Symptoms
Common signs and symptoms of Decompression Illness (Caisson Disease) include:
When to see a doctor
If you experience severe or worsening symptoms, seek immediate medical attention. Always consult with a healthcare professional for proper diagnosis and treatment.
Causes & Risk Factors
Several factors can contribute to Decompression Illness (Caisson Disease).
The root cause lies in Henry's Law of physics, which states that gases dissolve in liquids under pressure.
The root cause lies in Henry's Law of physics, which states that gases dissolve in liquids under pressure. During a dive, nitrogen from breathing air dissolves into blood and tissues at higher concentrations due to increased water pressure. The deeper and longer the dive, the more nitrogen accumulates in the body. Problems arise during ascent when ambient pressure decreases rapidly, causing dissolved nitrogen to come out of solution and form bubbles in blood vessels and tissues.
Arterial gas embolism represents a more severe form where bubbles enter the arterial circulation, potentially blocking blood flow to vital organs including the brain, heart, and spinal cord.
Arterial gas embolism represents a more severe form where bubbles enter the arterial circulation, potentially blocking blood flow to vital organs including the brain, heart, and spinal cord. This can occur from lung overexpansion injuries when divers hold their breath during ascent, causing lung tissue to rupture and release gas bubbles directly into pulmonary blood vessels.
Certain diving practices significantly increase risk, including rapid ascent rates exceeding 30 feet per minute, skipping required decompression stops, making multiple dives in a single day without adequate surface intervals, and flying or ascending to altitude too soon after diving.
Certain diving practices significantly increase risk, including rapid ascent rates exceeding 30 feet per minute, skipping required decompression stops, making multiple dives in a single day without adequate surface intervals, and flying or ascending to altitude too soon after diving. Environmental factors like cold water, strong currents, and poor visibility can also contribute by increasing physical exertion and stress levels during the dive.
Risk Factors
- Rapid ascent from depths greater than 30 feet
- Skipping required safety or decompression stops
- Multiple dives in a single day without proper surface intervals
- Flying or traveling to altitude within 24 hours of diving
- Dehydration before or during diving activities
- Excessive alcohol consumption before diving
- Age over 40 years old
- Obesity or poor physical fitness
- Previous history of decompression illness
- Patent foramen ovale (small heart defect present from birth)
Diagnosis
How healthcare professionals diagnose Decompression Illness (Caisson Disease):
- 1
Diagnosis relies heavily on diving history and symptom recognition, as no single test can definitively confirm decompression illness.
Diagnosis relies heavily on diving history and symptom recognition, as no single test can definitively confirm decompression illness. Emergency physicians and diving medicine specialists focus on recent diving activities, depth and duration of dives, ascent rates, and time elapsed since surfacing. The appearance of symptoms within 24 hours of diving, particularly joint pain, neurological symptoms, or breathing difficulties, raises immediate suspicion.
- 2
Imaging studies may include chest X-rays to check for lung damage and CT or MRI scans if neurological symptoms are present.
Imaging studies may include chest X-rays to check for lung damage and CT or MRI scans if neurological symptoms are present. Blood tests can rule out other conditions but don't directly diagnose decompression illness. Doctors often use standardized assessment tools to evaluate neurological function and track symptom progression.
- 3
Time becomes critical in diagnosis since delayed treatment significantly worsens outcomes.
Time becomes critical in diagnosis since delayed treatment significantly worsens outcomes. Medical professionals trained in diving medicine understand that symptoms can be subtle initially and worsen over hours. The diving community maintains emergency hotlines staffed by specialists who can guide both patients and treating physicians through proper evaluation protocols, especially in areas where diving medicine expertise may be limited.
Complications
- Neurological complications represent the most serious long-term effects, potentially including permanent spinal cord damage leading to paralysis, brain injury causing cognitive problems or personality changes, and inner ear damage resulting in permanent hearing loss or balance disorders.
- These complications are more likely when treatment is delayed beyond six hours after symptom onset.
- Cardiovascular complications can include heart rhythm abnormalities and, rarely, cardiac arrest from large gas bubbles affecting heart function.
- Lung complications may involve pneumothorax (collapsed lung) or ongoing breathing difficulties.
- Most patients who receive prompt hyperbaric treatment recover completely, but those with severe initial symptoms or treatment delays may face lasting disabilities requiring ongoing rehabilitation and medical care.
Prevention
- Safe diving practices form the foundation of prevention, starting with proper training from certified instructors and adherence to established decompression protocols.
- Never ascend faster than 30 feet per minute, always perform safety stops at 15 feet for at least three minutes, and follow dive computer or table recommendations for surface intervals between dives.
- Plan dives conservatively, especially when making multiple dives or diving in challenging conditions.
- Maintain excellent physical fitness and proper hydration before diving activities.
- Avoid alcohol for at least 24 hours before diving, and never dive when feeling unwell or fatigued.
- Wait appropriate time periods before flying after diving - typically 18-24 hours for recreational diving and longer for technical or decompression diving.
- Regular equipment maintenance and proper dive planning cannot be overstated.
- Use reliable depth gauges and timing devices, dive with properly trained buddies, and consider conservative dive computer settings.
- Those with medical conditions like heart defects should consult diving medicine specialists before participating in underwater activities.
Immediate treatment centers on high-concentration oxygen therapy and rapid transport to a hyperbaric chamber facility.
Immediate treatment centers on high-concentration oxygen therapy and rapid transport to a hyperbaric chamber facility. Breathing 100% oxygen helps eliminate nitrogen from tissues and can provide significant symptom relief even before recompression treatment begins. Emergency medical services should be contacted immediately, as delays in treatment directly correlate with poorer outcomes and potential permanent disability.
Hyperbaric oxygen therapy remains the definitive treatment, involving placement in a pressurized chamber where patients breathe pure oxygen at higher-than-normal atmospheric pressure.
Hyperbaric oxygen therapy remains the definitive treatment, involving placement in a pressurized chamber where patients breathe pure oxygen at higher-than-normal atmospheric pressure. This process forces nitrogen bubbles back into solution while delivering therapeutic levels of oxygen to damaged tissues. Treatment protocols typically involve multiple sessions over several days, with specific pressure and time schedules based on symptom severity and patient response.
Supportive care includes intravenous fluids to address dehydration, pain management for joint symptoms, and monitoring for complications.
Supportive care includes intravenous fluids to address dehydration, pain management for joint symptoms, and monitoring for complications. Patients may require intensive care management if neurological symptoms are severe or if lung injury is present. Anti-inflammatory medications are generally avoided initially as they may interfere with the body's natural healing response.
Recent advances in treatment include portable hyperbaric chambers for remote locations and improved understanding of optimal oxygen delivery protocols.
Recent advances in treatment include portable hyperbaric chambers for remote locations and improved understanding of optimal oxygen delivery protocols. Research continues into adjunctive therapies including specific medications that may enhance recovery, though hyperbaric oxygen therapy remains the cornerstone of treatment with success rates exceeding 90% when administered promptly.
Living With Decompression Illness (Caisson Disease)
Recovery from decompression illness requires patience and careful medical follow-up, as some symptoms may persist for weeks or months even after successful treatment. Many patients experience gradual improvement in neurological symptoms, joint pain, and energy levels over time. Regular check-ups with diving medicine specialists help monitor recovery progress and determine when it's safe to resume diving activities, if at all.
Latest Medical Developments
Latest medical developments are being researched.
Frequently Asked Questions
Update History
Mar 28, 2026v1.0.0
- Published by DiseaseDirectory