Fatal cardiopulmonary decompression sickness in an untrained fisherman diver in Yucatán, Mexico: a clinical case report.

INTRODUCTION: In Yucatán, Mexico, during the sea cucumber season fishermen dive intensely to obtain good catches but are often at risk of decompression sickness (DCS). We present a single case fatality. OBJECTIVE: We analyzed the clinical course, medical assessment and recompression treatment plan of an untrained fisherman. CASE REPORT: A 35-year-old male ascended rapidly using compressed-air diving. Before reaching the coast, he reported dizziness, shortness of breath, and pain in the abdomen and legs. Three hours later, when symptoms worsened, he went to the hospital. He was admitted with increased osteotendinous reflexes and cutis marmorata in the abdomen. The patient was diagnosed with carbon monoxide (CO) poisoning and Type I DCS, receiving the U.S. Navy Treatment Table 5 (USN TT5). Before completing his treatment at depth, he developed myocardial infarction and died. The death certificate indicated Type I DCS, thrombotic pulmonary embolism and cardiac arrest. DISCUSSION: Upon reviewing his medical records, we uncovered no evidence to support the diagnosis of CO poisoning and thrombotic pulmonary embolism. The clinical presentation seems to be compatible with a serious decompression insult, not a Type I hit. Based on the information gathered, it seems likely that the patient died as a result of cardiopulmonary DCS. This case report suggests a need to provide fishermen divers in this region with formal dive training. There also seems to be a need to improve medical education for physicians who work at hyperbaric programs, and to ensure that sufficient and qualified staff is present to supervise patients inside the chambers.

Decompression sickness among diving fishermen in Mexico: observational retrospective analysis of DCS in three sea cucumber fishing seasons.

The probabilities of decompression sickness (DCS) among diving fishermen are higher than in any other group of divers. Diving behavior of artisanal fishermen has been directed mainly to target high-value species. The aim of this study was to learn about the occurrence of DCS derived from sea cucumber harvesting in the Yucatán Peninsula, Mexico. We conducted a retrospective chart review of diving fishermen treated at a multiplace hyperbaric chamber in Tizimín, Mexico. In total, 233 recompression therapies were rendered to 166 diving fishermen from 2014 to 2016. The average age was 36.7 ± 9.2 years (range: 20-59 years); 84.3% had experienced at least one DCS event previously. There was a correlation between age and DCS incidents (F: 8.3; R2: 0.07) and differences in the fishing depth between seasons (H: 9.99; p⟨0.05). Musculoskeletal pain was the most frequently reported symptom. Three divers, respectively, suffered permanent hearing loss, spinal cord injury and fatal outcome. Diving fishermen experience DCS at an alarmingly high rate, probably due to the type of species targeted, given the requirements in each case. Understanding divers' behaviors and their incentives while in pursuit of high-value species such as sea cucumber could help to find ways to mitigate health risks and help enforce regulation.