Background:
- Shellfish harvester and hookah diver, 29, with history of paraplegia
- Had four consecutive days multiple dives. On the fourth day did three dives to 18 meters, each dive lasting 1 to 1.5 hours
Reported Incident
The diver is a 29-year-old shellfish harvester, hookah diver. He was treated for paraplegia, three years ago. He is now collecting razor clams (Ensis macha).
On his fourth day of diving, he did three dives to about 18-meter depth, one to one and a half hours each, between 11 am and 4 pm. He did not do any deco or safety stops. Instead, he tried to maintain a slow ascent. Fifteen minutes after his last dive, while in the boat, he started feeling a pain in his right elbow. He did in-water recompression to 8 meters for 10 minutes, and 30 minutes at 3 meters, while breathing air. Forty minutes after the recompression, when he already was at his house, he got pain in his both knees and opted to visit the local hospital for treatment.
On admission, the pain in his knees was a six on a scale of zero to 10.* The strength of his lower limbs was three on the scale of 0 to 5, knee flexor three and knee extensor 4.# The patient received 1,000 ml of Ringer’s lactate for rehydration. His chest X-ray and ECG were normal, and his skin had no signs of skin bend. On first aid surface oxygen, his symptoms started to decrease. He was recompressed on USN TT5. Pain diminished three minutes after reaching the recompression depth and completely resolved within 15 minutes. Upon completion of treatment, his strength was normal.
*Pain scale: 0 – no pain, 10 – worst possible pain
#MRC Muscle Strength Scale 0 – 5
0 – No contraction
I – Flicker or trace of contraction
2 – Active movement, with gravity eliminated
3 – The active movement against gravity
4 – The active movement against gravity and resistance
5 – Normal strength
Review
Because there was a recompression chamber available locally, the attempt at in-water recompression while breathing air was not a good choice. Indeed, the patient did not complain about the weakness in his legs before the in-water recompression attempt. This was a sign of spinal cord decompression sickness (DCS), which may have developed because of additional tissues saturation with nitrogen from breathing air at depth. In-water recompression using air should never be attempted except in desperation.
Recommendations
Joint pain after a dive usually resolves soon upon recompression in a hyperbaric chamber, if recompressed early. When recompressed with a delay, pain usually resolves by the end of recompression, but minor soreness may remain for a few days. In any case, the outcome of this incident was good. There is no need to rush and attempt in-water recompression for pain-only DCS, especially when a hyperbaric chamber is available locally.