Determination of DCS

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Kendall Raine

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Pretty sure I know the answer to this, but is there a way to confirm a diagnosis of DCS through examination of the blood?

This relates to another thread where patient states diagnosis of DCS based in part on results of "blood work." Not sure what kind of "blood work" could confirm DCS or that examination of blood is even part of normal protocol determine whether to treat patient for DCS.
 
Hi Kendall,

Thanks again for the papers. I may have another for you soon (in German).

This abstract published by UHMS may be of interest but there is not a test per se.

STRESS BIOMARKERS IN A RAT MODEL OF DECOMPRESSION SICKNESS
Montcalm-Smith et. al., 2006
RRR ID: 3659
 
The only thing I could think of is that some other diagnosis was EXCLUDED by normal results on blood work. As far as I am aware, there is no blood abnormality consistently associated with DCS.
 
TSandM:
The only thing I could think of is that some other diagnosis was EXCLUDED by normal results on blood work. As far as I am aware, there is no blood abnormality consistently associated with DCS.

Exclusion was the only thing I could think of, too. Gene's article on markers is interesting, but, given that paitent was examined in a non-hyperbaric ER by non-hyperbaric types, my guess is they took a blood sample in the normal course of evaluation and patient inferred a link between tests and diagnosis which didn't exist. When I asked him about linkage, he said he didn't know and could only guess.
 
...paitent was examined in a non-hyperbaric ER by non-hyperbaric types, my guess is they took a blood sample in the normal course of evaluation and patient inferred a link between tests and diagnosis which didn't exist. When I asked him about linkage, he said he didn't know and could only guess.
Probly - and a lot of times we patients have no idea what's going on, especially if the exam is rushed. The A&I thread reference is a good post for the recreational diver to accept that caca happens, don't deny the need for professional help. Some info could have been misunderstood by the diver, tho.
 
There is one serum test that should be mandatory on all DCS cases, creatine kinase, it is not diagnostic but highly suggestive of AGE or DCS 2. Its been well known since the mid-1990s. All other tests are much more non-specific.


http://content.nejm.org/cgi/content/full/330/1/19
 
Hi Kendall,

No, there is not.

BTW, the link provided by Saturation requires registration. Here is the abstract:

"Engl J Med. 1994 Jan 6;330(1):19-24.

Elevation of serum creatine kinase in divers with arterial gas embolization.Smith RM, Neuman TS.

Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine.

BACKGROUND. Arterial gas embolism due to pulmonary barotrauma and the resultant cerebral gas embolism are catastrophic complications of diving. Previous studies have only rarely noted evidence of gas embolism to noncranial sites.

METHODS. Among 142 persons with diving-related injuries evaluated between January 1982 and July 1991, we identified 29 who had arterial gas embolism and who underwent biochemical studies indicative of muscle injury. Of the 29 patients, 4 were excluded because cardiopulmonary resuscitation had been performed and 3 were excluded because the duration of their dives met or exceeded standard limits set for dives not requiring staged decompression. The outcome at the time of hospital discharge in the remaining 22 patients was correlated with clinical factors and the results of biochemical studies. We also studied 22 subjects after uncomplicated dives and 11 patients who had sustained blunt trauma.

RESULTS. All the patients with diving-associated gas embolism had elevated serum creatine kinase activity (normal, < or = 175 U per liter); the values were markedly elevated (> 900 U per liter) in 14. The MB isoenzyme of creatine kinase was detected in the serum of 13 of 20 patients in whom it was measured and was > or = 4 percent of total creatine kinase activity in 6 patients. In three patients electrocardiography showed myocardial injury. Changes in serum creatine kinase activity of similar magnitude were not present in the subjects who had uncomplicated dives or in the patients with blunt trauma. Thirteen patients recovered fully, four had minor residual neurologic deficits, three were severely impaired, and two died. Logistic-regression analysis revealed a significant correlation between peak serum creatine kinase values and clinical outcome.

CONCLUSIONS. Biochemical evidence of muscle injury is frequently found after diving-associated arterial gas embolism. The correlation between serum creatine kinase activity and outcome suggests that serum creatine kinase is a marker of the size and severity of arterial gas embolism."
 
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