If DCI does happen, proper treatment is very important. First aid for DCI is immediate administration of 100% oxygen either through a demand mask that cover’s the patient’s face and delivers oxygen when the patient breathes. If the patient cannot tolerate a demand mask, a nonbreatheable, free-flow mask can be used with a flow rate set to 15 liters per minute. Masks should seal to the patients face so that maximum O2 is delivered to the patient. Air leaks in the mask will dilute the O2 percentage inspired. Do not use less than 100% oxygen as a way to prolong oxygen supply. Divers Alert Network (DAN) offers a variety of oxygen kits for the diving community as well as training in their use.
Patients should stay on 100% oxygen until they are transported to a recompression chamber or until the oxygen supply is exhausted. Oxygen is administered primarily to help eliminate inert gas and reduce bubble size. When you breathe O2 at the surface, your blood’s oxygen partial pressure is elevated dramatically. This provides a breathing media that is absent of inert gas, which could cause more damage, and establishes a steep gradient across the tissue and bubble interface. This allows for a more effective off gassing of the inert gas and contributes to better oxygenation of the body’s tissues where the bubble has lodged.
Removal of the patient’s wetsuit or dry suit is desirable, but the patient must be kept warm and comfortable. Use blankets or towels to cover the patient.
Oral fluids should be given is the patient is conscious. Drinking water or a Gatorade type drink in the amounts of 12 to 16 ounces every 30 minutes. This keeps the patient properly hydrated. This may require the patient to have to urinate, which is a good sign and should be accommodated in the supine position. If the patient is unable to urinate, a more serious Type II DCI may be manifested. If the patient isn’t able to urinate in a reasonable amount of time, back off on the administration of fluids.
Do not administer pain medications as they can mask the symptoms of DCI. Knowing the symptoms is important for the proper treatment.
Be prepared to administer CPR and rescue breathing if the patient’s condition deteriorates. Somebody in your dive team should be trained in these techniques and it helps if more than one person is trained.
Transport the patient to a recompression chamber as soon as possible. Prompt hyperbaric treatment is essential to the recovery of a patient with DCI. Hyperbaric treatment consists of recompressing the patient until the inert gas bubbles are forced back into solution, so that the body can off gas the excess inert gas. Most cases of DCI can be cured without permanent damage if 100% oxygen and hyperbaric treatment are administered promptly.
Hyperbaric medicine is a subject unto itself. The important thing to remember is that quick and decisive hyperbaric treatment is extremely important for a full recovery and the ability to return to diving.
It’s a good idea to have the telephone number and address of the hyperbaric chamber nearest to where you are diving. Sometimes finding out this information is difficult. If you don’t of a chamber near where you’re diving or have an incident during a dive, contact DAN at 1-919-684-8111 for advice and support.