Bab 3 – Mendiagnosis Penyakit Dekompresi

“While DCS is commonly thought of as a bubble disease, bubbles are probably only the gateway to a complex array of consequences and effects.”

DCS may develop when a diver’s 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’s tissues to the bloodstream — and then from the bloodstream to the lungs and the lungs to the environment — 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.

Meskipun banyak yang diketahui tentang DCS, mekanisme pembentukannya masih diselidiki. Dan sementara DCS umumnya dianggap sebagai penyakit gelembung, gelembung itu sendiri mungkin hanya pintu gerbang ke serangkaian konsekuensi dan efek yang kompleks.

In this chapter, you’ll learn about:

Bintik-bintik kulit seperti ini adalah karakteristik dari cutis marmorata, suatu kondisi yang dapat memperingatkan kemungkinan perkembangan gejala Tipe 2 yang lebih serius.

Tanda dan Gejala DCS

The collective insult to the body’s systems can produce symptomatic DCS. The condition’s 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’s health.

The ability to recognize the signs, or objective evidence, and the symptoms, or subjective perceptions, of DCS — and to differentiate them from signs and symptoms less likely to be associated with DCS — 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.

DCS Tipe 1

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 — 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 — such as in the armpits, groin or behind the ears.

Kolase menunjukkan rasa sakit di beberapa bagian tubuh

Gejala DCS Tipe 1 dapat meningkat intensitasnya. Misalnya, rasa sakit mungkin berasal dari rasa sakit ringan di sekitar sendi atau otot dan kemudian bertambah besar. Namun, rasa sakit yang terkait dengan DCS biasanya tidak meningkat pada pergerakan sendi yang terkena, meskipun memegang anggota badan dalam satu posisi daripada yang lain dapat mengurangi ketidaknyamanan. Rasa sakit seperti itu pada akhirnya bisa sangat parah.

DCS Tipe 2

Tes Romberg mengevaluasi kontrol postural. Romberg yang diasah, yang mencakup menyilangkan lengan dan meletakkan satu kaki di depan yang lain, lebih sensitif terhadap perubahan keseimbangan statis.

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; problems 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 “tinnitus”; hearing loss; vertigo or dizziness; nausea; vomiting; and impaired balance. Cardiopulmonary symptoms, known commonly as “the chokes,” include a dry cough; chest pain behind the sternum, or breastbone; and breathing difficulty, also known as “dyspnea.” The respiratory complaints, which are typically due to high bubble loads in the lungs, can compromise the lungs’ ability to function — threatening the affected diver’s health, and even life, if treatment is not sought promptly.

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 — especially if their onset is quick — 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.

Presentasi DCS

The presentation of DCS is frequently idiosyncratic — that is, its “typical” pattern can be atypicality. In some cases, an affected diver’s 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):

  • Nyeri, terutama di sekitar persendian
  • Mati rasa atau parestesia
  • Constitutional concerns — such as headache, lightheadedness, unexplained fatigue, malaise, nausea and/or vomiting, or anorexia
  • Pusing atau vertigo
  • Kelemahan motorik
  • Cutaneous, or skin, problems — such as an itch, rash, or mottling (“cutis marmorata”)
  • Ketidaknyamanan otot
  • Gangguan status mental
  • Pulmonary problems — such as breathing difficulties (“the chokes”)
  • Koordinasi terganggu
  • Penurunan tingkat kesadaran
  • Auditory symptoms — such as hearing sounds that are not there or having a hard time hearing
  • Lymphatic concerns — such as regional swelling
  • Bladder or bowel dysfunction — such as retention of urine
  • Fungsi kardiovaskular terganggu

Menurut tinjauan baru-baru ini, nyeri dan mati rasa, juga dikenal sebagai parestesia, dilaporkan awalnya pada hampir dua pertiga kasus DCS, gejala konstitusional pada sekitar 40 persen kasus, pusing/vertigo dan kelemahan motorik pada sekitar 20 persen, dan gejala gangguan kulit pada sekitar 10 persen (Vann et al. 2011).

Diagnosis Diferensial DCS

DCS adalah cedera menyelam profil tinggi karena potensi keparahannya. Tetapi penyelam perlu mengingat bahwa tidak semua masalah yang berhubungan dengan penyelaman berubah menjadi DCS. Ketika dua atau lebih kondisi memiliki gejala yang tumpang tindih, seperti halnya dengan banyak cedera terkait penyelaman, diagnosis banding adalah proses di mana tenaga medis mencari tahu kondisi potensial mana yang paling mungkin bertanggung jawab atas gejala tersebut.

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 — sometimes due to excessive heat, but usually due to cold exposure — 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.

Sangat penting bagi penyelam dengan gejala-gejala ini untuk mencari evaluasi dan dukungan medis. Sementara responden pertama mampu melakukan analisis awal dari individu yang terluka, seperti memberikan penilaian neurologis lapangan, kemampuan non-dokter tidak mendekati keterampilan klinis dan wawasan yang dimiliki oleh spesialis klinis berpengalaman.

Berikutnya Chapter 4 – Treating Decompression Sickness >

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