CAISSON'S DISEASE (DECOMPRESSION ILLNESS). Research Paper

CAISSON'S DISEASE (DECOMPRESSION ILLNESS)
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1.0 Background
The disease arises from diving underwater, causing depressurization conditions. Other activities such as flying at altitude in an unpressurized aircraft or spacecraft extravehicular actions lead to illness. The illness occurs when dissolved gases in water form bubbles which enter the human body. Its symptoms range from rashes, joint points, or paralysis. In severe cases, the illness can lead to death. The disease has now become rare due to modern decompression techniques, which ensures the safety of divers. What occurs is when a diver gets deeper into the water, their lungs compress, making it hard to breathe. The illness can arise from ascending an altitude or descending into the water, in the case of diving. Nitrogen is usually found dissolved in human blood. Normal atmospheric pressure often sustains it. However, when the average pressure is disrupted, such as going underwater or high altitudes, the dissolved nitrogen comes out in the form of gaseous bubbles. The occulation of small blood vessels causes pain in the bones and soft tissue. This pain later leads to shortness of breath.[Cooper, Jeffrey S., and Kenneth C. Hanson. "Decompression Sickness]
Caisson disease is commonly referred to as decompression illness. It was first discovered in the 19th century. The illness was observed in caisson workers who were in a compressed environment. After affecting those workers, the disease came to be known as caisson disease. The disease has since been commonly observed in astronauts, high-altitude pilots, and divers. The United States records over 900 cases annually relating to decompression illness. Today, steps have been taken to reduce the incidences of decompression illness. This includes minimizing the formation of bubbles through measures such as staging ascents or limiting the duration of dives. This procedure ensures divers have decompression stops that help in re-equilibration of tissue tensions.[. Ibid]
2.0 Physiological mechanisms of Decompression illness
Water pressure increases faster compared to air pressure. For every 33 feet of sea level, it increases by one atmospheric pressure. When a diver enters an area with high strength such as deep underwater, inert gases like nitrogen begin to accumulate in body tissues. The rate of absorption of these gases becomes particularly intense when the diver gets deeper into the sea. However, when the diver moves up the situation is reversed, the pressure and the rate of absorption decreases. As a result, the gases are released from the tissues. Notably, a diver doesn't just move instantly to remove the accumulation of the gas. Instead, the diver must run in a systematic and slow process to remove the gas in stages. For an orderly elimination of washout to occur, the process must be controlled. This situation allows the safe release of the gas However, if the decompression process is conducted rapidly, it may result in decompression illness.[. Vann, Richard D., Frank K. Butler, Simon J. Mitchell, and Richard E. Moon. "Decompression illness.]
The ambient pressure usually determines the concentration of these inert gases inside the human body. Ambient pressure here refers to the pressure in the surrounding environment. The concentration of these inert gases is usually in equilibrium with the ambient pressure. Therefore, the tissues are saturated so long as there are in an environment of normal atmospheric pressure. Thus, gas tension doesn't necessarily happen when a person dives into water or moves to a place of elevated pressure. Minor changes usually occur due to such factors as changes in weather changes. This situation creates a situation of high and low concentration between the body tissues and the surrounding environment. The result is molecules move from the higher level in the outside atmosphere to lower intensity within the body tissues. The purpose of this mechanism is to maintain the equilibrium of inert gases between the body tissues and ambient pressure. So, gas tension in human bodies is never static; instead, a dynamic situation caused by various changes in the surrounding environment.[Ibid]
Comparing the surface atmospheric pressure under pressure clearly illustrates the intensity of pressure underwater. First, the pressure is measured using the unit atmosphere. The space between sea level and outer space is estimated to be around 100 kilometers. Notably, the concentration of gases within this space only exerts one atmosphere. However, when the pressure is measured going vertically underwater, the pressure changes dramatically. For every 34 feet of freshwater or 33 feet of saltwater, the pressure increases by one atmosphere. This highlights the drastic changes that occur underwater. This explains why divers must take a gradual descent or ascent underwater to prevent any decompression illnesses.[Vann, Richard D., Frank K. Butler, Simon J. Mitchell, and Richard E. Moon. "Decompression illness.]
During these mechanisms, the lungs act as the primary connection between the environment and the body tissues. Being in a place of elevated pressure results in the compression of the lungs. This situation creates a gradient within the body. As a result, the tissues will absorb the inert gases while the gradient is still present. Also, the process of tissues being saturated is slow. So, it will take a long time for equilibrium to be established. One factor affecting uptake or release of nitrogen is the flow of blood. When tissues receive more blood flow, the rate of elimination and absorption is higher. This mechanism leads to the concept of fast and slow tissue.[Ibid]
One aspect of caisson disease is the formation of bubbles in the body. The following section discusses the two potential sources of bubble formation, which causes problems in body tissues. The first source is the dissolved nitrogen in the tissues. During a dive, the increased pressure causes more of the dissolved nitrogen to enter the tissues via the arteries. The deeper the dive, the more nitrogen dissolves into the tissues. Also, the longer the time taken under an environment of elevated pressure, the higher the concentration of nitrogen in the tissues. Then, during ascent in fast tissues, the nitrogen is quickly eliminated through the lungs While in slow tissues, the slow rate of dissolved nitrogen release causes the formation of bubbles in the tissues.[. Mitchell, D. S. The Mechanisms of decompression Illness.]
The second potential source is the over-expansion of lungs during a dive. This isn't related in any way to the dissolved nitrogen or the duration or depth a diver is underwater. This explains why divers are discouraged from holding their breath. This because when the pressure reduces during an ascent, the air which was trapped during the holding of breath will expand. This expansion may rupture some of the associated blood vessels found in the lungs in a process referred to as pulmonary barotrauma. This will lead to the formation of air bubbles in the capillary circulation of the lungs. The situation may be dangerous because specific organs such as the brain are sensitive to the creation of bubbles as these block blood vessels These may even induce stroke showing the danger of bubble formation in divers.[. Ibid]
3.0 Common symptoms of decompression illness
* Extreme tiredness or fatigue
* Red itchy rashes
* Pain in shoulder and elbow joints.
* Chest or abdominal or lower back pains.
* Swollen and painful lymph glands.
* Headaches, lightheadedness
* Staggers which include vomiting, deafness, spinning sensations.
* Numbness
* Dizziness
* Skin problems such as rashes and itching
* Breathing difficulties
* Loss of consciousness
* Hearing problems
4.0 Types of decompression illness
4.1 Type I decompression illness
This type is less severe and isn't life-threatening. However, if it isn't addressed earlier, it can lead to further problems for victims. The pain typically occurs in the muscle, leg, arm, or back joints. The pain is usually mild in the beginning but can grow in severity if the pain is allowed to persist. Victims are particularly affected when involved in some form of movement. Other common symptoms of type I decompression illness also include swollen lymph nodes, rashes, extreme fatigue, or itching. The pain in this type is usually compared to that of a toothache. For deep divers, the knee joints are commonly affected. However, for shallower waters of less than 40m, their shoulders are usually affectedAlso, the upper limbs are more severely impacted than the lower limbs.[. Balestra. "an introduction to Clinical aspects of Decompression illness (DCI)." The future of diving 100 (2009).]
4.1.1 Two forms arise under type I decompression illness
One is the cutaneous decompression illness: these are red rashes that are present on shoulders or chest. They usually occur when nitrogen bubbles out of solution and then affecting skin capillaries. The second form is the Joint and Limb Pain Decompression Sickness: this causes the pain in the joints. It results from bubbles affecting the tendon, joints, and bone marrow.
4.2 Type II decompression illness
This a more severe form and is life-threatening. It attacks the nervous system. This form starts with mild numbness, which may lead to paralysis or death. The symptoms begin to show immediately but can sometimes begin to show after a day. Due to the involvement of the nervous system, it causes problems with the pulmonary, circulation, or lung systems. The most affected area in this type is the spinal cord. Its symptoms resemble those of spinal cord trauma. It commonly starts with lower back pain after a dive, which may gradually increase and lead to loss of sphincter control or paralysis. Some of the common systems also include confusion, cognitive dysfunction, headaches, and dizziness. Some major forms of type II decompression illness include the following:[. Kerut et al. "Intrapulmonary shunts and its implications for assessment in stroke and divers with type II decompression illness."]
4.2.1 Cerebral Decompression Sickness
This form is exhibited by symptoms such as unconsciousness, blurred vision, or headaches. It is particularly dangerous makes the air bubbles can reach the brain and cause clots in the blood vessels.
4.2.2 Neurological Decompression Sickness
It is characterized by unconsciousness, numbness, or respiratory issues. It needs immediate medical attention to prevent it from being fatal or causing paralysis. It arises due to the effects of nitrogen bubbles on the central nervous system, which has an impact on the whole body.
4.2.3 Pulmonary Decompression Sickness
This is caused by bubbles forming in lung capillaries, which prevents the natural dissolution of bubbles within the lung blood vessels. It is usually a rare form of decompression illness, which may lead to severe heart and respiratory problems for victims.[. Kerut et al. "Intrapulmonary shunts and its implications for assessment in stroke and divers with type II decompression illness."]
5.0 Risk factors of Decompression illness
5.1 Exercise
High workload may leave divers susceptive to decompression stress. Rapid intensity, while descending underwater, will result in an increased intake of inert gases. This will accelerate the formation of bubbles that will affect circulation in the lungs. It is recommended that divers use low exercise intensity during the bottom phase of their dives. This action will decrease the decompression effects for divers. Also, during upper ascent, divers should engage in mild exercise that involves low joint forces. Another risk factor is engaging in high joint workloads post-dive. This should be avoided to prevent being exposed to decompression risks.[. Balestra. "an introduction to Clinical aspects of Decompression illness (DCi)." The future of diving 100 (2009).]
5.2 Levels of carbon dioxide
Concentrated levels of carbon dioxide pose severe risks to contracting Decompression sicknesses. Its quality of being a vasodilator causes the widening of blood vessels. This situation permits more inert gases to enter tissues. Some of the conditions that increase carbon dioxide levels include intense breathing dense gas underwater and using breathing equipment with ample dead space. Therefore, divers must stay relax underwater and use appropriate breathing equipment that minimizes the volume of dead space.[. Ibid]
5.3 Thermal status
The thermal status influences the risk potential of DCS. This is particularly evident when considering the two stages involved during diving, that is the ascent and descent phases.
The rate of gas uptake increases during the descent and bottom phase of diving. This is attributed to the warm state that develops during this period. This situati...