Shoulder Pain After a Compressed-Air Shift With Prior DCS
A 38-year-old compressed-air tunnel worker is decompressed after a 6-hour shift at 1.6 bar gauge. Two hours later he reports right shoulder pain that is worse with movement and partially relieved by ibuprofen. He had type I decompression sickness 8 months ago and was cleared for return to work. There is no hyperbaric chamber on site; the nearest is 90 minutes away. He wants to finish the shift paperwork, drive home, and 'see how it feels tomorrow.' His colleague had similar shoulder pain last month that resolved with rest. The site physician is off duty and the supervisor asks you for advice by phone.
1. How should you triage the shoulder pain by phone?
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Treat it as possible decompression sickness until proven otherwise. Shoulder pain after a 1.6 bar gauge, 6-hour shift is a classic type I presentation, but his prior DCS and partial response to ibuprofen do not exclude it. Advise 100% oxygen, hydration, avoidance of further compressed-air exposure, and urgent transport to the nearest chamber, 90 minutes away. Do not tell him to drive himself or wait until morning. A musculoskeletal explanation is possible, but the safe path is evaluation by a physician with diving medicine experience; if symptoms resolve en route, he still needs assessment. Document the call and advise the supervisor.
2. What does his prior type I DCS mean for return-to-work and prevention?
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Prior DCS is a marker of individual susceptibility or inadequate decompression. Before returning to compressed-air work, review the decompression schedule, work rate, hydration, thermal status, and-if episodes recur-evaluate for a right-to-left shunt. The current episode should be treated and documented; return to work only after full resolution and medical clearance, with a lower threshold for future symptoms. The colleague's similar pain is a cluster signal: review the site's decompression tables and supervision. The judgment is that repeating 'he was cleared before' is inadequate; the exposure history and recurrence pattern should change the plan.
3. What site-level actions and records would you require?
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Require incident reporting, retention of the decompression log and gas records, and review of the shift's pressure-time profile. The supervisor should arrange transport, not just advice, and ensure the worker is not left alone. If the diagnosis is DCS, report it under the applicable occupational injury system, and consider a site stand-down to review decompression procedures. Fit-for-duty assessment should include a neurologic exam and, if recurrent, evaluation for a patent foramen ovale. The judgment is that individual treatment and system prevention are linked: a single case is a signal to audit the whole compressed-air operation.