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Case Reports in Emergency Medicine
Volume 2017, Article ID 7203085, 4 pages
Case Report

Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional Transport Considerations

1Emergency Medicine Residency Program, Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
2Department of Emergency Medicine, Division of Emergency Medical Services, University of Florida, Gainesville, FL, USA
3ShandsCair Critical Care Transport Program, UF Health, Gainesville, FL, USA
4Florida Hospital/Central Florida Pulmonary Group, Orlando, FL, USA

Correspondence should be addressed to Karl Huesgen; ude.lfu@negseuhlrak

Received 30 June 2017; Accepted 27 August 2017; Published 4 October 2017

Academic Editor: Ching H. Loh

Copyright © 2017 Julie Estrada et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system. No abnormality was seen on head CT and the patient had normal mental status. Prehospital nonrebreather oxygen therapy was changed to continuous positive airway pressure (CPAP) upon ED arrival, and the patient was intubated prior to transfer to a hyperbaric facility. However, within 24 hours the patient was found to have multiorgan failure, diffuse cerebral edema, and brain death despite no further episodes of hypotension or hypoxia. No intracranial gas was seen on repeat head CT. Our case demonstrates the importance of early recognition of decompression illness by EMS personnel, consideration of ground versus flight transportation of these patients to the nearest hyperbaric center, and the possible use of prehospital CPAP as an alternative to enhance oxygenation.