What is the initial management for suspected decompression sickness during air transport?

What is the initial management for suspected decompression sickness during air transport?

• A. Administer antibiotics
• B. Provide 50% oxygen
• C. Administer 100% oxygen and arrange rapid transfer to hyperbaric therapy
• D. Place patient in Trendelenburg

Answer: (C)

Decompression sickness is caused by inert gas bubbles forming in tissues after a rapid ascent, so the first goal during air transport is to maximize oxygen delivery and start moving toward definitive therapy. Administering 100% oxygen ensures tissues get ample oxygen, helps speed nitrogen washout from the bubbles, and reduces hypoxia risk in the low-ambient-oxygen environment of flight. At the same time, arranging rapid transfer to hyperbaric therapy is essential because increasing ambient pressure in a hyperbaric chamber compresses the gas bubbles, promotes re-dissolution of nitrogen, and is the primary treatment that addresses the underlying problem. Antibiotics don’t treat gas bubbles, 50% oxygen is not enough for optimal oxygenation and bubble resolution, and placing the patient in Trendelenburg offers no therapeutic benefit and can worsen circulation.