Level 1 decompression sickness presents with joint pain, typically in the shoulders and elbows, with onset usually within an hour of surfacing and intensifying over the next 2 days. Other signs include pruritus, localized erythema, cyanosis, painful lymphadenopathy, and edema.
Level 2 decompression sickness is serious and may be life-threatening. Movement of bubbles can create severe risk of pulmonary embolism, neurologic damage, venous obstruction, increased heart pressure, and death. Symptoms include weakness, paresthesias, headache, ataxia, visual disturbance, memory loss, personality changes, dyspnea, wheezing, chest pain, and throat irritation.
T70.3XXA – Caisson disease [decompression sickness], initial encounter
89684003 – Bends
Differential Diagnosis & Pitfalls
- Arterial gas embolization – Has more immediate onset than decompression sickness (< 10-120 minutes versus 0-36 hours), and neurologic deficits manifest only in the brain.
- Carbon monoxide poisoning
- Pulmonary embolism
- Retinal artery occlusion
- Heart failure