Close Call; Glad I could write this incident report.

[raftingtigger]

Breathing often does not improve upon ascent. The person's lungs are filling with liquid and less and less oxygen is getting to the brain. Sometimes it resolves on the surface but sometimes it does not. The protocol is to administer O2 right away (even if symptoms diminish), possibly with a CPAP, and then seek medical attention.

My thoughts based on this information for shore diving is (pretty much the only thing I do):

If Solo diving: Get as buoyant as possible, not just buoyant enough. Get on your back, so if you lose consciousness there is a chance of air. Reduce your workload to the minimum while still signaling to shore. If there is no reasonable possibility of anyone seeing you then the tank and BCD (I'm a cold water diver so my exposure suit provides flotation) need to go. This will reduce the work of SLOWLY swimming in. Lastly PRAY, the chance of survival is not good.

If Buddy diving: Buddy should signal for help, then strip all your and their non-essential gear (weights, tank/BCD (if exposure protection provides enough buoyancy), signal again, and then swim in as rapidly as possible. Depending on the length of the swim it may not be fast enough. This is a place where a few in-water rescue breaths might help (positive pressure). Once on shore some more rescue breaths might help (even if the victim is breathing only weakly). CAUTION: the idea of rescue breaths in a weakly breathing victim is NOT one I have seen in any medical literature. It is an idea that comes to mind with an understanding of the underlying physiology. I would love some of the MDs to comment.

In other words: React immediately, get very Buoyant, Signal, Reduce workload, and PRAY - your hands are now in a higher power.

 

[InTheDrink]

First, slight need to clear throat
Second, more clearing of throat, and more intense (stuff coming up)
Third, labored breathing; severe rattling in my chest; some wheezing.
Fourth, Very labored breathing; a feeling of suffocating which led to light-headedness; the next step would be passing out.

That's kind of interesting. I don't remember any throat clearing stuff from then on in pretty much exact same symptoms: wheezing, rattling then thinking going to pass out (which I did moments after hitting the surface). It might be ideal as a warning sign but the rattling started happened to me maybe 3 or 4 minutes before the thinking I'm going to pass out phase. It's not a lot of time, especially if a lot of deco has been accrued but for a recreational dive that 3 or 4 minutes could be quite valuable.

FWIW, that feeling of think I am going to pass out can be confused with anxiety. I get this on pretty much most of my first dives on a trip now. It's scary cos you think 'is it happening again' but for me at least so far it's not been, it's just anxiety and I just need to ride it out for 30 seconds and then get back in the groove.

For your first dive back might be worth considering a pool.

Secondly, I've devised a signal for catastrophic problem so ppl know serious issue as opposed to just fancy canning the dive.

Thirdly I brief what they need to do if it happens. When it happened to me I was either unconscious or could not speak. I desperately wanted to say 'ventilation' but no words came out. Best if ppl are prepped to know that's what you need plus continuous flow O2.

Finally, until you're comfortable just avoid working hard.

Oh, and get you BP and general heart condition checked out. I presume that's a given for you anyway.

And yes talk to Duke. He is a man in the know. Likewise Simon Mitchell in NZ and Carl Edmonds from Dan Asia altho they will likely give you more somber prognoses.

Best of luck,
John

P.s. I'll still post some of those links once I locate them and hopefully dont violate any copyright.

 

[Rkelleyj]

Glad you made it out alive, welcome to the exclusive club of narrow misses. Thanks for sharing your story, I appreciate it.

I want to say there's a VERY similar story here about medium to high dosage beta blockers and diving...end result was stay away from combining the two.

I called Dan on this topic last year, and their position was that very low dose was ok for a medication I was asking about.

FYI
I do not work for DAN, if you want to know about your situation/medication and their position, call and just ask.

 

[Duke Dive Medicine]

Would TSandM, Duke Dive Medicine, Debersole or any other medical practitioner be able to answer Skydiver1's question? Thanks!

We're using sildenafil as part of our study. ED drugs can lower the seizure threshhold so they don't combine well with diving, especially using hyperoxic mixes. They do not increase the risk of IPE, though, and Skydiver1's observation is correct. Sildenafil was originally developed to treat pulmonary hypertension.

 

[Martigan]

Question: was the water cold or warm? I am sorry but don't know where you are diving.

My question is because on an other forum, a woman had an IPE in cold water after many years diving. She did extensive "tests" controlled by a doctor, and cold water was clearly the issue. She had "starts" of IPE when exposed to cold water, not warm one.

She can dive again, but only in warm water (more than 24/25°C). Even with proper suit, the cold water have an effect through the face and hands.

It happened late in life, when she approached 60 years old. She is now diving with no issues, years after the IPE.

Is it not the only possible reason, but it might be an area to explore.

 

[InTheDrink]

Ok so here are a few of the links that were provided to me around the time of my incident. If I'm breaching any copyright and such please do let me know and I'll remove this post.

http://dspace.rubicon-foundation.or...handle/123456789/4032/15796313.pdf?sequence=1


http://archive.rubicon-foundation.org/xmlui/bitstream/handle/123456789/2388/9068153.pdf?sequence=1


http://www.michaelmcfadyenscuba.info/downloads/SDPE Fatalities DHM 2012.pdf

Best,
John

---------- Post added February 28th, 2013 at 01:07 AM ----------

and finally my report

Pulmonary Oedema incident [Archive] - ScubaBoard - Scuba Diving Forum - Diving Social Network

 

[clownfishsydney]

This is a report on a dive I organised where my wife's best friend died: Michael McFadyen's Scuba Diving Web Site.

Note that the current advice in Australia will be that you should never enter the water again, not just dive.

 

[Barracuda2]

Question: was the water cold or warm? I am sorry but don't know where you are diving.

My question is because on an other forum, a woman had an IPE in cold water after many years diving. She did extensive "tests" controlled by a doctor, and cold water was clearly the issue. She had "starts" of IPE when exposed to cold water, not warm one.

She can dive again, but only in warm water (more than 24/25°C). Even with proper suit, the cold water have an effect through the face and hands.

It happened late in life, when she approached 60 years old. She is now diving with no issues, years after the IPE.

Is it not the only possible reason, but it might be an area to explore.

I was drift diving off Jupiter, FL. The water temp was about 72 degrees, not what I consider cold by a long shot. I was wearing a 3 mm full with a 7 mm short legged jacket over it; plenty of protection.

 

[Rkelleyj]

Did I miss commentary about beta blockers being a very real possible contributing factor?

If I'm playing detective correctly...and I've been following IPE for a few years now...that is a med that seems to keep coming up in a few of the cases as a common denominator.

What do the medical experts say?

 

[Diver0001]

I asked my Dr. about beta blockers for a medical condition I had a few years ago (that's the reason I knew something about them ) and while she isn't a dive-medical expert she said to me, and I quote, "I would find scuba diving on beta blockers inadvisable". Upon asking follow up questions her opinion was based on beta blockers effectively lowering (damn, I can't think of the English word right now..) "inspanningstolerantie"... I guess literally translated it means "tolerance to endure exercise". It had to do with the limiting effect on how high the heart-rate can get. She described exactly what the OP said, which is that high levels of exercise, like jogging, can cause you to feel exhausted. Her opinion (and again, she doesn't have a dive-medical specialty) was that feeling exhausted on scuba probably wasn't a good idea.

She referred me to a dive medical specialist but I didn't go. I had already decided to take her advice so I refused the beta blockers and put a fair amount of effort into solving my issue with life-style changes instead. It still resulted in several months of being dry but for the time being I'm still here and I'm still diving (and teaching)

As an instructor in Holland I've also been told (would need confirmation) that using beta blockers would be a reason for a dive-medical doctor to ....ach.... (damn, the Gods of the English language have abandoned me today...) to..... meh... "refuse approval" for you to dive in a teaching capacity.

I hope at least part of that made sense.

The crux of it is that at least where I live, medical experts seem to see a risk involved in using beta-blockers and diving.

R..