A diver presenting with AMS, chest pain, dyspnea and wheezing after ascent is most likely to have which condition and what is the pathophysiology?

A diver presenting with AMS, chest pain, dyspnea and wheezing after ascent is most likely to have which condition and what is the pathophysiology?

• A. Fat embolism; lipid emboli
• B. Barotrauma of the chest
• C. Decompression sickness; nitrogen bubbles in tissues
• D. Acute allergic reaction

Answer: (C)

Rapid ascent after diving lowers ambient pressure, causing nitrogen that was dissolved in tissues to come out of solution and form gas bubbles. These bubbles travel in the bloodstream and lodge in tissues, producing ischemia and inflammation. If bubbles reach the brain, they disrupt cerebral perfusion and cause altered mental status; in the lungs, they obstruct small vessels and trigger chest pain, dyspnea, and wheezing. This pattern after ascent is classic decompression sickness, explained by nitrogen bubbles forming in tissues and causing multi-system effects. Fat embolism is trauma-related, barotrauma typically causes a pneumothorax or chest injury, and an acute allergic reaction would not specifically align with diving history and the pulmonary–neurologic presentation described.

Rapid ascent after diving lowers ambient pressure, causing nitrogen that was dissolved in tissues to come out of solution and form gas bubbles. These bubbles travel in the bloodstream and lodge in tissues, producing ischemia and inflammation. If bubbles reach the brain, they disrupt cerebral perfusion and cause altered mental status; in the lungs, they obstruct small vessels and trigger chest pain, dyspnea, and wheezing. This pattern after ascent is classic decompression sickness, explained by nitrogen bubbles forming in tissues and causing multi-system effects. Fat embolism is trauma-related, barotrauma typically causes a pneumothorax or chest injury, and an acute allergic reaction would not specifically align with diving history and the pulmonary–neurologic presentation described.