What’s in a name? Decompression illness, commonly known as “the bends” is caused by gas bubbles absorbed into tissues whilst breathing under pressure, typically underwater. Construction workers working on large bridge building projects and the like at the turn of the century were breathing air under pressure for the duration of their work shifts, the modern equivalent would be diving to a similar pressure or depth for several hours.
When the shifts were completed and the workers would emerge from the tunnels, many would be seen to be bent over double in considerable pain – hence the term “the bends.”
During every dive, the diver is breathing compressed breathing gases at the chosen depth for the duration of the dive.
During this time elements of the gas are absorbed into the diver’s tissues – the rate being dependent on a number of factors such as the depth, the gas in question, the time spent at depth and so on. This dissolved gas has to come out later on and if all goes to plan – a controlled ascent, followed by ‘decompression stops’ where the diver continues to breath their diving gas at a specified depth to for several minutes - the dissolved gas generally has enough time to dissolve back into the bloodstream, pass through the lungs and be expired.
Problems can occur though if there is just too great a gas load and the diver cannot get rid of enough of it during the ascent. Equipment failure at depth, or any other problems encountered which lead to a rapid ascent increase the likelihood of suffering decompression illness dramatically – as the body has not had the opportunity to rid itself of the dissolved gases.
Tiny bubbles are present following all dives, but there is a point at which either the number of bubbles present and/or their size, is enough to cause symptoms. What symptoms are experienced will in large part depend on amount and position of those bubbles, which are of course numerous.
Common causes of decompression illness are:
Ultimately, decompression illness is treated in hyperbaric chambers. Once assessed, a diver will be placed inside a hyperbaric chamber where the pressure will be increased, they will be “recompressed.”
As the pressure is increased the offending gas bubbles reduce in size. This in itself is often enough to promote an improvement in the diver’s symptoms. Oxygen or oxygen rich gases are breathed, which depends on treatment depth. This, combined with the reduction in bubble sizes, allows the diver to quickly get rid of dissolved gas bubbles, as well as helping repair any damage they may have caused.
Treatment itself consists of several hours inside a hyperbaric chamber, with oxygen or other gas breathing sessions interspersed with “air breaks”. Slow controlled ascents are used throughout the treatment where required by the protocol.
Divers are assessed throughout the treatment to monitor progress and if treated rapidly following the dive, one treatment is usually all that is required. In some cases, either those involving spinal decompression illness or delay to recompression, one or more further short treatment tables of around 90 minutes may be required.
A final medical review is carried out and as long as a full recovery has been made, divers are usually advised that a return to diving will be possible after 4 to 6 weeks – though local policies vary. In some cases divers may be advised to have follow up checks, or potentially even advised not to dive again if it is felt that it is not safe to do so.
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