Be Aware of Unusual DCS Symptoms

When a diver begins to suffer from extreme fatigue, achy joints and confusion, dive professionals will recognize these as signs of decompression sickness (DCS) and act quickly to ensure the divers gets the care they need.

However, there are also numerous uncommon symptoms, and these are often associated with lesser-known forms of DCS. Because the most common symptoms represent only a partial list of potential complications, gaps in dive professionals’ (and even doctors’) understanding of DCS are common. This can lead to misdiagnoses and delays to treatment.

Regardless of how DCS manifests, it’s important to act at the onset of any out-of-the-ordinary symptoms. And it’s important to teach your students about DAN’s support for divers. When a dive accident occurs, DAN can be instrumental in facilitating medical care, and having dive accident insurance can defray potentially significant medical expenses. With more than 40 years of experience assisting divers, DAN can help you better understand the symptoms you or one of your divers is experiencing — and determine the best course of action.

DAN member Kelly, a Master Scuba Diver Trainer with more than 500 lifetime dives, had taken months to prepare for her technical sidemount diving certification — she was ready to tackle the classroom portion of her course, manage multiple gas cylinders and complete 12 dives in six days.

The course started in shallow water, with dives becoming progressively deeper and longer. Kelly’s overall approach was cautious — she had experienced skin DCS the previous year, and she wanted to follow her decompression stops exactly as her late-model, multi-gas dive computer prescribed.

First she completed two 29-foot dives on air. Then Kelly completed three nitrox dives to 90 feet. After one dive, Kelly had a small snag while climbing exiting the water — rough seas jostled her, and she collided with the ladder. For the next two dives, Kelly introduced 100-percent oxygen as her decompression gas. These dives were to 95 feet for 42 minutes and then to 119 feet for 67 minutes.

Now more than halfway through her dives, Kelly noticed her left bicep was sore and the skin felt taut and warm. She assumed the injury came from her collision with the ladder, and unphased, kept diving.

But the pain worsened and spread to her left breast. The working hypothesis among those on the dive boat was that Kelly had suffered a hematoma on her left bicep. However, the lack of bruising to the area contradicted that assessment.

Four days had passed since symptom onset, and the symptoms were worsening — her fingers were tingling, her chest was tight, and her vision was becoming impaired. The boat crew decided to transport Kelly back to shore and take her to the nearest medical facility while her partner contacted DAN.

Once the DAN medic heard Kelly’s symptoms they became concerned about the possibility of inert gas bubbles in Kelly’s lymphatic system, creating a buildup of lymph fluid in her upper arms and chest: lymphatic DCS.

At the hospital, Kelly was directed to the nearby hyperbaric chamber for treatments. When she arrived at the chamber she relayed the information she received from DAN about lymphatic DCS, and that helped inform her treatments.

Lung barotrauma was ruled out, and Kelly was wheeled into a hyperbaric chamber to undergo a five-hour U.S. Navy Treatment Table 6 — standard care for DCS. Kelly was eventually discharged, and her symptoms diminished as she continued recovery at home.

Kelly’s obscure symptoms were consistent with lymphatic DCS, but that’s a manifestation of DCS that is not well known. Her dives were long and deep but did not violate her planned depth/time profile.

Fortunately DAN knew what to do. The DAN medic’s knowledge and quick thinking gave Kelly’s doctors a starting point. Thanks to a combination of Kelly’s DAN insurance and personal medical insurance, her expenses were covered. DAN was there for Kelly every step of the way. 

Relay the importance of DAN membership to your students. DAN World dive accident coverage is available only to DAN members, and it covers accidents and injuries related to diving and many other water sports as well as non-diving-related accidents and injuries. Coverage starts at just US$40/year, and from day one DAN helps take the guesswork out of emergency logistics. Once a member calls the 24/7 hotline, DAN arranges whatever care is needed. Behind the scenes, DAN specialists coordinate medical care and transportation with local agencies, and in dive emergencies, DAN medical staff can even offer consultations to treating physicians who are not familiar with dive medicine.

With more than 40 years of experience managing emergencies in remote locations, DAN is much more than an insurance company. Learn more about talking to your students about DAN membership.