Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 236

 ICD Coding

ICD-10-AM Code: T70.30

Brief description

Also known as 'the bends', this is a condition that can occur in scuba divers on returning to the surface after an underwater dive, or in others exposed to a decrease in atmospheric pressure (typically after being in an environment of increased pressure).  It is caused by the formation of gas bubbles (of nitrogen and other inert gases) in the tissues/blood as the gases expand with lower pressure.  It occurs generally if the change in atmospheric pressure is too rapid for the body to cope with.  These gas bubbles can cause a range of problems throughout the body.

Confirming the diagnosis

The diagnosis is made clinically, based on the history and physical findings.

The relevant medical specialist is a physician.

Additional diagnoses covered by SOP

• Arterial gas embolism (not due to pulmonary barotrauma or air embolism)
• Caisson disease
• Decompression sickness
• "The bends"

Conditions excluded from SOP

• Air embolism^#
• Arterial gas embolism due to pulmonary barotrauma*
• Cerebrovascular accident*
• Ebullism (spontaneous formation of water vapour from liquid water in bodily fluids due to markedly reduced environmental pressure at extremely high altitude or in space)^#
• Fat embolism^#
• High pressure neurological syndrome/inert gas narcosis^#
• Osteonecrosis (dysbaric)*
• Pulmonary barotrauma*

* another SOP applies

^# Non-SOP condition

Clinical onset

The clinical onset will be acute, with the development of symptoms in most cases within one hour after an episode of decompression.  90% of cases will have symptoms within 12 hours.  A small number may develop symptoms more than 24 hours after decompression.  

Clinical worsening

This is an acute injury event.  The only SOP worsening factor is for inability to obtain appropriate clinical management.  Appropriate treatment in other than mild cases is recompression in a hyperbaric chamber, initiated as quickly as possible.