You are fed up with the big city, so you decide to take a job as an ‘island doc’ in the Caribbean. Life is good. It’s your second day on the job, and an 18 year old man is carried into your clinic with severe knee pain and shortness of breath. He’s just been diving. You examine the patient and note  clear lungs bilaterally and that the knee pain is not affected by movement of the knee. Aagh, he’s like a living board question! Congratulations, you correctly suspect decompression sickness.
Now what do you do?
– ABC’s (assess pt for need to intubate, assess for PTX)
– initiate 100% FiO2
– consider giving ASA (theorectical basis, no evidence).
– get this guy to a recompression chamber
Recompression therapy is the definitive treatment for DCS-related gas embolism.  In this make-believe scenario, there is no HBO chamber on your island. Thus, the patient need to be emergently transferred. You will need help.
Call International DAN, as a consult. They will help you locate a HBO and help arrange transfer.
DAN America/World – 1-919-684-9111 (accepts collect calls)
Covers – North, Central, and South America; Caribbean; US territories; Central Pacific Basin (Except Fiji); Anywhere else not covered below
For routine, nonemergency questions or information, call 1-919-684-894 during East Coast of United States business hours (Monday-Friday during the daytime).