What Is Decompression Sickness (DCS) – Prominent Symptom

11. Decompression Sickness1
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Answering the question of what is the most noticeable symptom of Decompression Sickness (DCS) requires knowledge of the distinction between a sign and a symptom. The victim exhibits a symptom and tells others about it. Others can see the disease’s outward manifestation.

What is Decompression Sickness?

Commonly referred to as the bends, caisson disease, or divers sickness / disease, decompression sickness or When nitrogen bubbles accumulate inside of divers’ bodies and are not thoroughly dissolved before they resurface, DCS results, causing symptoms like joint pain, wooziness, extreme fatigue, paralysis, and collapse.

What is the Most Prominent Symptom of Decompression Sickness

Joint pain is the most prominently occurring symptom of decompression sickness. In fact, in Deco for Divers, According to Mark Powell, 89% of all DCS cases in the US Navy involve local joint pain.

Decompression sickness is also commonly known as “the bends”. It confirms joint pain as a prominent symptom in cases of DCS and frequently appeared in 1871 in construction workers.

Decompression Sickness Symptoms

The most common symptoms of decompression sickness include the following:

  • Local joint pain (mainly in shoulders, elbows, wrists, hips, knees, and ankles)
  • Weakness in the arms and legs
  • Headache
  • Dizziness
  • Trouble thinking clearly
  • Numbness & tingling
  • Extreme fatigue

All of these symptoms are experienced by the decompression sickness patient and shared with others. Decompression sickness symptoms almost always come before physical symptoms, which makes diagnosis challenging.

I am aware from personal experience that any symptoms mentioned by a diver should never be disregarded. We do need to be vigilant without being overly watchful and contributing to the general anxiety surrounding DCS. A headache, tingling, and even weakness in the arms or legs can result from severe dehydration. Until it can be positively ruled out, decompression sickness must be treated.

100% Oxygen should be administered topically as first aid for signs and symptoms of suspected DCS.

In actuality, dehydration frequently predisposes to DCS. My own calls to dive medics for cases of what I thought might be decompression sickness were actually cases of dehydration.

Other Common Symptoms of DCS

Neurological symptoms come next, after local joint pain, according to Mark Powell’s research. Neurological symptoms, most frequently headaches and visual disturbances, were reported in 10% to 15% of DCS cases.

In about 10% to 15% of cases of DCS, skin manifestations also happen quite frequently. One symptom that divers may experience is itchy skin. A skin rash that is visible to others would need to be correctly categorized as a sign, though.

This leaves pulmonary symptoms, known as “the chokes”, the least common symptom. Depending on the severity, this can also be categorized as a sign, much like skin manifestations.

Prevention of Decompression Sickness

By always diving safely, decompression sickness can be avoided very easily. Diver error is, after all, the primary reason for DCS. Scuba divers who push themselves too far and don’t plan enough backups for their dives. A lot of the time, it’s just divers pushing the boundaries of their training and comfort zones.

Divers are still investigating and learning about their absolute physical limits. Decompression sickness is a common draw for thrill-seekers who dive deeper. It goes without saying that those explorers face significantly greater risks of the bends than recreational divers.

Make sure the dive operators you select always have enough pure oxygen (O2) onboard. I would never dive with an operation that does not provide 100% O2 is the best treatment for DCS currently on the market, and when used properly, it is safe.

Therefore, it is beneficial to understand what the primary sign of decompression sickness is. Even when there is reason for suspicion, precautions should be taken. This gives the victim the best opportunity for a complete recovery.

11. Decompression Sickness2


Clinical tests are used for diagnosis. When trying to rule out conditions like a herniated intervertebral disk, an ischemic stroke, or a hemorrhage in the central nervous system, CT and MRI scans may be helpful. Although these studies occasionally reveal brain or spinal cord abnormalities brought on by decompression sickness, their sensitivity is low, and treatment should typically start based on clinical suspicion.

Similar signs and symptoms can occur with arterial gas embolism (for a comparison of the features, see the table Comparison of Gas Embolism and Decompression Sickness). However, both conditions respond similarly to immediate care.

Skeletal x-rays of the joints may reveal joint degeneration in dysbaric osteonecrosis, which cannot be distinguished from joint degeneration brought on by other joint disorders; MRI is typically diagnostic.


  • 100% oxygen
  • Recompression therapy
  • Fluid therapy to maintain intravascular volume

The majority of patients fully recover.

In the beginning, high-flow 100% oxygen improves nitrogen washout by enlarging the nitrogen pressure gradient between the lungs and the circulation and thereby quickening the reabsorption of nitrogen-containing embolic bubbles.

For alert patients with minor symptoms, oral resuscitation fluid (or plain water) is recommended to replace lost intravascular volume. Those with severe manifestations should receive isotonic, glucose-free IV fluids.

All patients should receive compression therapy, with the possible exception of those with symptoms such as itching, skin mottling, and fatigue, which may be managed with oxygen alone; patients should be monitored for deterioration. Patients with more severe symptoms are taken to an appropriate recompression facility. Transport should not be delayed for the completion of unnecessary procedures because the length of time until treatment and the severity of the injury are crucial determinants of outcome.

An aircraft with a 1 atmosphere internal pressure rating is preferred if air evacuation is necessary. In ideal circumstances, low altitude ( 609 m [ 2000 ft]) and continuous oxygen administration should be practiced in unpressurized aircraft. Despite being pressurized, commercial aircraft typically have a cabin pressure of up to 2438 m (8000 ft) at normal cruise altitude, which could exacerbate symptoms. The symptoms may worsen if you take a commercial flight soon after diving.


Significant bubble formation can usually be avoided by limiting the depth and duration of dives to a range that does not need decompression stops during ascent (called no-stop limits) or by ascending with decompression stops as specified in published guidelines (eg, the decompression table in the chapter Diagnosis and Treatment of Decompression Sickness in the American Navy Diving Manual). The decompression schedule is calculated by a portable dive computer, which is frequently worn by divers. The device continuously measures depth and time spent at depth.

In addition to adhering to written and computer-generated recommendations, many divers stop for a brief period of time at 4.6 meters (15 feet) below the surface as a safety precaution. Despite the widespread use of dive computers, cases of decompression sickness can still happen after properly identified no-stop dives (although more serious cases are rare).

To determine the proper decompression procedures for dives that are less than 24 hours apart (repetitive dives), special techniques are needed.

Key Points

  • In 50% of affected patients, symptoms of decompression sickness appear within an hour of surfacing, and in 90% within six hours.
  • If the disorder is suspected, start high-flow 100% oxygen and set up the quickest possible transport to a recompression facility using ground transportation or an aircraft capable of 1 atmosphere of internal pressure.
  • Encourage divers to abide by accepted guidelines to reduce the risk of getting decompression sickness, such as diving depth and duration guidelines and the use of decompression stops during ascent.

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