I heard another diver inquiring, “What are the signs and symptoms of DCS?” Passing by, I stopped to listen and responded with the question: “What are you experiencing?” The diver described dull pain & tightness under both arm pits and across the stomach. A diver on the boat asked if she had implants as her left breast appeared swollen. My buddy and I begin to describe the signs and symptoms of decompression sickness (DCS) and asked the diver if she was experiencing any issues in other areas of her body. The diver said “no”. We asked the diver what type and how she wears her BCD. Her response indicated that BCD placement was in the same areas stomach (cummerbund with clip) and arm pits (shoulder straps cinched down) where pain was located.
The diver was also asked if she experienced anything after her morning dives. She indicated she had blood in her mask and had spit out blood. For further clarification we asked if the blood was mucousy and had she continued to spit blood. Response “yes’ to mucus and “no” to continued to spit blood. After a preliminary chat a neurological assessment was suggested and she agreed.
Neurological assessments responses were negative to all the following: numbness and tingling, dizziness, vertigo, ringing, rash or itching, difficulty breathing, vision. Pain was only localized in the arm pit area where the BCD straps are located and stomach where the cummerbund was located. Observation of skin around these areas showed no redness or appearance of rash. (the diver was wearing a two piece swimsuit). No nausea or vomiting, difficulty walking or weakness in legs/arms was noted or indicated and mental function was good; alert, verbal, very responsive. No issues with orientation. Easily followed commands, her eyes were alert and could follow my finger in all directions, no eye twitching, responsive to light touch, observes good motor functions, sensory functions good felt all areas, grip strength good balance and coordination was good. We offered to put the diver on surface oxygen anyway but the diver declined. We suggested for next day of diving to loosen her BCD straps and ensure she was properly weighted.
I followed up with the diver again at end of the next day of diving. The diver indicated she had loosened the BCD straps and cummerbund, and was much more comfortable. No longer tight under the arm pits or across her stomach but a little soreness remained.
This diver was fortunate that she had a knowledgeable dive professional that didn’t rely solely on a laundry list of symptoms when discussing her concerns. Often divers incorrectly rely more on internet searches in an attempt to self-diagnose rather than seeking medical care. This often results in inaccurate and incomplete information, not provided in context, and creates an unnecessary level of anxiety.
Mucus membranes are normally moist but can dry out quickly when breathing cold, dry compressed air. The body’s natural response is to create more mucus/moisture to lubricate and protect the tissues. When the tissues become drier, the mucus membranes can become cracked and bleed. This is common in dry, low-humidity climates. Bleeding membranes combined with excess mucus production can often lead to bloody mucus in a diver’s mask when surfacing. It is also not uncommon for the diver to blow blood-tinged mucus from the nostrils for several hours thereafter.
When a diver complains of pain in the armpit area and the abdominal region after diving, it seems reasonable to assume DCS. However, making the leap directly to DCS prevents consideration of other possible etiologies. After ruling out other symptoms, the dive professional rightly continued with additional questions and a proper field neurological assessment. After ruling out the presence of any neurological symptoms, the conversation turned to equipment. Having found the diver’s pain was directly correlated to the way her BCD fit, the proper recommendation of loosening the vertical straps in addition to the cummerbund around her wait resulted in a better dive experience with no additional problems.
Lana Sorrell, BS, EMT, DMT, CPT