Bab 4 – Mengobati Penyakit Dekompresi

“If signs or symptoms consistent with DCS develop, initiate appropriate first aid and contact the nearest emergency medical services. For additional emergency assistance contact DAN +1-919-684-9111.”

Ada beberapa elemen untuk manajemen DCS yang efektif, khususnya evaluasi di tempat dan pertolongan pertama, transportasi dan evaluasi dan pengobatan medis definitif. Siapa pun yang menderita DCS harus mencari evaluasi yang tepat, dan kemungkinan perawatan berkelanjutan, dari dokter yang mengetahui dengan baik tentang masalah medis terkait penyelaman.

In this chapter, you’ll learn about:

• Pertolongan Pertama di Lokasi Kejadian
• Evaluasi Selanjutnya
• Terapi Oksigen Hiperbarik
• Rekompresi Dalam Air
• Sumber Daya Darurat

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Pertolongan Pertama di Lokasi Kejadian

Dasar dari pertolongan pertama adalah bantuan hidup dasar. Tindakan pertolongan pertama utama untuk DCS adalah pengiriman oksigen tambahan dalam konsentrasi tertinggi, atau fraksi, yang praktis (Longphre et al. 2007). Fraksi oksigen yang tinggi, jika diberikan dengan cepat dan dalam jangka waktu yang lama, dapat mengurangi atau bahkan menghilangkan gejala DCS, meskipun seringkali hanya sementara jika pengobatan definitif tidak dijamin. Sistem oksigen aliran kontinu, menggunakan masker non-rebreather atau masker saku, sering tersedia di lingkungan menyelam; namun, peralatan tersebut memberikan fraksi oksigen sedang. Fraksi yang jauh lebih tinggi dapat dicapai dengan demand mask, meskipun hanya sesuai untuk individu yang sadar yang dapat bernapas sendiri.

Rebreather systems are another on-the-scene option; such systems permit the unused oxygen in the diver’s exhalations to be recycled, or rebreathed. A rebreather apparatus can thus provide high fractions with minimal gas use and may prove especially helpful in settings where the supply of oxygen is limited (Pollock 2004; Pollock and Natoli 2007).

Chemical oxygen generating systems — devices with a long shelf life that deliver oxygen via a chemical reaction — may in some situations be the only option available. However, if emergency medical services are not readily accessible, such devices are unlikely to provide a sufficient oxygen supply (Pollock and Natoli 2010).

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Evaluasi Selanjutnya

First aid is just the first step in treating an affected diver. Anyone who has experienced symptoms associated with DCS is advised to seek subsequent medical evaluation. This should occur even if the diver’s symptoms improved or disappeared upon the administration of oxygen, since subtle issues can be missed or symptoms can return once oxygen delivery is stopped. For the same reason, it is advisable to seek input from an experienced dive-medicine specialist — someone aware of all the nuances in the presentation, course and treatment of DCS.

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Terapi Oksigen Hiperbarik

Pengobatan definitif untuk DCS adalah terapi oksigen hiperbarik (HBO), atau pemberian oksigen murni pada tekanan yang jauh lebih tinggi daripada tekanan atmosfer. Terapi HBO mengurangi ukuran gelembung apa pun dan meningkatkan gradien yang meningkatkan pengiriman oksigen dan eliminasi gas inert. Terapi HBO biasanya diberikan di ruang rekompresi (chamber).

A common HBO regimen is the U.S. Navy Treatment Table 6 (USN 2008). According to this regimen, the hyperbaric chamber is initially pressurized to 2.8 atmospheres absolute (ATA), equivalent to the pressure found at 60 feet (18 meters) of seawater. The patient breathes pure oxygen, interspersed with scheduled periods of breathing regular air to reduce the risk of oxygen toxicity. The usual duration of the USN TT6 treatment is just under five hours, but extensions can be added as required, based on the patient’s response.

HBO treatment can be conducted in a monoplace chamber, often an acrylic tube sized to hold just one patient, or in a multiplace chamber, sized to accommodate one or more patients plus one or more “tenders” — that is, technicians or other medical personnel. Multilock chambers are designed to allow patients, tenders or equipment to be transferred into and out of the chamber while treatment is ongoing.

The course of HBO therapy will vary according to the particulars of each case; both the presentation of DCS and its response to treatment can be idiosyncratic. A full resolution of DCS symptoms can often be achieved with one or sometimes multiple HBO treatments. In some cases, however, resolution will be incomplete, even after many treatments. The normal clinical approach is to continue the treatments until no further improvement is seen in the patient’s symptoms. Modest residual symptoms will then often resolve slowly, after the treatment series is ended. Full resolution of symptoms can sometimes take months to achieve and in some instances may never be realized.

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Rekompresi Dalam Air

Rekompresi dalam air dapat menjadi alternatif untuk chamber rekompresi di lokasi terpencil, jika tidak ada chamber terdekat atau sarana untuk mengangkut pasien dengan cepat ke chamber di tempat lain. Teknik ini melibatkan membawa penyelam ke bawah air lagi, untuk mendorong gelembung gas kembali ke dalam larutan untuk mengurangi gejala dan kemudian secara perlahan mendekompresi dengan cara yang mempertahankan pembuangan gas berlebih secara teratur.

While in-water recompression is simple in concept, it is practical only with a substantial amount of planning, support, equipment and personnel; appropriate water conditions; and suitable patient status. Critical challenges can arise due to changes in the patient’s consciousness, oxygen toxicity, gas supply, and even thermal stress. An unsuccessful in-water recompression may leave the patient in worse shape than had the attempt not been made. The medical and research communities are divided on the utility of in-water recompression. It is beyond the scope of this publication to consider all of the relevant factors, but it is fair to say that there are probably more situations when in-water recompression should not be undertaken than situations when it would be a reasonable choice.

Sebagai aturan umum, seorang penyelam yang memiliki gejala yang konsisten dengan DCS harus dikeluarkan dari air, dan pertolongan pertama harus diberikan di permukaan, bahkan jika terdapat kemungkinan terjadinya penundaan sebelum sebuah perawatan medis definitif dapat dicari.

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Sumber Daya Darurat

Berikutnya Chapter 5 – Factors Contributing to Decompression Stress >