DNIPROPETROVSK STATE

MEDICAL ACADEMY
DEPARTMENT OF
OCCUPATIONAL DISEASES
CAISSON DISEASE
-R.SUBASARAVANAN
• The caisson disease is a pathological condition that develops owing to formation of gas
bubbles in blood and tissues in case of decrease of external respiration (in a man on leaving
caisson and emergence).
• Decompression sickness, also called generalized barotrauma or the bends, refers to injuries
caused by a rapid decrease in the pressure that surrounds you, of either air or water.
• It occurs most commonly in scuba or deep-sea divers, although it also can occur during high-
altitude or unpressurized air travel. However, decompression sickness is rare in pressurized
aircraft, such as those used for commercial flights.
• When you scuba dive with compressed air, you take in extra oxygen and nitrogen. Your body
uses the oxygen, but the nitrogen is dissolved into your blood, where it remains during your
dive. As you swim back toward the surface after a deep dive, the water pressure around you
decreases.
• If this transition occurs too quickly, the nitrogen does not have time to clear from your blood.
Instead, it separates out of your blood and forms bubbles in your tissues or blood. It is these
nitrogen bubbles that cause decompression sickness. The condition is called the bends
because the joint and bone pains can be so severe they double you over.
• What happens inside your body during decompression sickness is similar to what happens
when you open a carbonated drink. When you open the can or bottle, you decrease the
pressure surrounding the beverage in the container, which causes the gas to come out of the
liquid in the form of bubbles. If nitrogen bubbles form in your blood, they can damage blood
vessels and block normal blood flow. 
• Some technology processes are carried out under conditions of heightened atmospheric
pressure. For example, a drifting of horizontal and vertical underground excavations through
watered seams or fulfillment of work under water that is possible only under condition of
water forcing out from an air working chamber using compressed air.
ETIOLOGY AND PATHOGENESIS:
 Caisson sickness is a consequence of transition of gases of blood and tissues
from dissolved condition in free one – similar to gas - in case of decrease of
environment atmospheric pressure.
 At that, gas bubbles are formed, they destroy normal blood circulation,
stimulate nervous endings, deform and damage tissues of organism.
 Main part of general pressure of gases in lungs and consequently blood and
tissues falls on a portion of nitrogen, a physiologically inert gas that does not
take participation in gaseous exchanges.
 High partial pressure of nitrogen in lungs, its physiology and non-reactivity
predetermine its basic role in formation of gas bubbles in case of
decompression development.
 Term of dynamic balance recovery for various tissues of organism is unequal at change of
nitrogen partial pressure in external and alveolar air. Blood, lymph and tissues, which perfuse
well, are saturated faster and destroy it.
 Dynamic balance of gas becomes broken, tissues and liquid of organism become
oversaturated with gases first of all by nitrogen at lowering of pressure of environment
(when a worker leaves a caisson box, at ascent from depth onto surface).
 Process of excess nitrogen removal from tissues before arrangement of a new gas balance at
sluggish decompression usually flows without formation of gas bubbles.
 Oversaturation of tissues with gases reaches a critical level in case of fast decompression.
 Conditions for bubbles formation in tissues and liquids are formed.
 There are two basic types of bubbles.
1. The first one include bubbles located outside of vessels, formation and return development is
determined by process of diffusion - exchange of gases between a bubble and medium that
surrounds it.
 The bubbles located inside tissues, definitely refer to this type. They are capable to enlarge
and press on tissues that surround them, causing their deformation, and that invokes sensation
of pain in patients. Mechanism of development of sensations of muscular-articular
decompression pain at patients has such characteristics.
2) The second type involves gas bubbles, evolution of which is conditioned not only by
processes of diffusion, but also by junction of one bubble with another or, to the contrary,
by its splitting into even finer bubbles.
 They join one another, being formed in venous channel, that gives possibility for acute
aeroembolism development in circulatory system.
PATHOLOGIC AND ANATOMIC PICTURE:
o The most expressed and specific morphological manifestations in case of fast death from a
high-gravity decompression disease are availability of numerous bubbles in venous system, a
right half of heart overflowed and spread by gas bubbles, phenomenon of edema and
emphysema of lungs, numerous zones of hemorrhages in various organs and tissues.
CLINICAL PICTURE:
ACUTE DECOMPRESSION DISEASE:
• Three degrees of gravity of a decompression sickness are marked out:
1. Mild degree of gravity
2. Mean degree of gravity
3. High degree of gravity
1. MILD DEGREE OF GRAVITY:
 Itch of skin, eruption, non-acute pain in muscles, bones, joints and along nerve trunk is
characteristic for the mild degree.
 More often, continuous pain arises in one or several joints of extremities, in particular in
knees, shoulders, and also in radiocarpal, elbow joints and ankles. The pain has no concrete
localization. Most of all it is felt around of joint, being diffused to all directions from it. The
pain, as a rule, strengthens at palpation of joint and bending of extremities. Joints and
muscles experiencing the greatest physical loadings are involved in the process most often.
 Itch of skin is felt on a body or on proximal segments of extremities. It reminds itch of skin
after a bite of an insect.
 Some portions of skin have mottled pattern due to skin vascular embolism. Gas
accumulation in hypodermic layer gives rise to development of hypodermic emphysema.
2. MEAN DEGREE OF GRAVITY:
 The disease of the mean degree of gravity is characterized by disease of an internal ear,
gastrointestinal tract and organ of sight. First of all Meniere’s syndrome is formed as a
result of gas bubbles origination in labyrinth of internal ear.
 Acute weakness, gravity and headaches are watched in a clinical picture. These signs
integrates with a loss of consciousness, vomiting, buzzing in the ears, and decrease of
hearing.
 Strong paleness of dermal covers, heightened hydrosis appears. Patients complain that all
subjects are revolved before eyes; a minor turn of head strengthens agonizing sensations.
There is a possibility of consciousness loss.
 Gastrointestinal lesions are characterized with accumulation of gas in intestines, vessels of
mesentery and are accompanied by arise of strong abdominal pain, often defecation.
Palpation of abdomen is agonizing; it is strained.
 Visual acuity is reduced and accompanied by dilatation of pupils and oppression of their
reaction on light.
3. HIGH DEGREE OF GRAVITY:
 The high-gravity degree of caisson sickness is met today seldom. It is characterized by
formation of emboli in vessels of central nervous system, heart and lungs.
 Patients complain on general weakness and weakness in legs, sharp coughs, strong pain in
thorax, in particular at breathing, asphyxia.
 Clinical signs of edema of lungs occur in due course. A significant amount of gas bubbles of
different size that produce lesion of cardiovascular activity is accumulated in cavities of right
heart and in vessels of lungs in case of originating of multiple aeroembolism.
 Thus paleness, strong weakness, often and surface breathing is marked in patients: arterial
pressure drops. Pulse falls down, dermal covers gain cyanotic tint. Loss of consciousness
can be set at expressed phenomena of hypoxia. Myocardial and lung infarction is probable.
 The cerebral lesions are conditioned by gas emboluses in brain. Weakness, headache arises
after a short-lived latent period. Sensitiveness of one half of body disappears in light cases,
and phenomena of paralysis arise in more gravity cases: speech is lost; signs of facial nerve
paresis and paraparesis of lower extremities appear. It is accompanied by distress of
urination and defecation.
CHRONIC DECOMPRESSION DISEASE:
 The chronic decompression disease is determined. Two forms of it are marked
out:
1. Primary Chronic Decompression Disease
2. Secondary Chronic Decompression Disease

3. PRIMARY CHRONIC DECOMPRESSION DISEASE:

 The primary chronic decompression sickness develops slowly. Deforming
osteoarthrosis is the main clinical manifestation of this form.
2. SECONDARY CHRONIC DECOMPRESSION DISEASE:
 The secondary chronic form represents a complex of pathological changes owing to
experienced acute caisson sickness. Its main clinical symptom is aeropathic myelosis and
Meniere's syndrome.

 At chronic form of the disease, gas emboli are localized in different organs, mainly in bones.
At first the clinical picture flows without symptoms ; both permanent pain symptom and
lesion of function of extremities arise only at complication of the process by deforming
osteoarthrosis. Head and proximal ending of diaphysis of thigh are violated at the first turn.
After that, head and upper part of diaphysis of shoulder, then distal parts of thigh,
proximal endings of shinbone, lower endings shoulder and radial bones are struck.
DIAGNOSIS:
 Diagnosis of caisson sickness is established on a basis of the characteristic complaints and
clinical symptomatology that come up after decompression. Occurrence of dermal itch, pain
sensations, Meniere's syndrome, paralyses, sudden development of collapse - all this with
allowance for the preceding decompression is a direct evidence of caisson sickness.
TREATMENT:
I. A radical method of a caisson sickness treatment is recompression that influences patient by
heightened pressure in a recompression chamber.
 The method is based on the fact that gas bubbles located in patient’s organism decrease
their volume and solve at recompression.
 The recompression renders assistance for dissolution of the bubbles, that is it eliminates
etiological factor of illness. The medical recompression is carried out under a special
program.
II. Symptomatic treatment is used depending on patient’s condition:
 stimulation of cardiovascular system, warming, oxygen, means directed on struggle with
pain, with a possible edema of lungs.
 Application of a hyperbaric oxygenation gives quite good outcomes.
VERIFICATION OF THE ABILITY TO WORK:
 The sick-leave is given for a period of treatment for 10 days at mild degree of illness. Patient
can be temporarily given a work outside of heightened atmospheric pressure and other
unfavorable factors operation with issue of a labor sick-leave in case if further treatment in
out-patient conditions is necessary.
 Return of the sufferer of caisson sickness of mean gravity to the same work is authorized
after a period of temporary incapacity for work.
 Availability of complications in the form of firm organic changes on the part of organ of
sight and gastrointestinal tract leads to a steady disablement with a rather large list of
contraindicative kinds of labor activity.
 The labor forecast at a high-gravity degree of a caisson illness is always unfavorable. It is
necessary to send patients on commissioning for disablement degree definition and
rehabilitation measures elaboration.
PREVENTIVE MEASURES:
 The warning of decompression disease is envisioned, first of all, by observance of rules of
work in caisson-box. So, the maximal pressure during their realization should not exceed 3.9
atm.
 A working day in a caisson box is divided on two parts with a rest between them not less
than 9-10 hours outside of a caisson box.
 General number of working hours during a day, including time of locking and unlocking, is
ranged from 6 h till 2 h 40 minutes depending on pressure in a caisson box.
 Breathing with oxygen, struggle against overcooling of workers is a preventive action
against caisson sickness.
 An ambulatory or a medicine post with a day-night duty of medical staff is organized for the
well-timed and qualified health services on each site of construction where the caisson work
is realized.
 Isolation ward on the occasion of a decompression sickness, medical airlock can be at a
medical
Center.
 Persons permitted to decompression and diving jobs should pass preliminary medical
examination.
 Contraindications for admittance for these jobs is hypertensive disease, pulmonary
tuberculosis, respiratory tract lesion of non tubercular etiology, peptic ulcer of stomach and
duodenum, illness of kidneys and urinary bladder, Diabetes Mellitus, and excessive
stoutness.
 All people working in a caisson box are subject to weekly medical examination with
participation of doctor - therapist and otolaryngologist.