DCS Fact Sheet for the Emergency Room

[Akimbo]

Here is a recent thread discussing the dismal availability of chambers in the US to treat DCS:

http://www.scubaboard.com/forums/de...reatment-chamber-panama-city.html#post7228267

It’s not that there aren’t many chambers; it is just that not many accept DCS patients. It is sad. Anybody with a chamber would take a diver in need in the early days of sport diving, including military and commercial diving operations. It has actually gotten worse for divers since hospitals started using hyperbaric oxygen to treat non-diving patients.

 

[Hickdive]

There are useful downloads here that could be tweaked slightly for outside the UK;

Diving emergencies

Here is a brief piece on entonox use in divers with references;

Entonox

 

[knotical]

Fascinating. Thank you.

Trying to understand the mechanism, and while looking for the references in the article by scuba-doc you cited, I found:

Nitrous oxide is inappropriate for pain relief or as a component of a general anaesthetic for a coincidental procedure because it can cause an increase in the size of bubbles by inward diffusion.

( at: http://www.inti.gl/docs/DTN/Vann. Lancet .pdf )


If inward diffusion is the case, then it would seem the protocol using helium mentioned by dreamdive in post #20 would also be contra-indicated.

 

[dreamdive]

Fascinating. Thank you.

Trying to understand the mechanism, and while looking for the references in the article by scuba-doc you cited, I found:

( at: http://www.inti.gl/docs/DTN/Vann. Lancet .pdf )


If inward diffusion is the case, then it would seem the protocol using helium mentioned by dreamdive in post #20 would also be contra-indicated.

No,

The reason for the "inward diffusion" is due to nitrous oxide being about 35 times more soluble than nitrogen in blood. Thus it tends to diffuse into air-containing cavities more rapidly than nitrogen is absorbed by the bloodstream. i.e. if a patient with a 100 cc pneumothorax inhales 50% nitrous oxide, the gas content of the pneumo will tend to approach that of the bloodstream. Since Nitr. ox. will diffuse into the cavity more rapidly than the air diffusing out, the pneumo expands until it contain 100 cc of air and 100 cc of nitr. ox. If the walls of the cavity are rigid, pressure rises instead of volume.

VS:
Sayers, Yam, and Hildebrand (1925), assumingthe helium solu-bility coefhcient for blood to be the same as for water, suggestedthat breathing oxygen-helium mixtures would be effective in thetreatment of compressedair illness. They stated that, becausethesolubility of helium is less than that of nitrogen, and that itdiffuses more rapidly, the elimination of inert gasesfrom bloodand tissues would be more rapid if helium was substituted forthe nitrogen in ordinary air.

Hope that clarifies

Claudia

 

[h20_kat]

I am not in the slightest surprised by your friend's story. You definitely need to be your own advocate and get DAN on the phone to help. I suffered a hit in Fiji about a year ago.

I actually had to fight to get past the reception and into the ER in the first place! I had to battle to get oxygen when I arrived in the ER. I ended up having to show the nurse a text I had received from DAN with instructions about being put on oxygen and the best flow rate for the nasal prong (that's all they had for oxygen). I arrived too late in the evening - the chamber doc (not a dive doctor) had gone home - to get in the chamber. I had to battle with the ER doctor to give me a bed overnight as she wanted to send me away! She didn't believe me when I said I was sure I had DCI. When I got upstairs to the bed there was no oxygen! I had to ask to be moved to somewhere that they could provide oxygen. (Sadly that location came complete with a view of people's rotting limbs.) When I finally saw the chamber doctor (about 10 hours after I arrived!) the next day I completely lacked confidence in the treatment I was getting so got DAN on the phone to speak to the doctor. DAN recommended a table 6 treatment as I had moderate neurological DCI. The chamber doctor only planned to give me a 90 minute 14 metre treatment. Then there was a big fuss because nobody was available to operate the chamber for 5 hours so they nearly didn't treat me! It was only due to my insistence and DAN's support that I finally got in the chamber that day.

 

[dreamdive]

I am not in the slightest surprised by your friend's story. You definitely need to be your own advocate and get DAN on the phone to help. I suffered a hit in Fiji about a year ago.

I actually had to fight to get past the reception and into the ER in the first place! I had to battle to get oxygen when I arrived in the ER. I ended up having to show the nurse a text I had received from DAN with instructions about being put on oxygen and the best flow rate for the nasal prong (that's all they had for oxygen). I arrived too late in the evening - the chamber doc (not a dive doctor) had gone home - to get in the chamber. I had to battle with the ER doctor to give me a bed overnight as she wanted to send me away! She didn't believe me when I said I was sure I had DCI. When I got upstairs to the bed there was no oxygen! I had to ask to be moved to somewhere that they could provide oxygen. (Sadly that location came complete with a view of people's rotting limbs.) When I finally saw the chamber doctor (about 10 hours after I arrived!) the next day I completely lacked confidence in the treatment I was getting so got DAN on the phone to speak to the doctor. DAN recommended a table 6 treatment as I had moderate neurological DCI. The chamber doctor only planned to give me a 90 minute 14 metre treatment. Then there was a big fuss because nobody was available to operate the chamber for 5 hours so they nearly didn't treat me! It was only due to my insistence and DAN's support that I finally got in the chamber that day.

Wow, that sounds horrible. Hope you had complete recovery!

 

[h20_kat]

Wow, that sounds horrible. Hope you had complete recovery!

I did. But it took 6 months! (I had 4 more treatments after the first one.) I had delays getting to the hospital as well. The whole thing was a nightmare from beginning to end. It was beyond horrible. Thankfully I am recovered and back to diving. Cautiously and conservatively.