Tests
1st tests to order
clinical diagnosis
Test
Diagnosis is largely clinical and no tests are usually necessary.
Result
features of dysbarism
Tests to consider
chest x-ray
Test
Plain chest x-ray should be ordered if a diagnosis of pulmonary barotrauma is suspected.[7]
Lung field radiotranslucency and absence of vascular lung markings signifies a pneumothorax.
A radiotranslucent outline around the heart and mediastinum suggests mediastinal emphysema.
Pulmonary edema due to immersion or nonfatal drowning may also be observed.
Result
may show pneumothorax, mediastinal or subcutaneous emphysema, or pulmonary edema
ECG
Test
An ECG may be useful in ruling out alternative diagnoses. ECG changes may include those of ischemia (e.g., ST depression or elevation), arrhythmia, or pulmonary embolism.
Result
may be useful in rulling out alternative diagnoses (arrhythmia, ischemia, etc.)
echocardiography
Test
Echocardiography may be carried out following treatment of decompression sickness in selected cases, as an increased prevalence of patent foramen ovale in these patients has been reported.[26] Transthoracic or transesophageal techniques may be used to demonstrate interatrial shunting by color flow Doppler or visualization of the passage of bubbles after injection of agitated saline into a peripheral vein.[26] Maneuvers to increase right atrial pressure (e.g., Valsalva maneuver) after contrast injection improve the sensitivity of bubble contrast echocardiography.[27] Transcranial Doppler can also be used, which is more sensitive but less specific. Screening is not performed acutely but carried out after decompression sickness in selected cases. Routine screening for PFO in divers is not recommended, but may be useful in patients with unexplained decompression sickness or repeated episodes of DCS.[28]
Result
presence of a patent foramen ovale may be of clinical significance in divers who have had unexplained decompression sickness or repeated episodes of decompression sickness. There appears to be relationship with PFO and inner ear decompression sickness and cutaneous DCS
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