Recognizing DCS

[mccabejc]

I've read a lot of good info here on DCS symptoms. But as I am no longer a teenager, and since I am a new diver (25 dives) who is getting used to using the muscles needed for beach diving here in Southern California, I keep having these gnawing thoughts whenever I get a pain...hmmm, could it be?

I know DCS has many symptoms, and there's probably no clear answer to this, but I'm trying to narrow down my concerns to something less than the universe of all aches and pains I encounter.

I read on the DAN site that typically DCI symptoms appear within 24 hours. And I am trying to limit my dive depths to 40 feet or less as I start out. And I am very careful about doing 3 min. safety stops, even though beach diving around here is pretty much one big safety stop (as you return to the beach you are very gradually getting shallower). And I think I've been successful in making sure my ascents are VERY slow. And as Pasley mentioned previously, we do typically lug our 70 pounds of gear up and down steep stairs on the way to and from the dive, and do some serious surface swimming on entry and exit.

So under those conditions, is it reasonable to discard any aches and pains which show up the morning after the dive (24 hours) or later? How about aches and pains which show up a day or so later, then improve within a few days or a week?

I think I've finally gotten into the groove, and generally feel wonderful after diving. But the more I read about undeserved hits, the more paranoid I get. :11:

 

[android]

Good questions Jim. I sometimes wonder the same thing. I always have neck and upper back aches due to work stress. So far I've been assuming that:

1) if it's a place that usually hurts
2) it doesn't hurt more than normal +/- 10% due to lifting or exertion
3) stretching and massage mostly make it better

That it's probably not DCS.

If something just continued to get more and more painful over a 24 hr period, I'd assume it's DCS and call the hyp. doc.

Can any of the Medical Professionals comment on this?

I would never want to be in denial, but I don't want to worry or cry wolf for every minor ache either.

 

[pasley]

...
I would never want to be in denial, but I don't want to worry or cry wolf for every minor ache either.

Ahhh, denial, the first symptom.

Not a doctor or educated person. But from the been there, took the chamber ride perspective here is MHO. If you are in condition for diving, there should be no pain or other "symptoms" the following day. If you have an ache or pain, is it one you had before you went diving, or as stated in the usual place?

The biggest challenge here is DCS can be a collection of symptoms, or just one. If it gets worse, then I would be on the phone to the chamber pronto. But that thinking is what caused me to wait 48 hours before seeking treatment so what do I know. Then there is the issue of thinking it is a normal muscel pain and taking asprin or other medication which would inturn mask the symptom. Hmmm, that one needs thinking about. Bottom line, if in doubt, call Divers Alert Network (DAN) and run it by them.

Jim, to directly answer your question, there is no good answer. I will shut up now and await the experts responses which I am certain will be more informative.

 

[DandyDon]

While we're waiting on the experts - and we have some of the best here - here is the DAN 5 minute Neurological Exam. I printed out several copies, laminated them, and carry one in my dive bag always.

DAN Medical Center

On-Site Neurological Examination
By Ed Thalmann, M.D., Assistant Medical Director of DAN

Information regarding the injured diver's neurological status will be useful to medical personnel in not only deciding the initial course of treatment but also in the effectiveness of treatment. Examination of an injured diver's central nervous system soon after an accident may provide valuable information to the physician responsible for treatment. The On-Site Neuro Exam is easy to learn and can be done by individuals with no medical experience. Perform as much of the examination as possible, but do not let it interfere with evacuation to a medical treatment facility.

Perform the following steps in order, and record the time and results.

1. Orientation

Does the diver know his/her own name and age?
Does the diver know the present location?
Does the diver know what time, day, year it is?
Note: Even though a diver appears alert, the answers to these questions may reveal confusion. Do not omit them.

2. Eyes

Have the diver count the number of fingers you display, using two or three different numbers.
Check each eye separately and then together.
Have the diver identify a distant object.
Tell the diver to hold head still, or you gently hold it still, while placing your other hand about 18 inches/0.5 meters in front of the face. Ask the diver to follow your hand. Now move your hand up and down, then side to side. The diver's eyes should follow your hand and should not jerk to one side and return.
Check that the pupils are equal in size.

3. Face

Ask the diver to purse the lips. Look carefully to see that both sides of the face have the same expression.
Ask the diver to grit the teeth. Feel the jaw muscles to confirm that they are contracted equally.
Instruct the diver to close the eyes while you lightly touch your fingertips across the forehead and face to be sure sensation is present and the same everywhere.

4. Hearing

Hearing can be evaluated by holding your hand about 2 feet/0.6 meters from the diver's ear and rubbing your thumb and finger together.
Check both ears moving your hand closer until the diver hears it.
Check several times and compare with your own hearing.
Note: If the surroundings are noisy, the test is difficult to evaluate. Ask bystanders to be quiet and to turn off unneeded machinery.

5. Swallowing Reflex

Instruct the diver to swallow while you watch the "Adam's apple" to be sure it moves up and down.

6. Tongue

Instruct the diver to stick out the tongue. It should come out straight in the middle of the mouth without deviating to either side.

7. Muscle Strength

Instruct the diver to shrug shoulders while you bear down on them to observe for equal muscle strength.
Check diver's arms by bringing the elbows up level with the shoulders, hands level with the arms and touching the chest. Instruct the diver to resist while you pull the arms away, push them back, up and down. The strength should be approximately equal in both arms in each direction.
Check leg strength by having the diver lie flat and raise and lower the legs while you resist the movement.

8. Sensory Perception

Check on both sides by touching lightly as was done on the face. Start at the top of the body and compare sides while moving downwards to cover the entire body.
Note: The diver's eyes should be closed during this procedure. The diver should confirm the sensation in each area before you move to another area.

9. Balance and Coordination

Note: Be prepared to protect the diver from injury when performing this test.

First, have the diver walk heel to toe along a straight line while looking straight ahead.
Have her walk both forward and backward for 10 feet or so. Note whether her movements are smooth and if she can maintain her balance without having to look down or hold onto something.
Next, have the diver stand up with feet together and close eyes and hold the arms straight out in front of her with the palms up. The diver should be able to maintain balance if the platform is stable. Your arms should be around, but not touching, the diver. Be prepared to catch the diver who starts to fall.
Check coordination by having the diver move an index finger back and forth rapidly between the diver's nose and your finger held approximately 18 inches/0.5 meters from the diver's face. The diver should be able to do this, even if you move your finger to different positions.
Have the diver lie down and instruct him to slide the heel of one foot down the shin of his other leg, while keeping his eyes closed. The diver should be able to move his foot smoothly along his shin, without jagged, side-to-side movements.
Check these tests on both right and left sides and observe carefully for unusual clumsiness on either side.

Important Notes:

Tests 1,7, and 9 are the most important and should be given priority if not all tests can be performed.
The diver's condition may prevent the performance of one or more of these tests. Record any omitted test and the reason. If any of the tests are not normal, injury to the central nervous system should be suspected.
The tests should be repeated at 30- to 60-minute intervals while awaiting assistance in order to determine if any change occurs. Report the results to the emergency medical personnel responding to the call.
Good diving safety habits would include practicing this examination on normal divers to become proficient in the test.
Examination of an injured diver's central nervous system soon after an accident may provide valuable information to the physician responsible for treatment.
The On-Site Neuro Exam is easy to learn and can be done by individuals with no medical experience at all.


And I'll add - when in doubt, activate EMS and let the pros take over. Did this exam once; decided not to after the exam once.

 

[The Chairman]

DCS...

while NOT a medical doctor (surgeon for sick networks only), I am an instructor and here are a few things that you should know.

There are NO underserved hits. We might not understand WHY someone took a hit, but you can rest assured that DCS is an equal opportunity sickness.

You can minimize your propensity to develop DCS BEFORE you hit the water…
* Hydrate excessively (no alcohol)
* Get enough rest
* Get in shape (Fat people tend to get bent more)
* Stop Smoking!!!!!!!
* Avoid stresses (if possible)

You can minimize DCS risks while in the water...
* Avoid riding the NDLs.
* Avoid getting chilled.
* Keep moving gently during your safety stop.
* Practice deep stops and stretch your safety stop to 5 minutes (especially if using a computer).
* Avoid over exertion.

You can also minimize your risk after the dive…
* Hydrate some more (especially between dives)
* Avoid vigorous exercise (like lots of steps!)
* Stay warm but no hot showers!

So how do you “ID” DCS when you think you might be hit? You don’t. You are too close to the situation and are probably in denial. As previously suggested, call DAN (1-919-684-8111) with any symptoms and get their opinion over the phone. It’s a free call but the info is priceless. If they or you are still unsure, ask for directions to the nearest chamber or physician.

DCS can manifest itself in many ways… even to just being overly tired or a simple rash. While the usual symptom is a pain in a joint that eases in one position and hurts worse in another, there are other types and degrees of “the bends”.

For additional reading please consult Scuba Doc or DAN

 

[Ontario Diver]

While we're waiting on the experts - and we have some of the best here - here is the DAN 5 minute Neurological Exam. I printed out several copies, laminated them, and carry one in my dive bag always.

DAN Medical Center

On-Site Neurological Examination
By Ed Thalmann, M.D., Assistant Medical Director of DAN

....

And I'll add - when in doubt, activate EMS and let the pros take over. Did this exam once; decided not to after the exam once.

Please be careful, similar negative results can occur with a stroke or (in one case far from water) hypoglycemic shock (Diabetic shock)

You can't go wrong getting proper training and getting help.

Oh yeah and thanks Pete.... STOP SMOKING!

 

[DandyDon]

Well, I'm not sure? Have I been corrected here?

I was referred to the DAN test by another SB Moderator.

 

[Ontario Diver]

Well, I'm not sure? Have I been corrected here?

I was referred to the DAN test by another SB Moderator.

Not corrected, reinforced. But a warning not to get hung up on your own diagnosis. There can be several situations that mimic DCS (Stroke, Diabetes, Heatstroke, etc. ). The key point is to not always worry about the cause but to get medical aid as soon as possible no matter what the problem.

I apologize if I was less than clear.

 

[voop]

I think the point is that if the test "fails" somehow, we as laypersons should just record the fact, get EMS on site and hand them the result of the test.

We (as divers, unless also otherwise qualified etc.) can not and should not interpret the results of this test in any other way than an indication to get EMS to show up and take over.

 

[android]

I know the 5 minute psycho test and the minimization factors. The question is about how to distinguish true bends from chronic aches and pains that many people have for a variety of reasons.

For example, I have a separated shoulder that has long healed, but can still hurt sometimes. It's on the left side which probably contributes to my sore back on the left also, especially when hauling 50 or so pounds of scuba on my shoulders and back.

So I expect to be sore in that area the next morning. But what if I also got bent there? Would the pain great enough to easily tell the difference?