itching and mild rashes (as distinct from a clear mottled or marbled and sometimes raised discoloration of the skin \u2014 a condition that is known as cutis marmorata that may presage the development of the more serious symptoms of Type 2 DCS). Less common but still associated with Type 1 DCS is obstruction of the lymphatic system, which can result in swelling and localized pain in the tissues surrounding the lymph nodes \u2014 such as in the armpits, groin or behind the ears.<\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"399\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-1-symptom-sites-000048308414_Shoulder-DAN-800x400-1.jpg\" alt=\"\" class=\"wp-image-11942\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-1-symptom-sites-000048308414_Shoulder-DAN-800x400-1.jpg 800w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-1-symptom-sites-000048308414_Shoulder-DAN-800x400-1-360x180.jpg 360w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-1-symptom-sites-000048308414_Shoulder-DAN-800x400-1-768x383.jpg 768w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-1-symptom-sites-000048308414_Shoulder-DAN-800x400-1-18x9.jpg 18w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><figcaption>Collage montrant des douleurs \u00e0 plusieurs endroits du corps<\/figcaption><\/figure><\/div>\n\n\n\n<p>Les sympt\u00f4mes de la DCS de type 1 peuvent s'intensifier. Par exemple, la douleur peut commencer par \u00eatre l\u00e9g\u00e8re \u00e0 proximit\u00e9 d'une articulation ou d'un muscle, puis s'intensifier. Cependant, la douleur associ\u00e9e \u00e0 la DCS ne s'intensifie g\u00e9n\u00e9ralement pas lors du mouvement de l'articulation affect\u00e9e, bien que le fait de maintenir le membre dans une position plut\u00f4t qu'une autre puisse r\u00e9duire l'inconfort. Cette douleur peut finalement \u00eatre tr\u00e8s intense.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Type 2 DCS<\/h3>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"368\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-2-Jackie-DAN-256x368-1.jpg\" alt=\"\" class=\"wp-image-11943\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-2-Jackie-DAN-256x368-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-2-Jackie-DAN-256x368-1-250x360.jpg 250w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/DCS-type-2-Jackie-DAN-256x368-1-8x12.jpg 8w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><figcaption>Le test de Romberg \u00e9value le contr\u00f4le postural. Le test de Romberg affin\u00e9, qui consiste \u00e0 croiser les bras et \u00e0 mettre un pied devant l'autre, est plus sensible aux modifications de l'\u00e9quilibre statique.<\/figcaption><\/figure><\/div>\n\n\n\n<p>Type 2 symptoms are considered more serious. They typically fall into three categories: neurological, inner ear and cardiopulmonary. Neurological symptoms may include numbness; paresthesia, or an altered sensation, such as tingling; muscle weakness; an impaired gait, or difficulty walking;\u00a0problems with physical coordination or bladder control; paralysis; or a change in mental status, such as confusion or lack of alertness. Inner-ear symptoms may include ringing in the ears, known as \u201ctinnitus\u201d; hearing loss; vertigo or dizziness; nausea; vomiting; and impaired balance. Cardiopulmonary symptoms, known commonly as \u201cthe chokes,\u201d include a dry cough; chest pain behind the sternum, or breastbone; and breathing difficulty, also known as \u201cdyspnea.\u201d The respiratory complaints, which are typically due to high bubble loads in the lungs, can compromise the lungs\u2019 ability to function \u2014 threatening the affected diver\u2019s health, and even life, if treatment is not sought promptly.<\/p>\n\n\n\n<p>Type 2 symptoms can develop either quickly or slowly. A slow build can actually obscure the seriousness of the situation, by allowing denial to persist. For example, fatigue and weakness are common enough concerns, especially if their onset is protracted, that they can be very easy to ignore. Less common symptoms, such as difficulty walking, urinating, hearing or seeing \u2014 especially if their onset is quick \u2014 can sometimes prompt faster recognition of the existence of a problem. It is fair to say that divers can initially be reluctant to report symptoms, though they usually will do so if their symptoms do not go away. This is a shortcoming divers should be aware of, lest they fall prey to it.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Pr\u00e9sentation du DCS<\/h3>\n\n\n\n<p>The presentation of DCS is frequently idiosyncratic \u2014 that is, its \u201ctypical\u201d pattern can be atypicality. In some cases, an affected diver\u2019s chief complaint may draw attention away from more subtle but potentially more important symptoms. The following list ranks the initial manifestations of DCS, from those most commonly to least commonly reported (Vann et al. 2011):<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Douleur, en particulier pr\u00e8s des articulations<\/li><li>Engourdissement ou paresth\u00e9sie<\/li><li>Constitutional concerns \u2014 such as headache, lightheadedness, unexplained fatigue, malaise, nausea and\/or vomiting, or anorexia<\/li><li>\u00c9tourdissements ou vertige<\/li><li>Faiblesse motrice<\/li><li>Cutaneous, or skin, problems \u2014 such as an itch, rash, or mottling (\u201ccutis marmorata\u201d)<\/li><li>G\u00eane musculaire<\/li><li>Alt\u00e9ration de l'\u00e9tat mental<\/li><li>Pulmonary problems \u2014 such as breathing difficulties (\u201cthe chokes\u201d)<\/li><li>Troubles de la coordination<\/li><li>Diminution de l'\u00e9tat de conscience<\/li><li>Auditory symptoms \u2014 such as hearing sounds that are not there or having a hard time hearing<\/li><li>Lymphatic concerns \u2014 such as regional swelling<\/li><li>Bladder or bowel dysfunction \u2014 such as retention of urine<\/li><li>Fonction cardiovasculaire compromise<\/li><\/ul>\n\n\n\n<p>Selon cette \u00e9tude r\u00e9cente, la douleur et l'engourdissement, \u00e9galement connus sous le nom de paresth\u00e9sie, ont \u00e9t\u00e9 signal\u00e9s initialement dans pr\u00e8s de deux tiers des cas de SCD, les sympt\u00f4mes constitutionnels dans environ 40 % des cas, les vertiges\/vertiges et la faiblesse motrice dans environ 20 % des cas, et les sympt\u00f4mes cutan\u00e9s dans environ 10 % des cas (Vann et al. 2011).<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"diff-dx\">Differential Diagnosis of DCS<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"256\" height=\"385\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/differential-diagnosis-DCS-000008233479-DAN-256x385-1.jpg\" alt=\"\" class=\"wp-image-11949\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/differential-diagnosis-DCS-000008233479-DAN-256x385-1.jpg 256w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/differential-diagnosis-DCS-000008233479-DAN-256x385-1-239x360.jpg 239w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/differential-diagnosis-DCS-000008233479-DAN-256x385-1-8x12.jpg 8w\" sizes=\"auto, (max-width: 256px) 100vw, 256px\" \/><\/figure><\/div>\n\n\n\n<p>Le DCS est une blessure de plong\u00e9e tr\u00e8s m\u00e9diatis\u00e9e en raison de sa gravit\u00e9 potentielle. Mais les plongeurs doivent se rappeler que tous les probl\u00e8mes li\u00e9s \u00e0 la plong\u00e9e ne se r\u00e9v\u00e8lent pas \u00eatre des DCS. Lorsque deux ou plusieurs pathologies pr\u00e9sentent des sympt\u00f4mes communs, comme c'est le cas pour de nombreuses blessures li\u00e9es \u00e0 la plong\u00e9e, le diagnostic diff\u00e9rentiel est le processus par lequel le personnel m\u00e9dical d\u00e9termine laquelle des pathologies potentielles est la plus susceptible d'\u00eatre responsable des sympt\u00f4mes.<\/p>\n\n\n\n<p>The term decompression illness (DCI) was coined to encompass both DCS and the related condition known as arterial gas embolism (AGE), the latter arising from barotrauma of the lungs that introduces gas into the systemic bloodstream. Some of the other conditions and circumstances that involve similar symptoms include inner-ear barotrauma; middle-ear or maxillary sinus overinflation; contaminated breathing gas; oxygen toxicity; musculoskeletal strains or trauma sustained before, during or after a dive; marine life envenomation; immersion pulmonary edema; water aspiration; and coincidental neurological disorders, such as stroke (Vann et al. 2011). Thermal stress \u2014 sometimes due to excessive heat, but usually due to cold exposure \u2014 can also be responsible for similar symptoms. In some cases, a careful medical history can easily rule out one diagnosis or another. For example, symptoms of immersion pulmonary edema often develop at depth. In such a case, a good history would rule out DCS, which only develops after significant decompression stress during ascent.<\/p>\n\n\n\n<p>Les plongeurs qui pr\u00e9sentent l'un de ces sympt\u00f4mes doivent imp\u00e9rativement demander une \u00e9valuation et un soutien m\u00e9dicaux. Bien que les premiers intervenants soient en mesure d'effectuer une analyse initiale d'une personne bless\u00e9e, par exemple en proc\u00e9dant \u00e0 une \u00e9valuation neurologique sur le terrain, les capacit\u00e9s des non-m\u00e9decins sont loin d'\u00e9galer les comp\u00e9tences cliniques et les connaissances des sp\u00e9cialistes cliniques exp\u00e9riment\u00e9s.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-text-align-right\"><strong>Suivant :&nbsp;<a href=\"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/decompression-sickness\/treating-dcs\/\">Chapter 4 \u2013 Treating Decompression Sickness &gt;<\/a><\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>Monoplace hyperbaric chambers hold only the patient being treated. The chamber walls are frequently made of acrylic to reduce any sense of claustrophobia.<\/p>","protected":false},"featured_media":11947,"parent":1642,"menu_order":39,"template":"","dan_health_resource_types":[405],"class_list":["post-1982","dan_health_resources","type-dan_health_resources","status-publish","has-post-thumbnail","hentry","dan_health_resource_types-dive-medical-reference-books"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Chapter 3: Diagnosing Decompression Sickness - DAN World<\/title>\n<meta name=\"description\" content=\"Decompression sickness may develop when a diver\u2019s degree of supersaturation is so high that a controlled transfer of inert gases from the body\u2019s tissues to the bloodstream\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/decompression-sickness\/diagnosing-decompression-sickness\/\" \/>\n<meta property=\"og:locale\" content=\"fr_CA\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chapter 3: Diagnosing Decompression Sickness\" \/>\n<meta property=\"og:description\" content=\"Decompression sickness may develop when a diver\u2019s degree of supersaturation is so high that a controlled transfer of inert gases from the body\u2019s tissues to the bloodstream.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/decompression-sickness\/diagnosing-decompression-sickness\/\" \/>\n<meta property=\"og:site_name\" content=\"DAN World\" \/>\n<meta property=\"article:modified_time\" content=\"2022-06-21T19:39:00+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/diagnosing-decompression-sickness-11346505-DAN-1200x700-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"700\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:title\" content=\"Chapter 3: Diagnosing Decompression Sickness\" \/>\n<meta name=\"twitter:description\" content=\"Decompression sickness may develop when a diver\u2019s degree of supersaturation is so high that a controlled transfer of inert gases from the body\u2019s tissues to the bloodstream.\" \/>\n<meta name=\"twitter:image\" content=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/diagnosing-decompression-sickness-11346505-DAN-1200x700-1.jpg\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/world.dan.org\\\/health-medicine\\\/health-resource\\\/dive-medical-reference-books\\\/decompression-sickness\\\/diagnosing-decompression-sickness\\\/\",\"url\":\"https:\\\/\\\/world.dan.org\\\/health-medicine\\\/health-resource\\\/dive-medical-reference-books\\\/decompression-sickness\\\/diagnosing-decompression-sickness\\\/\",\"name\":\"Chapter 3: Diagnosing Decompression Sickness - 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