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Hi Dr Deco,
True, but it is rather important how one interprets "late" tx of DCS. We're talking 2-3 days in the instant case, and multiple studies over the past 3 decades have shown significant improvement in the sxs of DCI even when not particularly complex recompression was initiated several days to weeks post-event. (*See below for a couple of abstracts that I quickly dug up as examples).
Cheers,
DocV
1. Delayed treatment of serious decompression sickness. Myers, RAM, Bray, P. Ann. Emerg. Med., March 1985; 14:254-257.
Abstract:
We report the cases of three patients with residual symptoms from diving decompression sickness, each of whom presented to a recompression chamber three to seven days following original exposure. All three had complete resolution of symptomatology despite the delayed treatment. The late resolution of symptoms is evidence both of residual bubble effect and of distal tissue hypoxia responding to oxygen therapy with the recompression. We recommend that decompression sickness symptoms be treated whenever they are seen, even ten to 14 days postinjury.
2. A review of thirty-three dive accidents with a delay to treatment of four days or greater. Dovenbarger, JA; Corson, K; Moon, RE; Bennett, PB . Abstract of the Undersea and Hyperbaric Medical Society, Inc. Joint Annual Scientific Meeting with the International Congress for Hyperbaric Medicine and the European Undersea Biomedical Society held 11-18 August 1990. Okura Hotel, Amsterdam, The Netherlands (Undersea and Hyperbaric Medical Society).
Abstract:
Myers (1) described three cases of decompression sickness which responded to hyperbaric therapy after a delay of up to 7 days. The Divers Alert Network collects data on diving accidents from the continental United States, U.S. territories, and Caribbean Islands. A total of 268 cases in 1988 had enough data present for detailed analysis. There were 33 cases (12.3%) out of the 268 cases with a delay of 4 days or greater from symptom onset to recompression therapy. These 33 cases were diagnosed as 11 Type I DCS (33%),21 Type II DCS (64%) and one gas embolism (3%). The median time from entering the water to onset of symptoms was 3 hours in this group (range 0-96 hours). There were two outliers in this group with a symptom onset of 30 and 96 hours, but both of these cases involved flying within 24 hours after diving and developing symptoms later. The median delay to treatment was 5 days (range 4-24 days). The USN Table 6 was used 17 times as initial therapy (51.5%). The others received a variety of tables including USN Table 5 (3), modified monoplace tables (4), and routine hyperbaric clinical tables (5), Eleven divers (33%) out of 33 experienced complete relief after initial hyperbaric recompression therapy. Eight of these 11 received USN Table 6. One of these divers had relief of symptoms after a 24 day delay to therapy, A total of 17 divers (51.5%) experienced complete relief of symptoms at the completion of hyperbaric therapy. Only 5 (15%) had symptoms at the 3 month follow-up period. In conclusion, hyperbaric therapy can be efficacious in the treatment of decompression even after considerable delays. We recommend that a delay to treatment not be a reason to deny hyperbaric therapy. 1. Myers, RAM, Bray, P. Delayed treatment of serious decompression sickness. Ann. Emerg. Med., March 1985; 14:254-257.
