Acceptable levels of vital signs during diving

[Web Monkey]

I'm told vitals are at different levels while diving (that they're basically off the charts).

I have a hard time imagining that vitals would be any more extreme in a diver exerting himself than anyone else playing a very physical sport. Maybe the levels would be different, but more extreme? I'd be interested in finding out why I'm wrong about that.

I'm not sure who said that, or under which conditions or which vitals they're talking about (or even which direction they're talking about), but I can tell you for certain that my heart rate and respiration are lower underwater than on the boat.

Terry

 

[stadler_cj]

Oh yeah... The current studies continue the CO2 project and also split to look at immersion pulmonary edema. Fun stuff, told you to come visit!

I wonder if early detection might include a microphone with a very small chipset that could listen for rales (or whatever the sound is that gives pulmonary edema away; I always forget). Plus, an increased respiratory rate with low levels of exhaled CO2.

Of course, the breathing sounds would be the only sign that would point specifically toward PE, right?

 

[Yerba Mate]

Oh yeah... The current studies continue the CO2 project and also split to look at immersion pulmonary edema. Fun stuff, told you to come visit!

I wonder if early detection might include a microphone with a very small chipset that could listen for rales (or whatever the sound is that gives pulmonary edema away; I always forget). Plus, an increased respiratory rate with low levels of exhaled CO2.

Of course, the breathing sounds would be the only sign that would point specifically toward PE, right?

You might hear fine crackles (traditionally referred to as rales), and perhaps increased Resp rate and decreased oxygenation if it was bad. You might also see slightly decreased PetCO2 due to the hyperventilation, but I don't think this would be indicative of a CO2 retention/deadspace issue.

Although crackles could point towards pulmonary edema, breath sounds alone are not likely definitive. ABG's, SpO2 and CXR would definitely be nice to have...a little difficult to get while diving though.

Hmm, it might be interesting to see the effects of some sort of depth compensating PEEP valve on the exhalation port of the Reg

Disclaimer, I am not too familiar with 'Immersion' pulmonary edema, per se. Although I am a diver myself, and I see pulmonary edema in various forms all the time clinically, I've never heard of pulmonary edema due to immersion. So anything I've said above is more based on my training as an RT.

 

[stadler_cj]

Although crackles could point towards pulmonary edema, breath sounds alone are not likely definitive. ABG's, SpO2 and CXR would definitely be nice to have...a little difficult to get while diving though.

Hmm, it might be interesting to see the effects of some sort of depth compensating PEEP valve on the exhalation port of the Reg

These kinds of technology are not out of the question. In fact, they're just the kind of thing we're trying to uncover at Iowa. Even though we don't make sensors, and we're not terribly knowledgeable in dive/flight medicine, we have the engineering capabilities to tie these things together in a usable system.

So how might a PEEP valve help? It would prevent lung collapse at the alveolar level, right? I don't think it would be a problem to create a PEEP valve that was pressure-adjusted. It would just take a little money for development (primarily ruggedization for the clinical environment). I wonder if there's an application for that in normo-baric medicine.

 

[Yerba Mate]

So how might a PEEP valve help? It would prevent lung collapse at the alveolar level, right? I don't think it would be a problem to create a PEEP valve that was pressure-adjusted. It would just take a little money for development (primarily ruggedization for the clinical environment). I wonder if there's an application for that in normo-baric medicine.

We use PEEP all the time in the hospital, especially with ARDS, pulmonary edema, Congestive heart failure (CHF), etc. Most patients on a ventilator are given at least 5 cmH2O of PEEP, even if their lungs are relatively healthy, and they are ventilated for other reasons. It keeps the patient's alveoli recruited, redistributes lung water, and maintains the patient's FRC. I was kinda of joking about putting a depth compensating peep valve on everyone's reg...it might not be the safest thing. Because there would always be a positive pressure in the diver's lungs the risk of volutrauma or barotrauma may be increased slightly. Also, as one of the contraindications of PEEP is untreated pneumothroax, pneumomediastinum, etc. if a diver was to suffer from one of these conditions then their pneumo would only be made worse by the PEEP. Unless this immersion pulmonary edema was actually resulting in moderate or severe hypoxemia which required treatment, I would think the risks would outweigh the advantages. However, if the health effects were actually that severe then that person should probably not be diving.

I'm sure a pressure compensating PEEP valve could be made pretty easily, I don't know if there would be a lot of demand for one in the acute care setting as atmospheric pressure doesn't change that much. I suppose it could be of use in the Air Ambulance or in the hyperbaric unit, however I don't really have any experience in those areas so I wouldn't be able to comment on that. I would think that there would be something already in place in those applications.