Symptoms You Should Not Ignore After Diving

Each year DAN receives thousands of emergency and information calls. Most calls are basic fitness-for-diving questions, but many calls involve a diver with symptoms after diving. These symptoms may herald the occurrence of Decompression Illness (DCI) in a diver.

The type of symptom, its severity and onset time after the dive usually indicate the need for evaluation. Divers don't always seem to grasp the urgency of this situation. That's why DAN is here: to help divers make the next step.

While this article does not include every symptom of DCl, it highlights the most common symptoms; those DAN thinks every diver should know. If after diving you experience signs and symptoms that you’re concerned about, call a DAN supported hotline early, as soon as you begin to worry about your condition.

After a brief telephone assessment, DAN diving medical specialists usually refer callers to local physicians, emergency departments or urgent care clinics. Once the referral is made for possible DCI, local medical personnel conduct an evaluation: This can result in a diagnosis of DCI and a trip to a recompression chamber facility or another diagnosis and appropriate medical care. Medical professionals might suspect DCI, but for proper diagnosis a thorough medical evaluation is needed.

Delays are common. DAN often encounters divers who choose to wait before calling for assistance, even when their symptoms need immediate action. ln some cases, divers have waited more than 24 hours before they call for help. The rationale? They want to see whether their symptoms will go away without medical care. Those symptoms can sometimes be very serious.

Sometimes the delay is understandable; symptoms are often new to the diver and with no previous experience with DCl, they may feel their symptoms are minor, unimportant or represent either an old injury or a recent activity.

Sometimes this is true, but DAN encourages any diver with symptoms after diving to contact a DAN supported Diving Emergency Hotline so that a specialist can make this assessment and valuable time is not lost in cases where early first aid and treatment can really make a difference.

What to look for

The obvious question for divers is this: "Which symptoms should I be concerned about after a dive?" Clearly, not every ache and pain after diving indicate DCl. Many times an increase in exertion with any type of exercise can result in muscle or joint soreness, stiffness and general discomfort, especially for those who do not exercise, do so sporadically or who are infrequent divers. Even with minimal exposures, new divers may also experience symptoms following dives.

How does DAN help? While DAN doesn’t diagnose divers' symptoms over the telephone, helping divers sort out their symptoms after diving is something DAN has been doing successfully for 30+ years. Most symptoms probably will require that a physician evaluate the diver, not because the symptom might indicate DCl, but because proper treatment requires an appropriate assessment. It will take a medical practitioner's assessment and diving insight to diagnose DCI and find the relationship among dive profiles, previous medical history – including acute and chronic illness and injury – and the symptoms a diver is experiencing.

The following symptoms and situations are some of the more common scenarios (but certainly not the only ones!) here DAN encourages divers to take heed and to call for an assessment. They represent many calls in which pain, paresthesia (tingling or numbness), balance , walking difficulties and respiratory problems were  primary reasons to call DAN. Often those symptoms occurred many hours after divers realised they simply weren't feeling well.

Should you or a dive buddy experience any of these symptoms we advise you to call DAN or act immediately:

Post-dive Pain

Each year DAN's Annual Diving Report lists pain as the most common first symptom reported to DAN in cases of DCl. Thus, divers need to pay attention when they experience muscle, joint and body pain after diving. Many times the pain results from using muscles that are not commonly used in regular activity. Interestingly, these aches and pains change with movement or activity; they may completely disappear or remain positional- that is, divers can find positions in which they do not experience any discomfort, such as sitting with arms resting on a table. Depending on the level of discomfort, the diver may need to see a physician immediately.

For divers, non-DCl pain is more common than DCI-related pain. Non-DCI pain resolves without treatment after the diver has rested, often by the next morning. As a result of this, many divers have adopted a "wait and see" attitude. This works well for the divers with simple post-exercise aches and pains, but it works against the diver who is actually experiencing mild DCI or the beginnings of a more serious pressure-related injury. Too often divers wait a day or more to call DAN or seek medical assistance. They had hoped the pain would resolve, but they find instead that it does not go away and/or it worsens instead.

The warning signs

Over the years, from thousands of conversations with divers who were ultimately diagnosed with DCI, we have identified characteristics that can serve as warning signs to help guide divers and dive professionals at the dive site.

DCI pain can occur within minutes – or hours – after a dive. Usually constant, it does not change with movement. It may start in a hand or wrist and expand to the forearm or shoulder on the same extremity. The pain is often disproportionate to the amount of effort
extended on a dive or dives. Divers most often describe the pain as a different sort of pain than they have previously experienced, and there is no sign of trauma, such as redness or broken skin, at the pain site (Note: although sometimes there can be an associated skin rash). It can easily occur in an area where there has never been a history of injury or recent trauma.

Gradual symptom onset with increasing intensity can mislead divers; seeking relief, they may self-medicate with non-steroidal medications like aspirin or ibuprofen. Some will rehydrate with their favourite beverage. While these methods may change the pain's intensity they are not effective treatments for DCl. Plus, the small relief they may provide could give false hope that the problem isn't DCI and therefore extend the wait time before the diver calls DAN.

Paraesthesia 

This symptom is better known to divers as numbness, tingling, so called “pins and needles” feelings or altered skin sensations. It also frequently occurs in combinations with pain.

Paraesthesia is more subtle than pain. A diver may sense only a change in touch to the skin or perhaps not notice a sensation is lacking in a small area of skin. This is an excellent reason why divers are referred for a medical evaluation once they have called DAN about their symptoms. Divers can describe only the symptoms they are aware of; they may be unaware of the loss of sensation on their backs or a more serious symptom such as weakness in one or both legs. While weakness is more serious than a mild tingling sensation, it can go undetected without a medical evaluation.

Like pain, several medical conditions might cause a diver to experience paraesthesia. Few are known to have a sudden onset like DCI, but one such condition is anxiety with hyperventilation (rapid breathing). This can cause tingling in both hands and both feet and with serious anxiety can lead to loss of consciousness while a diver is still in the water.

Two common conditions cause paraesthesia in one or more extremities: carpel tunnel syndrome, which causes both pain and paraesthesia in the hands, and spinal nerve impingement, a condition that results from ageing or back trauma.

Any complaint of paraesthesia after a dive needs to be evaluated and a physician should determine the root cause of the symptoms. Divers should not take a "wait and see" attitude about paraesthesia.

Balance Problems

Balance and walking difficulties represent a very serious, though infrequent side effect of DCl. There may be other reasons for having balance or walking difficulties, such as middle ear barotrauma or head injuries. Due to the serious nature of balance problems, medical professionals should sort out issues of vertigo/dizziness/balance. Whether they believe symptoms are due to sinus barotrauma or middle ear barotrauma or possibly something more serious, divers and dive leaders should make the call to DAN.

Likewise, problems with walking should always be taken seriously. Walking difficulties may be a sign of weakness and paraesthesia in the legs; this requires immediate medical attention. If the spinal cord is involved, then bowel and bladder function may also be impaired and can go unnoticed until documented with a medical examination.

Rash

Increasingly, DAN is receiving reports of divers displaying a red or reddish-blue mottled rash after diving. Rashes can be caused by a large variety of things, such as allergy, various marine organisms, chemicals in the water, among others. However, rashes can also be associated with decompression illness and can sometimes be a useful warning signal. More serious symptoms may or may not be present or follow. Over recent years there have been numerous cases of divers who have reported mottled rashes after diving, having later been diagnosed with a patent foramen ovale (PFO). A PFO can increase the likelihood of serious decompression illness. Such a rash may disappear with oxygen breathing but divers are well advised to call a DAN Hotline and get prompt advice.

Respiratory Difficulties

Everyone should know that you must have good pulmonary (lung-related) health to participate in scuba. Difficulty breathing after a diver can represent a number of medical issues, not just barotrauma. Many things can happen during a dive that will produce breathing difficulties or even barotrauma. Respiratory symptoms are especially important for divers because they represent numerous potential injuries to and complications for the lung.

Although breathing difficulty is not a common DCI symptom, it does occur in conjunction with other symptoms. Just because divers don’t show the more common symptoms of DCI, they should maintain critical self-awareness, especially after a dive incident. It is because the lungs are vital to gas exchange and circulation that divers should not wait to call for assistance if they have sustained an injury or if a medical condition has been intensified by diving.

Besides shortness of breath, injured divers often complain of chest pain, chest burning and chest pressure. The difficulty is this: While all three terms may mean something different to the observer, they may indicate something else to a medical professional who factors in medical history and the circumstances of the dive.

Without appropriate diagnostic testing, a diver cannot determine whether chest pain or chest pressure is from barotrauma related to a rapid ascent, straining while underwater, a lack of fitness, a previous medical condition or the onset of a heart problem related to exertion. Don’t take chances: Call DAN or get a medical facility involved.

Get treatment, even after oxygen

Divers have reported the recurrence of serious symptoms when they received no follow-up treatment after first aid. Symptoms may have partially or even fully resolved after receiving oxygen only to recur or worsen when oxygen provision was ceased prematurely and/or there was no further treatment. (e.g. in situations where transport to a recompression facility will take some time, DAN AP often advises divers to breathe oxygen constantly for 4 to 5 hours. It is important to stay on oxygen until told to stop by a diving physician {not simply a dive instructor as is sometimes the case!}).

Why? Oxygen is just the first step in the healing process after a pressure-related dive injury: A decompression injury usually requires further treatment in the form of recompression therapy. While oxygen is the correct first aid treatment and may initially help, it is not the definitive treatment for DCI.

Act! Don’t waste time with possible self-diagnosis or by getting a consensus among your dive buddies. While serious cases are relatively infrequent, quick thinking and action by those involved can have a positive effect on the outcome of injured divers.

Recommendations

  • Call early if you are a diver with symptoms.
  • Boost your knowledge of what to look for through courses and careful observation.
  • Know that divers can be fooled by symptoms.
  • Oxygen first aid should be commenced as soon as possible after a dive-related illness or injury if recognised and continued until a dive medical physician advises otherwise.

The above is not a complete list of DCI symptoms, you can review other symptoms below. The list does, however, represent post-dive symptoms about which many divers may not show concern. Divers should be especially concerned when symptoms come on shortly after a dive, especially those occurring within the first hour. Use this article – and your continuing dive education – to assist you in making the decision to call for assistance when you or a dive buddy exhibit symptoms.

Common Signs and Symptoms of DCI

  • Numbness                                         
  • Headache
  • Dizziness                                             
  • Nausea
  • Pain                                                      
  • Weakness
  • Unusual fatigue       
  • Difficulty walking

Other Signs and Symptoms of DCI

  • Difficulty breathing                        
  • Visual disturbance
  • Decreased skin sensation            
  • Restlessness
  • Itching / rash                                    
  • Paralysis
  • Muscle twitching                             
  • Unconsciousness
  • Speech disturbance                       
  • Personality change
  • Altered level of consciousness  
  • Bladder / bowel problems
  • Convulsions                                       
  • Hearing loss / ringing ears

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