Diver shares experiences with ambulance and hospitals

[Duke Dive Medicine]

While a PFO is the most common type of major shunt, they can also occur in other parts of the circulatory system and allow bubbles to pass through. Perhaps @Duke Dive Medicine could comment here?

Thanks for the add @Nick_Radov .

First, I'll go out on a limb given that I write under the auspices of an organization and say that if a dive operator allows their staff to use life support equipment to compensate for their inability to limit their alcohol intake (not to mention letting that same staff guide recreational divers afterward), they should be publicly outed and then avoided at all costs until they can demonstrate a permanent change in their safety culture. It's a clear demonstration of a poor safety mindset at a leadership level, and I would wonder what else they're letting slide.

That said, this probably didn't have any influence on the event. Given the dive profiles and similar sudden-onset neurological symptoms after both dives, a PFO test would likely be indicated. Nick, to your question, the PFO test would also pick up shunting elsewhere in the body. If the diver has a transpulmonary shunt for example, the bubbles would still reach the right heart and be visualized on ultrasound, it would just take a few seconds. A transthoracic echocardiogram with bubble contrast will detect a clinically significant shunt, but if the diver has had one of those already, a cardiologist might consider a transesophageal echo, also with contrast, since the resolution is a bit higher.

Also to the diver who posted the story (for whoever has comms with her - @Zane , @DandyDon? ): the pain while still in the water on ascent is extremely concerning if it's related to DCS. That is a rare manifestation that indicates significant decompression stress. I would strongly recommend that you not dive until this is sorted out by a physician who is trained, credentialed, and experienced in examining divers. Just to be thorough, in addition I'd recommend seeing a neurologist and getting imaging of the spine, probably with contrast to visualize the circulation. There could be something going on there that's mimicking DCS. If you're US-based, I'm happy to provide guidance to the nearest diving medical examiner via DM if desired.

Best regards,
DDM

 

[DanBMW]

From the rummer seat, (no medical background) I've always though/heard that if you ever get bent, there is a strong likelihood that it will happen again and diving afterwards needs to be as conservative as possible. I have nothing to back up the claim.

 

[Zane]

Thanks for the add @Nick_Radov .

First, I'll go out on a limb given that I write under the auspices of an organization and say that if a dive operator allows their staff to use life support equipment to compensate for their inability to limit their alcohol intake (not to mention letting that same staff guide recreational divers afterward), they should be publicly outed and then avoided at all costs until they can demonstrate a permanent change in their safety culture. It's a clear demonstration of a poor safety mindset at a leadership level, and I would wonder what else they're letting slide.

That said, this probably didn't have any influence on the event. Given the dive profiles and similar sudden-onset neurological symptoms after both dives, a PFO test would likely be indicated. Nick, to your question, the PFO test would also pick up shunting elsewhere in the body. If the diver has a transpulmonary shunt for example, the bubbles would still reach the right heart and be visualized on ultrasound, it would just take a few seconds. A transthoracic echocardiogram with bubble contrast will detect a clinically significant shunt, but if the diver has had one of those already, a cardiologist might consider a transesophageal echo, also with contrast, since the resolution is a bit higher.

Also to the diver who posted the story (for whoever has comms with her - @Zane , @DandyDon? ): the pain while still in the water on ascent is extremely concerning if it's related to DCS. That is a rare manifestation that indicates significant decompression stress. I would strongly recommend that you not dive until this is sorted out by a physician who is trained, credentialed, and experienced in examining divers. Just to be thorough, in addition I'd recommend seeing a neurologist and getting imaging of the spine, probably with contrast to visualize the circulation. There could be something going on there that's mimicking DCS. If you're US-based, I'm happy to provide guidance to the nearest diving medical examiner via DM if desired.

Best regards,
DDM

I've just sent her the link to your post here

 

[Nick_Radov]

First, I'll go out on a limb given that I write under the auspices of an organization and say that if a dive operator allows their staff to use life support equipment to compensate for their inability to limit their alcohol intake (not to mention letting that same staff guide recreational divers afterward), they should be publicly outed and then avoided at all costs until they can demonstrate a permanent change in their safety culture. It's a clear demonstration of a poor safety mindset at a leadership level, and I would wonder what else they're letting slide.

Besides the obvious safety issues with misusing emergency equipment, is there even any reliable evidence that breathing pure oxygen on the surface helps with hangover recovery? Or is that just an urban myth or maybe placebo effect? I have a hard time seeing how it would help from a physiological standpoint. The vasoconstriction and increased free radicals might even make symptoms worse.

 

[Duke Dive Medicine]

Besides the obvious safety issues with misusing emergency equipment, is there even any reliable evidence that breathing pure oxygen on the surface helps with hangover recovery? Or is that just an urban myth or maybe placebo effect? I have a hard time seeing how it would help from a physiological standpoint. The vasoconstriction and increased free radicals might even make symptoms worse.

No real clinical evidence that I'm aware of, but I seem to recall from my distant past that there could be some anecdotal evidence among military divers, likely a placebo as you noted.

Best regards,
DDM

 

[Zane]

I've just sent her the link to your post here

Here's her response to this thread:

All good info, and I truly appreciate you forwarding me this.
I've been advised not to scuba ever again by the dive Dr in Cozumel. He says it's way too risky with whatever my body has decided to do of late.
And I'm contacting a cardiologist in my insurance network to do a transesophageal echo, as the Dr on scubaboard suggested.
I've also reached out to my Neurologist and she's aware, but I'm not sure what the plan of action is as she is just hearing about it now.
Sadly, the oxygen misuse is common here on Cozumel. I don't recall the boat's name or I would gladly out them. I booked through a third party who is no longer in business.
I had checked for the O2 tanks, and there were 2 kits. I failed to foresee that they would both be empty by the time I or anyone else needed them.
Feel free to share as you see fit. My greatest hope is that no one ever needs to know any of this, but knowledge is always a good thing!

 

[NovaCane]

Thanks for the update. I'm glad she's consulted MDs to look into it further.