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2017 ; 2017
(ä): 7203085
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Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional
Transport Considerations
#MMPMID29109872
Estrada J
; Meurer D
; De Boer K
; Huesgen K
Case Rep Emerg Med
2017[]; 2017
(ä): 7203085
PMID29109872
show ga
A 46-year-old male presented to our tertiary care emergency department (ED) with
shortness of breath and chest pain following an uneventful four-hour SCUBA dive
at 100 feet. His prehospital emergency medical services (EMS) assessment revealed
transient hypotension and hypoxia. He later developed progressive skin mottling.
Serology was significant for acute kidney injury, transaminitis,
hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT)
angiography demonstrated intravascular gas throughout the mesenteric and
pulmonary arteries as well as the portal venous system. No abnormality was seen
on head CT and the patient had normal mental status. Prehospital nonrebreather
oxygen therapy was changed to continuous positive airway pressure (CPAP) upon ED
arrival, and the patient was intubated prior to transfer to a hyperbaric
facility. However, within 24 hours the patient was found to have multiorgan
failure, diffuse cerebral edema, and brain death despite no further episodes of
hypotension or hypoxia. No intracranial gas was seen on repeat head CT. Our case
demonstrates the importance of early recognition of decompression illness by EMS
personnel, consideration of ground versus flight transportation of these patients
to the nearest hyperbaric center, and the possible use of prehospital CPAP as an
alternative to enhance oxygenation.