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Chapter 16 — 3
at the recompression facility with a stomach and bladder full of fluid. A patient with spinal
DCS may be unable to empty the bladder and will therefore be in considerable pain.
The patient will usually be treated on a hyperbaric O
2
(HBO) treatment table. There is a very
real risk of nausea, vomiting and convulsions as complications of this treatment. A full
stomach can then possibly result in regurgitation of the stomach contents and aspiration into
the lungs – further complicating treatment.
If the brain or spinal cord is involved and the patient has difficulty in voiding urine, an
in-
dwelling urinary catheter
should be inserted whenever possible by a trained physician or
nurse. If this is not feasible, care must be taken not to overload the patient with fluids.
Anyone who is trained to institute and monitor an intravenous infusion can be expected to be
able to assess the state of hydration and determine the desirability and quantity of intravenous
fluids, remembering that glucose fluids can aggravate cerebral oedema.
!
Drugs.
Aspirin
as a first aid measure has not been demonstrated to be of value in DCS. It may
interfere with blood clotting and cause haemorrhage (bleeding) – especially in the stomach.
Haemorrhage is already a major pathology in spinal cord and inner ear DCS.
The authors have seen one patient with severe DCS bleed to death from an internal
haemorrhage just before he was to be given an "experimental last-ditch" anti-clotting agent.
We are therefore reluctant to advocate the routine use of aspirin either for pain relief or to
inhibit clotting in any DCS case.
Joint pains of DCS can be significantly eased without the risk of serious side effects by the
administration of
paracetamol (acetaminophen) –
1000 mg (or two tablets) 4 hourly.
NSAID drugs may be requested by a diving physician, but are not routinely needed.
Other drugs such as steroids, diuretics and special intravenous fluids such as
"Rheomacrodex" have been advocated but have not been proven to be beneficial. Anti-
epileptics and other drugs such as diazepam ("Valium") may be needed to control fitting
(convulsions), and for confusional states.
TRANSPORT OF PATIENT
WITH DCS
With mild DCS, or if there has been a delay of 12-24 hours or more, and there is no
progressive deterioration, local treatment with rest, monitoring and breathing 100% O
2
may
be all that is necessary. This decision is best made by a diving physician.
With more severely affected divers, or those that are deteriorating or need medical attention,
transport should be expedited. The diver should be transported with
minimum agitation
and
as close as possible to sea level or at
1 ATA
. Mountainous roads should be avoided whenever
an evacuation route by land is planned. 100% O
2
. should be breathed before and during
transport (see Chapter 40).