Signs and Symptoms of DCS
Skin mottling like this is characteristic of cutis marmorata, a condition that can warn of likely development of more serious Type 2 symptoms.
The ability to recognize the signs, or objective evidence, and the symptoms, or subjective perceptions, of DCS — and to differentiate them from signs and symptoms less likely to be associated with DCS — is important. A variety of classification systems have been established for DCS. One common approach is to describe cases as Type 1 or Type 2.
Type 1 DCS
Common sites of musculoskeletal pain associated with Type 1 DCS.
The symptoms of Type 1 DCS can build in intensity. For example, pain may originate as a mild ache in the vicinity of a joint or muscle and then increase in magnitude. However, the pain associated with DCS does not typically increase upon movement of the affected joint, although holding the limb in one position rather than another may reduce discomfort. Such pain can ultimately be quite severe.
Type 2 DCS
Type 2 symptoms are considered more serious. They typically fall into three categories: neurological, inner ear and cardiopulmonary. Neurological symptoms may include numbness; paresthesia, or an altered sensation, such as tingling; muscle weakness; an impaired gait, or difficulty walking;
The Romberg test evaluates postural control. The sharpened Romberg, which includes crossing the arms and putting one foot in front of the other, is more sensitive to changes in static balance.
Type 2 symptoms can develop either quickly or slowly. A slow build can actually obscure the seriousness of the situation, by allowing denial to persist. For example, fatigue and weakness are common enough concerns, especially if their onset is protracted, that they can be very easy to ignore. Less common symptoms, such as difficulty walking, urinating, hearing or seeing — especially if their onset is quick — can sometimes prompt faster recognition of the existence of a problem. It is fair to say that divers can initially be reluctant to report symptoms, though they usually will do so if their symptoms do not go away. This is a shortcoming divers should be aware of, lest they fall prey to it.
Presentation of DCS
Monoplace hyperbaric chambers hold only the patient being treated.
The chamber walls are frequently made of acrylic to reduce any sense
of claustrophobia.
- Pain, particularly near the joints
- Numbness or paresthesia
- Constitutional concerns — such as headache, lightheadedness, unexplained fatigue, malaise, nausea and/or vomiting, or anorexia
- Dizziness or vertigo
- Motor weakness
- Cutaneous, or skin, problems — such as an itch, rash, or mottling ("cutis marmorata")
- Muscle discomfort
- Impaired mental status
- Pulmonary problems — such as breathing difficulties ("the chokes")
- Impaired coordination
- Reduced level of consciousness
- Auditory symptoms — such as hearing sounds that are not there or having a hard time hearing
- Lymphatic concerns — such as regional swelling
- Bladder or bowel dysfunction — such as retention of urine
- Compromised cardiovascular function