Naqvi Asadullah, Clarence Derrick
1ACCS-ST2 Anaesthetics and Intensive Care Medicine, Walsall Manor Hospital, Walsall, UK.
2Walsall Manor Hospital, Walsall, UK.
J Intensive Care. 2018 May 21;6:29. doi: 10.1186/s40560-018-0299-3. eCollection 2018.
The case reinforces the importance of stepping back and looking at every possibility along with multiple co-existing pathologies. It takes into account the thought process of multiple systems and a multidisciplinary team approach. Learning points to take are that decompression illness can present atypically, but one must exclude other causes.
We present the case of a 42-year-old male from the West Midlands, UK, who attended the emergency department post-scuba diving with confusion, light-headedness, left arm weakness, and bilateral paraesthesia of the hands. Post-diving, he displayed typical symptoms of decompression illness. He attended the hyperbaric decompression chamber before attending the emergency department but to no resolve. A computed tomography of the head showed no signs of intracranial pathology. He had another session in the hyperbaric oxygen chamber but to no success. Upon admission, his blood showed polycythaemia. His saturation had dropped to 91% on room air, and a computed tomography pulmonary angiogram revealed no obvious cause. A magnetic resonance imaging of his head revealed some deep periventricular ischaemic changes, old and new, however no signs of gas embolism or poor flow. A bubble echo confirmed a patent foramen ovale. A leptospirosis and a vasculitis screen were both negative. Symptoms had slowly improved but he was left with a left arm motor weakness, and the team was left puzzled as to what could have caused his signs and symptoms. Through a diagnosis of exclusion, decompression sickness was the conclusive diagnosis. The patient made a full recovery.
Decompression illness results as a sudden decrease in pressures during underwater ascent; it is caused by nitrogen bubbles forming in tissue. Additionally, a patent foramen ovale allows arterial gas emboli to cause further harm. Type 2 decompression sickness is the more severe form and includes neurological, respiratory, and cardiovascular symptoms.
该病例强化了退后一步并审视每一种可能性以及多种并存病理情况的重要性。它考虑了多个系统的思维过程以及多学科团队方法。需要吸取的经验是减压病可能表现不典型，但必须排除其他病因。
我们报告一例来自英国西米德兰兹郡的42岁男性病例，他在潜水后因意识模糊、头晕、左臂无力及双手双侧感觉异常前往急诊科就诊。潜水后，他表现出减压病的典型症状。在前往急诊科之前，他进入了高压减压舱，但症状未缓解。头部计算机断层扫描未显示颅内病变迹象。他又进行了一次高压氧舱治疗，但仍未成功。入院时，他的血液检查显示红细胞增多症。在室内空气中，他的血氧饱和度降至91%，肺部计算机断层血管造影未发现明显病因。他头部的磁共振成像显示一些新旧并存的脑室周围深部缺血性改变，但没有气体栓塞或血流不畅的迹象。气泡回声检查证实存在卵圆孔未闭。钩端螺旋体病和血管炎筛查均为阴性。症状虽逐渐改善，但他仍遗留左臂运动无力，团队对其体征和症状的病因感到困惑。通过排除诊断，最终确诊为减压病。患者完全康复。
减压病是水下上升过程中压力突然降低所致；它是由组织中形成的氮气气泡引起的。此外，卵圆孔未闭会使动脉气体栓子造成进一步损害。2型减压病是更严重的形式，包括神经、呼吸和心血管症状。
