Congestion Problems

[CamG]

Greetings all from Indiana. Just like to post a question for other divers and any medical personel viewing. Last week end we were training with friends of mine and had a issue witha 44 year old male. He was at depth 120' had a free-flow which was no big deal. The print out of his profile was very good. The issue that developed was that congestion broke loose in his chest and made breathing short and difficult. He was put on 02 upon reaching the dock. He was then transoported to a Hyperbaric chamber and after 2 1/2 hours of observation, put in the chamber for 2 1/2 hours. When they took him down to 115' and brough him back, at 50-55 feet the congestion diminished. He is seemingly totally fine but concerned about what exactly happened. If anyone would like all the information profile etc. please PM me. I am a little concerned myself because he had no issues pre-dive nor any idea that he was congested. I am wondering if age and condition figured into the mix. Any one have this issue before?
Thank you for any and all advice on this issue. I have been very impressed with SB members and would appreciate your sensitivity on this issue. CamG Keep diving....keep training....keep learning!

 

[TSandM]

Wow . . . This one is interesting. To summarize, we have a patient who was not ill (not suffering from a cold or cough or other respiratory symptoms) who dove to 120 feet, experienced a freeflow and ascended, and developed shortness of breath on ascent -- Is that more or less right? And the shortness of breath improved with either time or recompression therapy.

I think we can assume that he did not have a pneumothorax, because that would have been diagnosed at the hospital. But I wonder if he had some other pulmonary barotrauma, like pneumomediastinum. Did he complain of any chest pain?

Another possibility would be "chokes", or pulmonary DCS. Did he cough up any frothy fluid on the surface? You did say that his ascent was okay, and chokes are a manifestation of a fairly severe case of DCS, so it seems unlikely that this was it.

Another possibility would be immersion pulmonary edema, but that usually occurs with brief exposure to relatively shallow depths, and would not improve with recompression (but would with time).

What did the doctors who treated him think was going on?

 

[CamG]

Thank you for your response TSandM. I actually thought of PM'ing you, I was anticipating your thoughts. Unfortunately I don't have the attending doctors findings. I am currently waiting for the report. I however have the profile print out and the benefit of being on the dive with him. It is a little concerning to not know you have an issue "congestion" and discover it at depth. I have been encouraging him to get this really checked out! I have wondered about the effects of age and physical condition, my friend is 5'9 and about 240 lbs. He has routine physicals every two years having a CDL, tries to eat right, does not smoke, has never had this issue before. The water temps were 39-41, he was diving wet so the dives were to the point and focused, then would start our ascent. I will try to get further information and post. If it is sensitive information I might PM you instead of posting. I am concerned for my buddy as he is the one who got me into diving. What I know is that seemingly little issues at depth can have fatal circumstances! It has changed my diving practices personally and as a DMC. You cannot ask enough questions and be more prepared for the worst, train for and expect the unexpected. This was a unfortunate incident with a happy ending, I will do everything in my power to prevent any further issues. Thank you again TSandM I hope to have more information soon. CamG Keep diving....keep training....keep learning!

 

[headsqueeze]

I read this a few days ago and have been thinking and reading about it. It's not clear to me when the congestion developed - @ 120' or after ascent?

The cause of acute pulmonary edema at depth is controversial - medication or a preexisting heart condition are thought to be the most likely causes. But your buddy has 2 important factors to consider- obesity and freeflow. The obesity is a reflection of fitness and the increased presence of other disease. Would he have suffered the same without the freeflow? If not obese? If not either?

I hope he is doing better.