Advice on possible DCI hit

[Diveyonder700]

Hello, new to the forum. 35 year old commercial diver 2000+ dives over past 14 years. Looking for some diving medical advice from any diving doctors that may read this.

Last week had my first ‘incident’ shall we say while diving. I was dragged up from 13m to the surface in a very short period of time. 10-15 seconds tops.

I exhaled while ascending however I did take in a breath halfway up which was exhaled quickly.

Having got back on the boat I felt ok bar a couple of dizzy spells. Sat on Oxygen for 20 minutes, twice. No more diving.

Later that afternoon/evening noticed a dull ache sort of pain (very minor) in my right upper chest radiating to my shoulder, and sometimes upper back.

Next day pain is there but intermittent.

The following day the pain (minor) is there again, with a couple spells of lightheadedness. At this point I start to be concerned that this could be some form of DCI or Lung Barotrauma and present to hospital for checks.

Chest X-ray I’m told by Doctor is clear in addition to blood tests and ECG.

Doctor said it’s unlikely this pain is diving or DCI related, 13m for 45 minutes first dive of the day, a bend is indeed unlikely.

Now 6 days later the pain is still there, no better or worse. But intermittent.

Could coincidently just be muscular? Or could be a minor lingering DCI/ lung barotrauma hit?

Need to return to diving soon. Any advice on this much appreciated.

 

[Duke Dive Medicine]

Hello, new to the forum. 35 year old commercial diver 2000+ dives over past 14 years. Looking for some diving medical advice from any diving doctors that may read this.

Last week had my first ‘incident’ shall we say while diving. I was dragged up from 13m to the surface in a very short period of time. 10-15 seconds tops.

I exhaled while ascending however I did take in a breath halfway up which was exhaled quickly.

Having got back on the boat I felt ok bar a couple of dizzy spells. Sat on Oxygen for 20 minutes, twice. No more diving.

Later that afternoon/evening noticed a dull ache sort of pain (very minor) in my right upper chest radiating to my shoulder, and sometimes upper back.

Next day pain is there but intermittent.

The following day the pain (minor) is there again, with a couple spells of lightheadedness. At this point I start to be concerned that this could be some form of DCI or Lung Barotrauma and present to hospital for checks.

Chest X-ray I’m told by Doctor is clear in addition to blood tests and ECG.

Doctor said it’s unlikely this pain is diving or DCI related, 13m for 45 minutes first dive of the day, a bend is indeed unlikely.

Now 6 days later the pain is still there, no better or worse. But intermittent.

Could coincidently just be muscular? Or could be a minor lingering DCI/ lung barotrauma hit?

Need to return to diving soon. Any advice on this much appreciated.

Hi, sorry to hear that this happened. Bends is unlikely at this depth and bottom time but not unheard of. What was your dive profile like? Square? Lots of up and down in the water column? What work were you doing?

How exactly were you dragged up? I'm assuming you were diving surface supplied. What rig were you diving, and how and where was your umbilical attached to your harness/bailout? Was there any excess strain on your umbilical that could have been transferred to your torso?

Being a commercial diver you are probably already aware of this but in case not, here is a list of UKDMC diving medical referees.

Best regards,
DDM

 

[Edward3c]

Hello, new to the forum. 35 year old commercial diver 2000+ dives over past 14 years. Looking for some diving medical advice from any diving doctors that may read this.

Last week had my first ‘incident’ shall we say while diving. I was dragged up from 13m to the surface in a very short period of time. 10-15 seconds tops.

I exhaled while ascending however I did take in a breath halfway up which was exhaled quickly.

Having got back on the boat I felt ok bar a couple of dizzy spells. Sat on Oxygen for 20 minutes, twice. No more diving.

Later that afternoon/evening noticed a dull ache sort of pain (very minor) in my right upper chest radiating to my shoulder, and sometimes upper back.

Next day pain is there but intermittent.

The following day the pain (minor) is there again, with a couple spells of lightheadedness. At this point I start to be concerned that this could be some form of DCI or Lung Barotrauma and present to hospital for checks.

Chest X-ray I’m told by Doctor is clear in addition to blood tests and ECG.

Doctor said it’s unlikely this pain is diving or DCI related, 13m for 45 minutes first dive of the day, a bend is indeed unlikely.

Now 6 days later the pain is still there, no better or worse. But intermittent.

Could coincidently just be muscular? Or could be a minor lingering DCI/ lung barotrauma hit?

Need to return to diving soon. Any advice on this much appreciated.

Was this diving in the U.K., if so your employer should have put you through a full DCI assessment. If you’ve need off work because of the incident for 7 calendar days a RIDDOR report should be submitted to the HSE.

But yes, speak to a diving doctor, preferably a HSE approved one.

 

[Diveyonder700]

Thanks for both replies, firstly, I was not diving at work when this happened so doesn’t involve DWR. Simply diving recreationally.

@Dukedivemedicine
Dive profile was relatively square give or take 1m depth from the 13m, not a yo-yo dive as some may call it. As mentioned was fun diving, looking for lobsters etc under boulders. Nothing strenuous.
Equipment consist of Scuba 15L cylinder on air, 3L pony and BCD. At end of dive I inflated my DSMB, which somehow became entangled with my drysuit inflation hose and with the time it took to try to untangle/cut this I was already at 4M and flying up rapidly. There was no point in fighting it at this stage.
It is a reminder to me no matter how experienced you think you are things can go south very very quickly…
The main question I have in this scenario is whether you think, given the mild intermittent pain symptoms in their location, it’s possible to have minor lung barotrauma from this. Another doctor thought it unlikely, however it’s good to get a 2nd opinion.

Many thanks

 

[Edward3c]

I had a similar situation from 20m.

Do you dive with a computer, if so did it lockout. Mine wasn’t happy, but didn’t lockout. I drank O2 until the cylinder was done. In my case no after effects. Speak to a UKDSC doctor, or ring the DCI helpline. Have a read of my blog on the BSAC website about DCI denial.

 

[Diveyonder700]

I had a similar situation from 20m.

Do you dive with a computer, if so did it lockout. Mine wasn’t happy, but didn’t lockout. I drank O2 until the cylinder was done. In my case no after effects. Speak to a UKDSC doctor, or ring the DCI helpline. Have a read of my blog on the BSAC website.

Yes, I use an Oceanic Geo 3. It made a lot of noise but strangely it didn’t lock out. Unlike the old grey Aladdin’s that bend in a heartbeat.

20m is a lot more serious to rapidly ascend from, glad you were alright after.

I’ll check out the blog.

Cheers

 

[Duke Dive Medicine]

Thanks for both replies, firstly, I was not diving at work when this happened so doesn’t involve DWR. Simply diving recreationally.

@Dukedivemedicine
Dive profile was relatively square give or take 1m depth from the 13m, not a yo-yo dive as some may call it. As mentioned was fun diving, looking for lobsters etc under boulders. Nothing strenuous.
Equipment consist of Scuba 15L cylinder on air, 3L pony and BCD. At end of dive I inflated my DSMB, which somehow became entangled with my drysuit inflation hose and with the time it took to try to untangle/cut this I was already at 4M and flying up rapidly. There was no point in fighting it at this stage.
It is a reminder to me no matter how experienced you think you are things can go south very very quickly…
The main question I have in this scenario is whether you think, given the mild intermittent pain symptoms in their location, it’s possible to have minor lung barotrauma from this. Another doctor thought it unlikely, however it’s good to get a 2nd opinion.

Many thanks

Ha, thanks, so much for assumptions! That's not what I'd pictured at all.

You didn't report any neurological symptoms so based on that, AGE can probably be ruled out. Other manifestations of pulmonary barotrauma are pneumothorax (air between the lung and chest wall) and pneumomediastinum (air in the center of the chest), both of which are detectable on x-ray. It's possible that a small amount of air could be missed depending on the experience of the reading radiologist. Subcutaneous emphysema (air beneath the skin) is another manifestation - your skin would feel like bubble wrap and you'd hear crackling sounds when pressing on the area where the air was. It's usually in the upper body/shoulder/neck area.

It seems like you're still concerned, so the best course of action for you IMO would be to go get evaluated in person by one of the medical referees in the link I posted.

Best regards,
DDM

 

[Diveyonder700]

Ha, thanks, so much for assumptions! That's not what I'd pictured at all.

You didn't report any neurological symptoms so based on that, AGE can probably be ruled out. Other manifestations of pulmonary barotrauma are pneumothorax (air between the lung and chest wall) and pneumomediastinum (air in the center of the chest), both of which are detectable on x-ray. It's possible that a small amount of air could be missed depending on the experience of the reading radiologist. Subcutaneous emphysema (air beneath the skin) is another manifestation - your skin would feel like bubble wrap and you'd hear crackling sounds when pressing on the area where the air was. It's usually in the upper body/shoulder/neck area.

It seems like you're still concerned, so the best course of action for you IMO would be to go get evaluated in person by one of the medical referees in the link I posted.

Best regards,
DDM

DDM, many thanks for responding and the advice you have given me.
It does seem unlikely I have any of the above manifestations.
The pain in my shoulder now seems to be dissipating slightly, since this morning. If it lingers on I will do as you suggest and contact one the Doctors on the list.

Kind regards

 

[boulderjohn]

I exhaled while ascending however I did take in a breath halfway up which was exhaled quickly.

There is no problem with inhaling while ascending. People do it on every normal ascent.

The concern is that it contradicts with the notion that in a rapid ascent, we need to exhale all the way up to avoid a lung overexpansion injury. That is indeed good practice in an emergency, but, again, we inhale and exhale during normal ascents.

That's because of the mechanism of inhaling. When we inhale, the lungs expand, and air is drawn into the passageways. If the lungs are already filled so that air must escape to avoid a lung overexpansion injury, then you cannot inhale. If you open your airway with fully expanded lungs, then air will come gushing out. If you are able to inhale during an ascent, then it is safe to do so.

 

[kinoons]

Ha, thanks, so much for assumptions! That's not what I'd pictured at all.

You didn't report any neurological symptoms so based on that, AGE can probably be ruled out. Other manifestations of pulmonary barotrauma are pneumothorax (air between the lung and chest wall) and pneumomediastinum (air in the center of the chest), both of which are detectable on x-ray. It's possible that a small amount of air could be missed depending on the experience of the reading radiologist. Subcutaneous emphysema (air beneath the skin) is another manifestation - your skin would feel like bubble wrap and you'd hear crackling sounds when pressing on the area where the air was. It's usually in the upper body/shoulder/neck area.

It seems like you're still concerned, so the best course of action for you IMO would be to go get evaluated in person by one of the medical referees in the link I posted.

Best regards,
DDM

Sensitivity for a cxr catching a pneumothorax, especially a small one, isn’t that good at all.

“The pooled sensitivity of CXR was 45.65% (36.04%-55.26%), and pooled specificity was 99.62% (99.00%-100%).”

https://journals.sagepub.com/doi/abs/10.1177/0885066620987813?journalCode=jica#:~:text=Numerous%20studies%20and%20meta%2Danalyses,62%25)%20in%20identifying%20pneumothoraces.

In the ER if I’m truly concerned for a pneumothorax bedside ultrasound or a CT scan is our go to. Yes we will often get the cxr because they’re quick, easy, and cheap, but if I truly concerned for a small pnuemo I won’t hang my diagnosis (or lack there of) on a 2V CXR.