Bent!

[WSOPFAN]

Tobin,

Thanks for the info......here's to getting wet again ASAP........

 

[Kevrumbo]

Kev,

I hear what you're saying, and perhaps if the diver had been in the immediate vicinity of the Isthmus (e.g. diving off of Ship Rock) it may have been appropriate to take him there first for evaluation. Tobin wrote a great summary, but don't forget that you're seeing the entire evolution of his incident in a few paragraphs. His initial presentation was chest tightness, dyspnea and dizziness. A number of non-diving-related medical emergencies can also present this way; acute myocardial infarction, congestive heart failure with flash pulmonary edema, and pulmonary embolus come immediately to mind. His decompression appeared to have been reasonable when I ran it through V-Planner and DecoPlanner, which lowers DCS in the differential. *Edited based on below info about surface interval*

I'm not sure what your level of medical qualification is, but assume now that you're a medic who takes the call from Tobin's buddy on Ch 16. What you hear on the radio is something like "53 year old male with a history of mild hypertension treated with medication, has been exercising over the past year but was previously sedentary, experienced technical diver, appropriate decompression and ascent with no problems on the dive, now presents with chest tightness, difficulty breathing and dizziness."

Do you see where the waters get muddy here? This is not a clear-cut case of DCS. If it HAD been an MI (which the receiving hospital took great pains to rule out), transport to the Catalina chamber would have been the wrong choice. Yes, they can shock him if he goes into cardiac arrest, but I'm sure they would rather have had him treated appropriately in a hospital with a good heart center.



You don't need consultation or pre-approval from DAN for any treatment for a diving injury. This isn't unique to LA County. DAN may perform a utilization review if they think a diver is being treated to excess, but they don't need to approve initial treatment.

The Emergency Room for the West End of Catalina IS the USC Hyperbaric Chamber enclosure compound, an extension of the mainland LA County General/USC Medical Center Emergency Department; if a boater at Two Harbors or a hiker on the Isthmus were exhibiting signs of MI, that would be where the Sheriff or Baywatch Paramedic would take the victim for stabilization and chopper transport back to the mainland for more specialized & definitive intensive care. Similarly, if a diver were presenting with the same symptoms, the USC Hyperbaric Chamber would be the best place to go to be evaluated (Rule Out AGE/DCS vs MI) --and in Tobin's case, I myself as a First Responder (with better local knowledge of acute health care options for diving accidents here in Southern California as a trained former member of the Volunteer USC Chamber Crew on Catalina --my medical qualification also comes from being a former DCS type I patient as well) -- I would rather have an experienced LA County Emergency Physician on call & enroute who is also an attending specialist in Hyperbaric Medicine make that tough differential diagnosis above along with the appropriate treatment decision at a facility that can intitially treat and stabilize both acute conditions expeditiously & competently, and then medevac chopper back to a mainland medical center as needed.

The mistake here was electing to return to the mainland port instead of immediate medical evacuation to the Catalina Chamber (again, they were in sight of the Isthmus of Catalina --a convenient rendezvous pick up for either Baywatch Boat or faster Coast Guard Helicopter): Time is the enemy for either acute conditions of MI, DCS and especially AGE --and a lot of it was wasted by motoring back to the mainland. I also believe that LA County's proven & experienced chain of care would have been one-third of the total time spent undergoing diagnostics & treatment at that "other medical facility". I'm thankful for Tobin's sake that the incident didn't turn out much worse than it could have. . .

. . .In the Southern California area around Catalina Island, the combination of effective on-site management of a diving accident along with the rapid response by Los Angeles County Baywatch Lifeguards, or the U.S. Coast Guard, and swift, effective treatment at the Chamber can save a diver's life. . .

Catalina Chamber 24 Hour Emergency Line
310-510-1053
LA County Medical Alert Center (MAC)
866-940-4401
U.S. Coast Guard Sector LA/Long Beach Search & Rescue
310-521-3815
Marine Channel 16
Divers Alert Network (DAN) Emergency Line
919-684-9111

USC Catalina Hyperbaric Chamber

 

[Duke Dive Medicine]

The mistake here was electing to return to the mainland port instead of immediate medical evacuation to the Catalina Chamber (again, they were in sight of the Isthmus of Catalina --a convenient rendezvous pick up for either Baywatch Boat or faster Coast Guard Helicopter): Time is the enemy for either acute conditions of MI, DCS and especially AGE --and a lot of it was wasted by motoring back to the mainland. I also believe that LA County's proven & experienced chain of care would have been one-third of the total time spent undergoing diagnostics & treatment at that "other medical facility". I'm thankful for Tobin's sake that the incident didn't turn out much worse than it could have. . .

LA County Lifeguards were involved with Tobin's care from the beginning. Wouldn't you imagine that transport to the Catalina chamber was considered? Relevant parts of his initial post below:

Huge thanks to La County Life Guards, La County Sheriffs, Ambulance Crews, ER staffers, HBM Doctors and staff....

...My teammates helped me to a berth in the boat cabin, and I stayed on O2. The chest tightness and coughing subsided over about 15-20 minutes, but I remained dizzy if I was not lying down. Knee hurts too. Decision is made to contact emergency responders / chamber. Boat ride back to port requires ~50 minutes from this point...

We were met at the berth by the local Los Angeles County Life Guards from Marina Del Rey Harbor....
Tobin

Maybe Tobin can shed some light on this if he's not too miffed at us for hijacking his thread

 

[The Chairman]

The mistake here

There was no mistake made according to Tobin. He got the treatment he needed and is expecting to make a total recovery. However, the next time someone gets bent, we'll have them run all their decisions through you first.

 

[VooDooGasMan]

when i went to the hyperbaric convention on catalina, my doc is a great diving doc and I asked him what he thought about the lecture karl gave and he said the man knows his stuff. The next day we all went for a dive and then stop by the chamber for a tour, and seen karls formula he came up with for treatments and how it works.

As far as calling dan or any one else, my best advice and you can not get better than this, is call your doc and make sure he is a diving doc of a few decades. Dr Edmond Kay is the type of doc I just call his cell and he will get back to me, I tell him exactly what happen, the dive profile, and how I am feeling. That to me is the first and best evaluation. I also have great respect for him on his confidence, I would go in on something and he would find something not related, which indeed helped cure what I went in for.


I am very fortunate to have the best diving doc in the world as far as I am concerned to be my doctor.

 

[cool_hardware52]

LA County Lifeguards were involved with Tobin's care from the beginning. Wouldn't you imagine that transport to the Catalina chamber was considered? Relevant parts of his initial post below:



Maybe Tobin can shed some light on this if he's not too miffed at us for hijacking his thread

Transport from the UCLA ER to either Long Beach or a flight out to Catalina were both under consideration. It was determined that the UCLA chamber could be used, that the necessary personal were available. I would estimate this was done ~2 - 3 hours after my arrival at the ER. It would be ideal every chamber was standing ready 24/7 for divers, but that's just not reality.

I of course did not participate in these discussions. I do however believe that the possible MI and apparent Type 2 / Stroke symptoms made Long Beach (mono place chamber) less attractive, and the idea of transport to Catalina problematic too.

There was sufficient concern about my condition by the chamber staff that I had two technicians with me for the first TT6. I overheard the lead tech decide to "add a second", I assume after seeing me suffer what was first thought to be a seizure.

If you have suffered a heart attack or stroke in So California there are few places better to be than UCLA.

Tobin

 

[beaverdivers]

Though it seems intuitive, it's pretty hard to pin down dehydration as an immediate cause of DCS (big discussion here: http://www.scubaboard.com/forums/diving-medicine/410931-dehydration-really-bad-6.html) You hit it on the head in saying that DCS can certainly aggravate dehydration, though, and it sounds like they caught it just in time if you're saying your kidney function was affected.

1st - Glad to hear a positive outcome.

2nd - thanks for sharing. This DCS incident is a very interesting case study. One of our divers has recently been put on a diuretic. Should they dive more conservatively?

 

[Duke Dive Medicine]

1st - Glad to hear a positive outcome.

2nd - thanks for sharing. This DCS incident is a very interesting case study. One of our divers has recently been put on a diuretic. Should they dive more conservatively?

Hi beaverdivers,
That depends more on the condition that the diuretic is being used to treat. Sorry to be so general, but without more info this is a difficult question to answer.
Best,
DDM

 

[Kevrumbo]

There was no mistake made according to Tobin. He got the treatment he needed and is expecting to make a total recovery. However, the next time someone gets bent, we'll have them run all their decisions through you first.

No Pete . . . (and you Cameron Crazies over at Duke). . .

By analogy: If you have a friend or family member at home experiencing symptoms of chest pain and difficulty breathing, you don't call a Cardiac Medical Department and say that you're coming and then pile into your car and drive over there. . . (this is the mistake and what Tobin and his boat crew essentially did).

The best course of action is to dial 911, wait for Emergency Paramedics to arrive, start initial treatment and stabilization for immediate transport to the nearest hospital Emergency Dept.

Doesn't this make better sense???

 

[cool_hardware52]

No Pete . . . (and you Cameron Crazies over at Duke). . .

By analogy: If you have a friend or family member at home experiencing symptoms of chest pain and difficulty breathing, you don't call a Cardiac Medical Department and say that you're coming and then pile into your car and drive over there. . . (and this is what Tobin and his boat crew essentially did).

The best course of action is to dial 911, wait for Emergency Paramedics to arrive, start initial treatment and stabilization for immediate transport to the nearest hospital Emergency Dept.

Doesn't this make sense???

Kevin,

I've asked you on another forum to please give it a rest. Now I'm asking here.

If you want to start a "Kevrumbo's Best DCS Response Protocol" thread have at, but please leave my thread alone.


Tobin