Editing Decompression sickness (section)

===First aid===
All cases of decompression sickness should be treated initially with the highest available concentration of oxygen until [[hyperbaric oxygen therapy]] (100% oxygen delivered in a hyperbaric chamber) can be provided.{{sfn|Marx|p=1912}} Mild cases of the "bends" and some skin symptoms may disappear during descent from high altitude; however, it is recommended that these cases still be evaluated. Neurological symptoms, pulmonary symptoms, and mottled or marbled skin lesions should be treated with hyperbaric oxygen therapy if seen within 10 to 14 days of development.{{sfn|Marx|p=1813}} Early recompression has a history of better outcomes and less treatment being needed.<ref name="Doolette and Mitchell 2018" />

Normobaric oxygen administered at as close to 100% as practicable is known to be beneficial based on observed bubble reduction and symptom resolution. For this reason diver training in oxygen administration, and a system for administering a high percentage of inspired oxygen at quantities sufficient for plausible evacuation scenarios is desirable. Where oxygenation may be compromised the administration rate should be adjusted to ensure that the best practicable supplementation is maintained until supplies can be replenished.<ref name="Doolette and Mitchell 2018" />

A horizontal position is preferable during evacuation if possible, with the recovery position recommended for unconscious divers, as there is evidence that inert gas washout is improved in horizontal subjects, and that large arterial bubbles tend to distribute towards the head in upright positions. A head down position is thought to be harmful in DCS.<ref name="Doolette and Mitchell 2018" />

Oral hydration is recommended in fully conscious persons, and fluids should ideally be isotonic, without alcohol, carbonation or caffeine, as diving is known to cause dehydration, and rehydration is known to reduce post-dive venous gas emboli.<ref name="Doolette and Mitchell 2018" />

Intravascular rehydration is recommended if suitably competent responders are present. Glucose free [[Tonicity#Isotonicity|isotonic]] [[crystalloid solution]]s are preferred. Case evidence shows that aggressive rehydration can be life-saving in severe cases.<ref name="Doolette and Mitchell 2018" />

If there are no contraindications, a [[non-steroidal anti-inflammatory drug]] along with hyperbatic oxygen is likely to improve rate of recovery. The most prominent NSAIDs are [[aspirin]], [[ibuprofen]], and [[naproxen]]; all available [[Over-the-counter drug|over the counter]] in most countries.<ref name="The Physician and Sportsmedicine 20103" /> [[Paracetamol]] (acetaminophen) is generally not considered an NSAID because it has only minor anti-inflammatory activity.<ref name="Hinz_20083" />[[Corticosteroid]]s, [[pentoxyphylline]], [[aspirin]], [[lidocaine]] and [[nicergoline]] have been used in early management of DCS, but there is insufficient evidence on their effectiveness.<ref name="Doolette and Mitchell 2018" />

Divers should be kept comfortably warm, as warm subjects are known to eliminate gas more quickly, but overheating aggravates neurological injury.<ref name="Doolette and Mitchell 2018" />