decompression sickness

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24/01/2008 Peter Giarso 1 SYNONIMS SYNONIMS CAISSON DISEASE CAISSON DISEASE BENDS BENDS STAGGERS STAGGERS CHOKES AND AEROEMBOLISM CHOKES AND AEROEMBOLISM DECOMPRESSION SICKNESS DECOMPRESSION SICKNESS

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24/01/2008 Peter Giarso 1

SYNONIMSSYNONIMS CAISSON DISEASECAISSON DISEASE BENDSBENDS STAGGERSSTAGGERS CHOKES AND AEROEMBOLISMCHOKES AND AEROEMBOLISM

DECOMPRESSION SICKNESSDECOMPRESSION SICKNESS

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Penyakit yang disebabkan pelepasan Penyakit yang disebabkan pelepasan dan mengembangnya gelembung-dan mengembangnya gelembung-gelembung gas dari fase larut dalam gelembung gas dari fase larut dalam darah atau jaringan akibat penurunan darah atau jaringan akibat penurunan tekanan disekitarnya.tekanan disekitarnya.

DEFINISI

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PENTING DIKETAHUI

Gas yang terlarut berbanding lurus dengan tekanan parsial gas tersebut

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PENTING DIKETAHUI

SUPERSATURASI

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PENTING DIKETAHUI

Jaringan cepat-jaringan lambat

Daya larut nitrogen dalam jaringan

Aliran darah

•Darah Lemak

•Otak

•Tulang rawan

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PENTING DIKETAHUI

Penyelaman

singkat dan dalam :

Jaringan cepat

Bublle dlm darah

Chokes, neurologis

Penyelaman

lama dan dangkal :

Jaringan lambat

Bublle dlm jaringan

Bends

vs

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ETIOLOGY AND PATHOPHYSIOLOGYETIOLOGY AND PATHOPHYSIOLOGY

Decompression sickness is a disease of protean clinical manifestations Decompression sickness is a disease of protean clinical manifestations which is produced by excessively rapid lowering ambient pressure. which is produced by excessively rapid lowering ambient pressure.

This reduction causes inert gas dissolved in tissue to come out This reduction causes inert gas dissolved in tissue to come out of physical solution and enter the gas phase. of physical solution and enter the gas phase.

The result is the formation of gas bubbles in the tissue, The result is the formation of gas bubbles in the tissue, and in arterial and the venous blood.and in arterial and the venous blood.

DECOMPRESSION SICKNESSDECOMPRESSION SICKNESS

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TIPE I

Classification for identification, prognosis, and therapy.Not well defined or applied appropriately

Pain only bendsSkin manifestations

Devined (US Navy Diving) :Devined (US Navy Diving) :8.8. Pain only, skin rash or lymphatic disease, withPain only, skin rash or lymphatic disease, with9.9. A normal neurological examination before treatment andA normal neurological examination before treatment and10.10.Symptoms resolved within 10 minutes at 2.8 ATA on Symptoms resolved within 10 minutes at 2.8 ATA on

oxygenoxygen

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MUSCULOSKELETAL

• Rasa tidak enak, kaku, yang enak bila digerakkanRasa tidak enak, kaku, yang enak bila digerakkan• >>> Nyeri tumpul, fluktuasi, kadang berdenyut dan >>> Nyeri tumpul, fluktuasi, kadang berdenyut dan

tajam, nyeri geraktajam, nyeri gerak• Usually no sign of joint inflammation Usually no sign of joint inflammation • 1/3 shoulder in diver; knee in caisson, aviator1/3 shoulder in diver; knee in caisson, aviator• Rarely symmetrical, if 2 joint are involved and adjoiningRarely symmetrical, if 2 joint are involved and adjoining

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Cutaneus• Local >>> generalLocal >>> general

• Pruritus Pruritus lengan bawah, pergelangan tangan, tangan, pahalengan bawah, pergelangan tangan, tangan, pahaBubbles in dermis, epidermis, kel sebaceaBubbles in dermis, epidermis, kel sebaceaSegeraSegera

• Scarnatinatiorm rashScarnatinatiorm rashStimulasi piloerector, pelepasan histaminStimulasi piloerector, pelepasan histaminRed punctate rashRed punctate rashDistribusi : Chest, shoulder, back, upper abdomen, Distribusi : Chest, shoulder, back, upper abdomen, thighthighBeberapa jamBeberapa jam

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Cutaneus• Erysipeloid rash Erysipeloid rash

Gas in venous drainageGas in venous drainageSystemic DCSSystemic DCSPapules with flat and firm bordersPapules with flat and firm borders

• Cutis marmorata marblingCutis marmorata marblingSmall pale area, cyanotic mottling, spread Small pale area, cyanotic mottling, spread peripherally, peripherally, Becoming erythematous, extension cyanotic mottlingBecoming erythematous, extension cyanotic mottlingSerious sign of DCS, reliefableSerious sign of DCS, reliefable

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Cutaneus• Subcutaneous emphysema Subcutaneous emphysema

Dx : Tanda krepitus, localized, along tendon sheats, Dx : Tanda krepitus, localized, along tendon sheats, radiologisradiologisDD : Barotrauma pulmonerDD : Barotrauma pulmoner

• Lymphatic obstructionLymphatic obstructionLocalized swelling. Localized swelling. Involves hair follicles, a peau d’orange or pigskin Involves hair follicles, a peau d’orange or pigskin appereance with brawny oedema.appereance with brawny oedema.The trunk, but it is also seen over the head and neckThe trunk, but it is also seen over the head and neck