Differential diagnosis considerations of sickness after rapid pressure changes at altitude

INTRODUCTION Aviation has undergone significant advancement over time; despite our best practices, injuries can still occur. Occasionally aviators will suffer from injuries of barotrauma, decompression sickness, or arterial gas embolism. The history and physical examination are important when evaluating the injury and its subsequent treatment. This article will help readers identify key components of the history and physical examination in a patient to recognize decompression sickness and arterial gas embolism. CASE REPORT This case report is of a Naval F/A-18C pilot who demonstrated acute and delayed neurologic symptoms when his cockpit underwent four rapid decompression cycles from 11,000 to 29,000 ft (3353 to 8839 m) in a 20-s period. He was subsequently treated with hyperbaric oxygen via a standard U.S. Navy TreatmentTable 6 with complete neurological recovery as determined by his improved neurological abilities. DISCUSSION Naval aviators are exposed to multiple stresses during flight. When injuries occur it is important to obtain a careful history and physical examination. A broad differential diagnosis, including decompression sickness, hypoxia, and arterial gas embolism, should be considered to ensure prompt and appropriate evaluation and treatment. In this case report, the pilot had acute neurological injuries concerning for arterial gas embolism or an hypoxic episode, as well as a delayed recurrence of symptoms consistent with decompression sickness.