Jitsuiki Kei, Kushida Yoshihiro, Nishio Ryota, Yanagawa Youichi
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
Wilderness Environ Med. 2021 Mar;32(1):70-73. doi: 10.1016/j.wem.2020.09.006. Epub 2020 Dec 10.
A 26-y-old experienced scotoma scintillans after 59 min of scuba diving at a maximum depth of 26 m. After the patient smoked a cigarette, the scotoma scintillans ceased. However, he then developed a headache, general fatigue, and shoulder and elbow pain. He therefore called an ambulance. Based on the rules of the medical cooperative system for decompression sickness in Izu Peninsula, the fire department called a physician-staffed helicopter. After a physician checked the patient, his complaints remained aside from a low-grade fever. A portable ultrasound revealed bubbles in his inferior vena cava. Because of the risk of his being infected with COVID-19, he was transported to our hospital not by air evacuation but via ground ambulance staff while receiving a drip infusion of fluid and oxygen. After arriving at the hospital, his symptoms had almost subsided. Whole-body computed tomography revealed gas around the bladder, left hip, right knee, bilateral shoulder, joints, and right intramedullary humerus. The patient received high-concentration oxygen, infusion therapy, and observational admission. On the second day of admission, his symptoms had completely disappeared, and he was discharged. To our knowledge, this is the first report that computed tomography might be useful for detecting gas in multiple joints, suggesting the onset of decompression sickness after diving. This might be the first report of gas in an intramedullary space after diving as a potential cause of dysbaric osteonecrosis.
一名26岁的潜水者在26米的最大深度进行了59分钟的水肺潜水后出现了闪烁暗点。患者吸了一支烟后，闪烁暗点消失。然而，随后他出现了头痛、全身乏力以及肩部和肘部疼痛。于是他呼叫了救护车。根据伊豆半岛减压病医疗合作系统的规定，消防部门呼叫了配备医生的直升机。医生检查患者后，除了低热外，他的症状依然存在。便携式超声检查发现其下腔静脉有气泡。由于他有感染新冠病毒的风险，他不是通过空中转运，而是在接受静脉输液和吸氧的同时，由地面救护车工作人员送往我们医院。到达医院后，他的症状几乎已经消退。全身计算机断层扫描显示膀胱周围、左髋部、右膝部、双侧肩部、关节以及右肱骨髓腔内有气体。患者接受了高浓度吸氧、输液治疗并留院观察。入院第二天，他的症状完全消失，随后出院。据我们所知，这是第一份关于计算机断层扫描可能有助于检测多个关节中的气体，提示潜水后发生减压病的报告。这可能是第一份关于潜水后骨髓腔内气体作为减压性骨坏死潜在原因的报告。
