2 embolisms

[ajduplessis]

A Tale of 2 Embolisms. A friend & I suffered Arterial Gas Embolisms (AGE) almost exactly a year apart, on very similar dives, on the same boat, in almost the exact same location, while we were diving together. Both dives:
1) @185fsw
2) Back gas was air
3) Short bottom times because the anchor was dragging
4) No computer violations
5) Onset of symptoms within 3-4 minutes
6) Paralyzed on 1 side – his left, my right
7) Fully resolved on surface O2 within 30 minutes
8) We both walked up on the dock when we got back
9) Both took a level 1 chamber ride as a precaution
10) Both have resumed diving with no aftereffects
A few differences:
1) My dive had 3-4 minutes bottom time; his was a true bounce dive
2) My ascent was slower due to the amount of scope on the anchor
3) I switched to 50% O2 @ 70fsw even though I didn’t need to as I wasn’t sure I could use the O2 hang reg because of the current. I was able to use it so I had quite a bit safety margin.
Posted for information purposes only. Informed, thoughtful comments are welcome.

This I would assume was a "second" dive? What is the detail of the first dive and what was the surface interval (SI)?

 

[Mobile Diver]

185 is above the 1.4 mod, what's the problem?



yeah, but what OP said was the 70' stop wasn't required. maybe u could stick to what OP said rather than guessing from ur assumption on OP's training??



do u know if OP had enough 50% & air in gas plan to deco out w/o the O2 he hung at 20'? if u don't know for sure, kinda makes u sound clueless, no?



ur really eager 2 make this into a situation u have in ur mind, but not what the OP said: dives were cut shorter than planned bc anchor was dragging & they elected 2 abort in each case.

i guess DIR mean make up facts and then comment on them

Thanks much for actually reading my post. Take care.

 

[treasurehunter]

185 is above the 1.4 mod, what's the problem?

PPo2 1.4 is for CNS so that all fine and dandy,The issue is the PPn2 of 5.2 N2. If you are OK diving to that partial pressure that is fine.I have a few buddies that have done it, but also later said that it was not a pleasant experience and would probably not go there again. If you are used to it and can handle emergency situation with that kind of narcosis it is your call.


yeah, but what OP said was the 70' stop wasn't required. maybe u could stick to what OP said rather than guessing from ur assumption on OP's training??

Actually what he said was:
3) I switched to 50% O2 @ 70fsw even though I didn’t need to as I wasn’t sure I could use the O2 hang reg because of the current. I was able to use it so I had quite a bit safety margin.

Hence my assumption that dive had no plan. He brings 50% but intends to use the o2 hange maybe if he can reach it?? On the ascent kind of realises "hey maybe i might not reach the 100%, after reaching 70 and the narcosis is better ''?? yes no which is it. Doesn't sound like a plan to me. You carry on your person what you need to complete deco according to a planned worst case **** hitting the fan scenario, the hang o2 is for emergency.

According to V-Planner at conserve @ 2, 185 for a bottom time 3 to 4 minutes, with lost 50% gas and no 100%, entails deco to start at 40', 2 mins at 30, 2 mins at 20 and 4 mins at 10'. did he plan for that??

do u know if OP had enough 50% & air in gas plan to deco out w/o the O2 he hung at 20'? if u don't know for sure, kinda makes u sound clueless, no?

How much air or deco gas you have is irrelevant if you don't perform you decompression properly. No?? Deco theory is a crap shoot so hence there is reason to put every thing on your side.
Therefore, if he got bent as did his friend on the same dive one year apart diving the same profile that got his friend bent, maybe they are doing something wrong or are under estimating the conservatism they need to factor in the plan there body needs to stay safe

ur really eager 2 make this into a situation u have in ur mind, but not what the OP said: dives were cut shorter than planned bc anchor was dragging & they elected 2 abort in each case.

If dives where cut short?? Bail out plan maybe?? and Follow it??
I don't know the level of training he has, doesn't say, so i have to go with my gut and experience that proper risk management planning was not part of training.

i guess DIR mean make up facts and then comment on them

I'M not a DIR disciple by any means, and was trained to do what works for each dive circumstance, by incorporating from all forms of training out there.Before any deep dive all the team goes over need gear and/or configuration and all possible contingencies that can arise.A well planned dive whether aborted or completed has effect of making any **** hitting the fan scenario become more of an inconvenience that an emergency,whether below or above water.


From what Mobile Diver wrote from original post didn't give me the impressions of a planned dive, sorry.
I could be wrong and there could of been other info on dive not mentioned because Mobile diver was tired and wanted to go to bed so short cut his post,and if so I Apologize for Assuming.




Dive safe and good luck

 

[Freewillow]

How much air or deco gas you have is irrelevant if you don't perform you decompression properly. No?? Deco theory is a crap shoot so hence there is reason to put every thing on your side.
Therefore, if he got bent as did his friend on the same dive one year apart diving the same profile that got his friend bent, maybe they are doing something wrong or are under estimating the conservatism they need to factor in the plan there body needs to stay safe

OPP is talking about A.G.E and you about Bends. Are you sure that they are related complications?????????????????????

 

[fsardone]

OPP is talking about A.G.E and you about Bends. Are you sure that they are related complications?????????????????????

Arterial is adjective of artery the vases which have a muscular structure and generally carry oxygenated blood (except in the small circle where they carry venous or unoxygenated blood)
Gas is gas
Embolism is bubble

So AGE is blubble of gas in the blood ... if you have bubble in the tissues you will have bends (which is a symptom of embolism in the articular joints) and you will have VGE venous gas embolism which in turn can cause AGE
----Quote---
Bubbles in the arterial circulation can arise from basically three sources: venous gas embolism with breach of the pulmonary vascular filter (paradoxic gas embolism), patent foramen ovale (paradoxic gas embolism) and tear of the pulmonary parenchyma with entry of gas into pulmonary venous outflow. Studies show that systemic venous bubbles are trapped in the pulmonary arterial tree and are usually completely eliminated from that site. The lung traps the air and excretes it into alveoli from the arterioles. (RG Presson, J Appl Physiol; 1989;67(5),1898-1902)
----End Quote---

I very much doubt you can have a diagnosis of AGE vs VGE and therefore 'bends' as you call them, without a thoracic eco doppler scan ...
I very much prefer DCS/DCI.

Just my 2 cents. I am no physician ...

Cheers

Fabio

 

[treasurehunter]

OPP is talking about A.G.E and you about Bends. Are you sure that they are related complications?????????????????????

By Dr. E.D. Thalmann, DAN Assistant Medical Director
With reports by Renée Duncan, editor, and Joel Dovenbarger, vice president, DAN Medical Services
NOTE: This article was published in March/April 2004.
Decompression illness, or DCI, is a term used to describe illness that results from a reduction in the ambient pressure surrounding a body. A good example is what happens to your body when you're surfacing after a dive.
DCI encompasses two diseases, decompression sickness (DCS) and arterial gas embolism (AGE). DCS is thought to result from bubbles growing in tissue and causing local damage, while AGE results from bubbles entering the lung circulation, traveling through the arteries and causing tissue damage at a distance by blocking blood flow at the small vessel level.
Who Gets DCI?
Decompression illness affects scuba divers, aviators, astronauts and compressed-air workers. It occurs in approximately 1,000 U.S. scuba divers each year. Moreover, DCI hits randomly. The main risk factor for DCI is a reduction in ambient pressure, but there are other risk factors that will increase the chance of DCI occurring. These known risk factors are deep / long dives, cold water, hard exercise at depth, and rapid ascents.


Two diseases caused by the same effect (other than medical).If due to medical condition,then you can see a doctor and if permitted you can adjust your conservative factor to match condition if possible.

 

[Nuribromanski]

PPo2 1.4 is for CNS so that all fine and dandy,The issue is the PPn2 of 5.2 N2. If you are OK diving to that partial pressure that is fine.I have a few buddies that have done it, but also later said that it was not a pleasant experience and would probably not go there again. If you are used to it and can handle emergency situation with that kind of narcosis it is your call.

So u went from "Enough said" 2 'it's a judgment/experience call'? Kinda different sounding 2 me...i agree w/ the 2nd one, btw. not so much w/ the "Enough said" obvi

Actually what he said was:
3) I switched to 50% O2 @ 70fsw even though I didn’t need to as I wasn’t sure I could use the O2 hang reg because of the current. I was able to use it so I had quite a bit safety margin.

Hence my assumption that dive had no plan. He brings 50% but intends to use the o2 hange maybe if he can reach it?? On the ascent kind of realises "hey maybe i might not reach the 100%, after reaching 70 and the narcosis is better ''?? yes no which is it. Doesn't sound like a plan to me. You carry on your person what you need to complete deco according to a planned worst case **** hitting the fan scenario, the hang o2 is for emergency.

yes, u carry what u need for worst-case scenario...but ur plan can certainly include 'use O2 to shorten deco time if all goes well, & if not, fall back to what ur carrying'...this is not rocket science

 

[markmud]

Hi Mobile Diver,

I have some questions regarding your DCI hit:

1. Which Doctor diagnosed AGE? (I don't mean name him/her--is the doctor trained in hyperbaric medicine?)
   1. Your AGE sounds a lot like it could be DCS (fsardone's post regarding the possibility of AGE or VGE seems remote and his general assumption of DCI/DCS seems to be a better guess).
2. You wrote that your bottom time was 3-4 minutes. Some of us assume that bottom time is just that, bottom time. TDI Decompression Procedures Guide (cpyrght, J. Odom) states that bottom time starts when you splash to the time you start your direct ascent to the surface (paraphrased).
   1. Did your posted bottom time include your descent time?
3. You wrote that your bottom mix was air.
   1. Generally, a 3.16 ata of nitrogen is where narcosis can start (depending on lots of factors and very mild at 3.16 PP).
      1. Your PPn2 was 5.2, did you suffer any symptoms of narcosis?
      2. Did you have a contingency in case you, your buddy, or both of you did have to physically exert yourselves and thereby, run a greater risk of being narced?
4. My Buhlman table indicates that a bottom time of 5 minutes at 180 fsw requires deco.
   1. Did you plan for that?

When I read your (Mobile Diver's) original post, my first thought was "who diagnosed AGE." And, how does that work for this profile (I seriously doubt you held your breath while on the ascent). According to Fsardone's post, it would seem to be difficult condition to have with two divers on the same dive profile on different days. The odds don't seem to favor that diagnosis (IANAP).

Disclaimer: IANAP. I am only asking questions so that I may learn from your incidents.

markm

 

[Nuribromanski]

My Buhlman table indicates that a bottom time of 5 minutes at 180 fsw requires deco.

Did you plan for that?

now im curious: why do u think OP took one deco gas with him (50%) and staged O2 on the anchor line if he didnt plan 4 deco??

 

[markmud]

now im curious: why do u think OP took one deco gas with him (50%) and staged O2 on the anchor line if he didnt plan 4 deco??

Hi Nuribromanski,

I don't think that. I read the Mobile Diver's post and can only assume that he did not perform deco as he did not write about deco stops.

You know, just a hunch, but were you with Mobile Diver (you seem to be protesting too much!)? Why are you protesting so much...

Look, divers do you use Nitrox as a washout gas while staying within NDL. It is not unheard of. I own a computer that lets me use 3 different EANX gases on a single dive. It is a recreational computer.

markm