Decompression Illness: What Clinicians Need to Know w Prof Simon Mitchell.

Decompression illness, an umbrella term that includes decompression sickness and arterial gas embolism which may occur after diving, aviation, and spaceflight. with Professor Simon Mitchell we explore what happens in the body during these conditions, the key risk factors, and how they can present with sometimes subtle and nonspecific symptoms. Simon discusses how to recognise and assess those who may have decompression illness, the role of investigations, and the principles of treatment including recompression and hyperbaric oxygen therapy. We also cover who to call, what to expect in the management pathway, and clinical pearls for primary care and emergency clinicians.

Practical clinical pearls:

Decompression illness is an umbrella term covering decompression sickness and arterial gas embolism occurring after diving, aviation, and even spaceflight.

Symptoms most commonly present immediately or with in the first hour of resurfacing.

Sick divers need urgent assessment including a thorough neuro examination.

First aid includes 100% oxygen, Non-steroidal anti-inflammatories and IV fluids and consider recompression.

Talk to a friend at the NZ Emergency diving services by calling 0800 433 711- they will advise next steps including the need for evacuation to a hyperbaric oxygen chamber.

If diving overseas consider joining DAN- Divers alert network, use their insurance and call them if you run in to trouble USA +19196849111

Guest bio: Simon Mitchell is an anaesthesiologist at Auckland City Hospital, a diving physician at North Shore Hospital (Auckland), and Professor of Anaesthesiology at the University of Auckland.

He is widely published, with two books and over 170 scientific papers or chapters, including co-authorship of the 5th edition of Diving and Subaquatic Medicine and the Hyperbaric and Diving Medicine chapters in the last four editions of Harrison’s Principles of Internal Medicine.

Simon has twice served as Vice President of the Undersea and Hyperbaric Medicine Society (USA) and received the Behnke Award for scientific contributions to diving medicine in 2010. Since 2019, he has been Editor-in-Chief of the Diving and Hyperbaric Medicine Journal.

Outside of medicine, Simon has had a long career in sport, scientific, commercial, and military diving. He has participated in exploratory wreck and cave diving expeditions worldwide and in 2002 performed what was then the deepest dive to a shipwreck. In 2023, he was part of the Wet Mules expedition to the Pearse Resurgence in New Zealand, where a 230 m hydrogen dive was conducted — the first of its kind in over 30 years. He is a Fellow of the Explorers’ Club of New York and was named Rolex Diver of the Year in 2015.

Resources:

Mitchell, Simon J, Michael H Bennett, and Richard E Moon. “Decompression Sickness and Arterial Gas Embolism.” Ed. by C. Corey Hardin. The New England journal of medicine 386.13 (2022): 1254–1264. Web.

Mitchell, Simon J et al. “Pre-Hospital Management of Decompression Illness: Expert Review of Key Principles and Controversies.” Diving and hyperbaric medicine 48.1 (2018): 45–55. Web.

https://www.nzunderwater.co.nz/emergency

https://dan.org/

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