Cutaneous Decompression Sickness

[Saturation]

One of the things the DAN Medic told me is that this in not what has been known as skin bends-that's something different.

Skin bends is a non technical term for cutaneous DCS, cutaneous means skin. Cutaneous DCS has a spectrum of activity, from very mild to severe:

http://scuba-doc.com/SkinDCS.htm

Since neither I nor the DAN Medic were on hand to see the event, nor pictures taken, we clearly cannot be the last word on the diagnosis.

However, in most times I have heard dive medics give advice over the phone, they are usually on the spot right with general approaches, but their details are often not well informed.

Cutaneous DCS is a common form of DCS.

Academically, skin is made of 4 layers: epidermis, dermis = cutaneous, then connective tissue + fat = subcutaneous layer. Its only the subcutaneous layer that has blood vessels and primarily sources gas bubbles.

http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZQYMPCGJC&sub_cat=98


Dive Safe.

 

[TSandM]

I have to say that it astonishes me that you weren't placed on oxygen in the ER. In my ER, the nurses seem to put hangnails on oxygen -- it's a very inexpensive intervention with almost no contraindications. And particularly after you specifically requested it . . . makes me worry that you got hold of a physician with control issues, which is not a good thing. You should have paperwork giving the name of the physician -- you could consider photocopying an article about decompression sickness and sending it to him. It would be a gentle way of providing additional information that might make him handle another such patient better. The note with it could say, "Thank you for your care the other day. I thought you might find this reference interesting reading."

 

[Dive-aholic]

It was actually VPM-B (off the top of my head), but you are right the wheel doesn't let you do it. I used a bad example to highlight that.

No problem. Actually a good example, just a couple of details that needed tweaking.

 

[Cacia]

I have a couple questions:


When using Enriched Air:
I thought I remembered that although theoretically one's Nitrogen load is reduced there is no statistically significant reduction in the incidence of DCI probability. Did I get that wrong? I am asking because the diver keeps mentioning her Nitrox class.

Also, does subcutaneous bends present clinically anything like subcutaneous emphysema like you would sometimes see with a punctured lung?

 

[MilitantMedic]

You're right Catherine, there is no evidence that Nitrox is any safer than air. I would hazard to guess that becuase of the complexity it *can be* more dangerous. But as with all things in diving, proper training and proper planning greatly reduce those factors.

Sub-Q Emphysema and Sub-Q DCI are very different. The typical presentation of Sub-Q Emphysema is a "rice crispy" feel upon palpation, usally near the collar bone. Sub-Q DCIs usally present more like a "rash" looking (and a slew of other presentations). DCIs (sub-q) are caused by the nitrogen expanding within the skin and fat layers. Sub-Q emphysema is cuased by having air trapped under the skin from the lungs secondary to a pneumothorax.

 

[wylerbear]

The Medic highly recommended that I start using Nitrox on all dives. It is my understanding that the advantage is that I would not be Nitrogen loading as much with Nitrox as with air. Less Nitrogen = less chance of DCS. Is this not true?

 

[MilitantMedic]

Not statistically, but to do your same dive plans that you were doing might be "safe" on nitrox (sorry still don't have the exact profile from your dive). Basically if you were to go to 80' for 40 mins on air you'd probably get bent. But if you were to do the same dive on EAN 32 (32% O2) you would be OK (there's always that chance though...) because the NDL for 32% is 45 mins.

It all comes down to staying within the limits of the gas you are using. What the DAN medic was probably saying was use NITROX for your dives and use AIR TABLES to calculate with. That gives you a bigger margin of safety. (I think DiveAholic mentioned that)

 

[Uncle Pug]

Basically if you were to go to 80' for 40 mins on air you'd probably get bent.

That is incorrect.

 

[MilitantMedic]

I'm just saying it's breaking PADI air tables. Assuming no multi-level, etc.

 

[Uncle Pug]

Oh. I though you were saying "...you'd probably get bent."