Navigator1242
Registered
I have lurked this board for a while and registered to make this post. This was posted in Finnish to a public local diving community website by a diver who was involved in a very serious accident. It is a unique view into an accident that you normally will not survive. I have translated the text to the best of my ability and added brackets to clarify a few terms. There are some translation errors due to the original text being partly in informal language and has detailed medical terminology I'm not familiar with. I hope you enjoy reading this story even if it is chilling and very long.
Original text in finnish
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Greetings everyone. I was in a serious diving accident on the 26th of June 2015 at the Kaatiala mine and that almost took my life. I have been recovering since that and just now returning to work. I decided to write this chain of events for an example to everyone so you can see how ”little” it takes to end up in a critical condition and in the worst case even die. Being cold is a dangerous foe in diving and is not something you should play with.
Me and my friend Pekka Hartikainen started driving from Iisalmi to Kaatiala on Friday morning on the 26th. Our car was packed full, the weather was good and our spirits high. Our plan was to do a so called check dive to the cave system and then dive in it for the whole weekend. We arrived in the evening and camped at the site. Our plan was to dive through the whole cave system, that is to say all the passages, crossings and dead ends. I estimated that a 50 minute bottom time would be enough to dive these with a slow pace. So we made our dive plan, 36 meters and 50 minutes. We both dived CCR with 1,3 PPO2. As diluents we both had “thin” trimix 20/24, as bottom bailout 21/35, as deco bailout 100% oxygen and 50% Nitrox and our suit gasses were 100% Argon. Estimated total length of dive around 75 minutes.
We had camped at the shallow end and all of our stuff was there, so we put on our gear and entered water from there and swam on the surface to the deep end. We took a short breather on the surface and checked our gear and started the dive. At three meters we checked our bubbles and bailouts, everything was ok and down we went. At the Bell (a certain underwater landmark, an old diving bell) we left our deco bottles and entered the system through the “ventilation hole”.
We checked the area around the ventilation hole and followed the edge to the end of the cave. Water temperature was 3,6C and I started to feel the cold. My undersuit was a standard Ursuk 1,97clo (X-Tex Heavy) and I had dived long dives with it before though sometimes it had felt a little cold. From “The Wheel” we started following the other edge back and checked the tunnels on that side too. After that we swam to the “right entrance”, through the first connector to the “middle entrance” and then again the passages to the end and so forth. Then we swam back to the “Ventilation Hole” and out to the bell to recover our bottles. We spent the estimated 50 minutes in averagely 35 meters. At this point I was feeling very cold and had been for a while already. I thought it would go away when we reached the warmer and shallower waters for our decos. We started to ascend slowly and I started to think that I might be wet under the suit as the cold did not go away even if the water was considerably warmer. Thinking nothing about it I just waited for the minutes to run out and getting up to the warm surface.
After our last decos at three meters I hooked all my offboard bottles in a rope under the “pier” to be ready for the next day and that clocked my total dive time to 80 minutes, that means I spent three minutes longer at three meters than required by my computer and seven minutes longer than Pekka. Our dive profiles were identical, but he was using a different algorithm so he was able to get up at 73 minutes. I got up from the water and climbed up to the bench to get my gear off my back as I was so cold I was shivering. I opened my drysuit zipper and noticed that all of my clothes were soaking wet! Otherwise everything was good, a great dive even if goddamn cold. We left our gear on the spot and immediately started walking to our camp to get changed into warm and dry clothing. The dive was in exception to getting wet completely normal. I went to my RV to change clothes and wondered how I didn’t feel the leak in my suit, it was cold, but I guess it always is when diving with that undersuit in that kind of water.
When I got changed into dry clothing I started getting symptoms. A heavy cough started, the shivering would not end and my stomach skin started to get red. This was about ten minutes after surfacing. We decided that everything was not right and Pekka prepared the oxygen and called the emergency services while I put on the rest of my clothes. At this point the shivering started to end but the cough was completely uncontrollable and my stomach skin started to marmorize. The ambulance arrived in 10 minutes.
The ambulance crew was consulting a doctor through the phone and the doctor concluded that it was not decompression sickness. I was feeling very sick and tried to tell them that I do have DCS symptoms or that at least this is a result diving. They started to drive me towards Seinäjoki hospital. During the drive I started to get pain in my lower back and hip area joints. This is pretty much the point where my memory of the whole ordeal starts to get hazy and I can’t even remember visiting the hospital. When arriving at the hospital my blood pressure was good, my pulse was 112 and I was well saturated. First I was sent to lung x-ray and my saturation started to drop extremely fast. My blood pressure dropped to 80/50 and with additional oxygen my saturation was only around 80. I was taken fast to CT-Angiogram of my lungs and that did not show anything related to lung or air embolism, no pneumothorax and no air in heart chambers. Lung parenchyma had however showed “matte glass formations” that could fit to hemorrhagic lung parenchyma trauma. They called TYKS (Turku Hospital) from where they ordered me to be transferred there.
They could not get a helicopter to come right away so they started to drive me towards Turku. Soon afterwards the helicopter was free and I was transferred to FinnHems (LifeFlight, also known generally as MediHeli) where my condition was getting worse. Here are my last memories of the next two weeks, the FinnHems doctor was giving some orders about being in the helicopter. While being transferred to Turku my condition had gone even worse and even if they were flying as low as possible I had thrashed around, been tachycardic and generally in a very bad shape. I had not been intubated while in the copter but gotten large doses of Ketamine, Midazolam and Noradrenaline infusion. When arriving at the hospital I was unresponsive, my pulse at 150 and blood pressure so low that the artery cannula could not get a reading. My skin had been full of syanotic patches. This was a few hours after the dive. They could not get me into a chamber right away and took me to be stabilized and intubated. First astrup showed carbon dioxide at 3,9 with oxygen being 6,9 and hemoglobin of 245. They took a lung x-ray and it was very bad, Pulmonary edema. When they had gotten me stabilized they started overpressure treatment by table 6. My ear drums had been bursted as I was already in a medically induced coma and in a Ventilator. The treatment had ceased at 10 am and after that followed an extremely hard and difficult “changing of gas”/oxidation problem. In the Ventilator my Fi02 was 100% and artery oxygen only 6.
This was probably the low point in my lung condition. Lung Alveoli were largely damaged and those that still worked were covered in liquid as in pulmonary edema. There were no rips anywhere, so most likely due to coldness my periferic blood flow had ended or blocked and that is why decompression did not happen. Nitrogen had been in my tissues and after started to bubble up. When my body got warmer and blood flowing the bubbles entered my lungs doing massive damage. I spent 13 days in a Ventilator as my lungs did not work and blood did not oxidize. Here are some quotes from my treatment log:
27.6 The situation with lungs is so bad and hemodynamics so labile that a second overpressure treatment can’t be administered even if the tables require it. The changes in skin have gotten smaller during the first 5,5 hours in the chamber. Blood pressure non existent.
28.6 Oxidation situation gotten a little better. Oxygen at 40% in the ventilator, PEEP however 12. Hemoglobin still exceptionally high. A CT scan of the head would be neccessary but due to the unstable condition it can’t be done.
29.6 Hemodynamics stabilizing. We are planning to do the CT scan. Ventilator oxygen again at 80% after the CT.
30.6 We are trying breaks in sedation to check neurological status, most likely will not easily wake up due to large doses of Midazolam, Ketamine etc.
1.7 Ventilator oxygen 50%, PEEP 10.
2.7 Ventilator oxygen 45%, PEEP 10. When lowering the sedation moves his limbs and appears to use right hand when requested.
3.7 Two Asystole heart attacks this night. Due to this we fitted a pacemaker temporarily. Ventilator oxygen 65%, PEEP 12.
4.7 We are seeing Bradycardia and pacemaker activates at times. Ventilator Oxygen 45%, PEEP 12.
5.7 Still Bardycardia. Heart checked with ultrasound, everythings looks fine. Ventilator Oxygen 40%, PEEP 12. We conclude that heart attacks and bradycardia are caused by other parts of the body being in a very bad shape.
6.7 Ventilator Oxygen 35%, PEEP 12. Blood pressure getting too high.
7.7 Ventilator Oxygen 35%, PEEP 12. Tomorrow morning transfer to Kuopio Hospital.
8.7. Will be transferred with an intensive care unit to KYS (Kuopio Hospital). Ventilator Oxygen 35%, PEEP 12, oxidizing well.
9.7 Starting to get out of the ventilator, will be extubated after noon. In the beginning breathing was hard but started to get going well and does well with additional oxygen.
At this point I regained consciousness for the first time after the night of 26th and have been conscious after that. At KYS I was in intensive care for a few days more but still awake and did not require ventilator care after that. The Pacemaker was removed on 11th of July. After intensive care I was transferred to a general heart condition ward and there I started to train walking and eating etc. again. My motoric problems were caused by heavy doses of medicine given in the primary part of my sickness. Walking and other motoric actions were going well when I was released from the hospital but my lung x-ray was still bad and there were signs of heavy damage, but it was estimated to heal with time. In September I returned for another lung x-ray and my lungs looked normal and healthy! Before this I had taken a heart test and 24 hour EKG and got good results.
On the 14th of September I had a meeting with a cardiology professor that was familiar with diving medicine. He gave me a permission to start slowly diving again within recreational limits. Because my rehabilitation is still going on I will have a new meeting in December where we will take a so called “gas bubble”, ultrasound PFO to make sure there are no heart conditions. At this moment on the 2nd of October I’m starting to return to work. Somehow I feel that my mental recovery is a longer process than physical recovery. This has been a hard thing for me and my family (wife and two kids, 3 ja 1 year olds) but I guess it just gets better from here.
So this is it. Something big and serious came of out a small problem, that is to say my suit leaked and I got cold. I’m happy that I survived this, one expert named Ben Reyemants told me that he knows four similar cases from his carreer and I’m the only one to survive it. The doctors who treated me called it a small miracle that I have healed so well and there is no brain damage or other complications. Decompression sickness is a factor here, but that was not what almost killed me, it was pulmonary edema, ARDS and other lung complications.
Medical Diagnosis:
J80 – Adult Respitory problem
W84 – Other or Unknown respitory problem
T70.3 – Decompression Sickness
W94 – Exposure to high or low air pressure and pressure changes
For me personally this has raised many questions. How did this happen, what went wrong, what causes pulmonary edema, how completely opposite conditions at the same time (pulmonary edema and extreme drying adding up to extremely high hemoglobin), permeability problem and how to prevent these things in the future? I have gotten many thoughts and answers, but there is still much to think about. I’m glad that my diving insurance was up to date. You never think about how high price you might pay for that “one easy dive” you just feel like doing that day.
But I now have permission to dive within recreational limits and have already done so. I have to get used to this wonderful hobby again! That’s how you say it, put your head down and head towards new disappointments
!
Safe dives to every single one of you and remember to prepare well. Do not downplay the risks of cold because I can now say from experience: Those Risks Are Real!
Regards
Jarkko Tuovinen
Original text in finnish
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Greetings everyone. I was in a serious diving accident on the 26th of June 2015 at the Kaatiala mine and that almost took my life. I have been recovering since that and just now returning to work. I decided to write this chain of events for an example to everyone so you can see how ”little” it takes to end up in a critical condition and in the worst case even die. Being cold is a dangerous foe in diving and is not something you should play with.
Me and my friend Pekka Hartikainen started driving from Iisalmi to Kaatiala on Friday morning on the 26th. Our car was packed full, the weather was good and our spirits high. Our plan was to do a so called check dive to the cave system and then dive in it for the whole weekend. We arrived in the evening and camped at the site. Our plan was to dive through the whole cave system, that is to say all the passages, crossings and dead ends. I estimated that a 50 minute bottom time would be enough to dive these with a slow pace. So we made our dive plan, 36 meters and 50 minutes. We both dived CCR with 1,3 PPO2. As diluents we both had “thin” trimix 20/24, as bottom bailout 21/35, as deco bailout 100% oxygen and 50% Nitrox and our suit gasses were 100% Argon. Estimated total length of dive around 75 minutes.
We had camped at the shallow end and all of our stuff was there, so we put on our gear and entered water from there and swam on the surface to the deep end. We took a short breather on the surface and checked our gear and started the dive. At three meters we checked our bubbles and bailouts, everything was ok and down we went. At the Bell (a certain underwater landmark, an old diving bell) we left our deco bottles and entered the system through the “ventilation hole”.
We checked the area around the ventilation hole and followed the edge to the end of the cave. Water temperature was 3,6C and I started to feel the cold. My undersuit was a standard Ursuk 1,97clo (X-Tex Heavy) and I had dived long dives with it before though sometimes it had felt a little cold. From “The Wheel” we started following the other edge back and checked the tunnels on that side too. After that we swam to the “right entrance”, through the first connector to the “middle entrance” and then again the passages to the end and so forth. Then we swam back to the “Ventilation Hole” and out to the bell to recover our bottles. We spent the estimated 50 minutes in averagely 35 meters. At this point I was feeling very cold and had been for a while already. I thought it would go away when we reached the warmer and shallower waters for our decos. We started to ascend slowly and I started to think that I might be wet under the suit as the cold did not go away even if the water was considerably warmer. Thinking nothing about it I just waited for the minutes to run out and getting up to the warm surface.
After our last decos at three meters I hooked all my offboard bottles in a rope under the “pier” to be ready for the next day and that clocked my total dive time to 80 minutes, that means I spent three minutes longer at three meters than required by my computer and seven minutes longer than Pekka. Our dive profiles were identical, but he was using a different algorithm so he was able to get up at 73 minutes. I got up from the water and climbed up to the bench to get my gear off my back as I was so cold I was shivering. I opened my drysuit zipper and noticed that all of my clothes were soaking wet! Otherwise everything was good, a great dive even if goddamn cold. We left our gear on the spot and immediately started walking to our camp to get changed into warm and dry clothing. The dive was in exception to getting wet completely normal. I went to my RV to change clothes and wondered how I didn’t feel the leak in my suit, it was cold, but I guess it always is when diving with that undersuit in that kind of water.
When I got changed into dry clothing I started getting symptoms. A heavy cough started, the shivering would not end and my stomach skin started to get red. This was about ten minutes after surfacing. We decided that everything was not right and Pekka prepared the oxygen and called the emergency services while I put on the rest of my clothes. At this point the shivering started to end but the cough was completely uncontrollable and my stomach skin started to marmorize. The ambulance arrived in 10 minutes.
The ambulance crew was consulting a doctor through the phone and the doctor concluded that it was not decompression sickness. I was feeling very sick and tried to tell them that I do have DCS symptoms or that at least this is a result diving. They started to drive me towards Seinäjoki hospital. During the drive I started to get pain in my lower back and hip area joints. This is pretty much the point where my memory of the whole ordeal starts to get hazy and I can’t even remember visiting the hospital. When arriving at the hospital my blood pressure was good, my pulse was 112 and I was well saturated. First I was sent to lung x-ray and my saturation started to drop extremely fast. My blood pressure dropped to 80/50 and with additional oxygen my saturation was only around 80. I was taken fast to CT-Angiogram of my lungs and that did not show anything related to lung or air embolism, no pneumothorax and no air in heart chambers. Lung parenchyma had however showed “matte glass formations” that could fit to hemorrhagic lung parenchyma trauma. They called TYKS (Turku Hospital) from where they ordered me to be transferred there.
They could not get a helicopter to come right away so they started to drive me towards Turku. Soon afterwards the helicopter was free and I was transferred to FinnHems (LifeFlight, also known generally as MediHeli) where my condition was getting worse. Here are my last memories of the next two weeks, the FinnHems doctor was giving some orders about being in the helicopter. While being transferred to Turku my condition had gone even worse and even if they were flying as low as possible I had thrashed around, been tachycardic and generally in a very bad shape. I had not been intubated while in the copter but gotten large doses of Ketamine, Midazolam and Noradrenaline infusion. When arriving at the hospital I was unresponsive, my pulse at 150 and blood pressure so low that the artery cannula could not get a reading. My skin had been full of syanotic patches. This was a few hours after the dive. They could not get me into a chamber right away and took me to be stabilized and intubated. First astrup showed carbon dioxide at 3,9 with oxygen being 6,9 and hemoglobin of 245. They took a lung x-ray and it was very bad, Pulmonary edema. When they had gotten me stabilized they started overpressure treatment by table 6. My ear drums had been bursted as I was already in a medically induced coma and in a Ventilator. The treatment had ceased at 10 am and after that followed an extremely hard and difficult “changing of gas”/oxidation problem. In the Ventilator my Fi02 was 100% and artery oxygen only 6.
This was probably the low point in my lung condition. Lung Alveoli were largely damaged and those that still worked were covered in liquid as in pulmonary edema. There were no rips anywhere, so most likely due to coldness my periferic blood flow had ended or blocked and that is why decompression did not happen. Nitrogen had been in my tissues and after started to bubble up. When my body got warmer and blood flowing the bubbles entered my lungs doing massive damage. I spent 13 days in a Ventilator as my lungs did not work and blood did not oxidize. Here are some quotes from my treatment log:
27.6 The situation with lungs is so bad and hemodynamics so labile that a second overpressure treatment can’t be administered even if the tables require it. The changes in skin have gotten smaller during the first 5,5 hours in the chamber. Blood pressure non existent.
28.6 Oxidation situation gotten a little better. Oxygen at 40% in the ventilator, PEEP however 12. Hemoglobin still exceptionally high. A CT scan of the head would be neccessary but due to the unstable condition it can’t be done.
29.6 Hemodynamics stabilizing. We are planning to do the CT scan. Ventilator oxygen again at 80% after the CT.
30.6 We are trying breaks in sedation to check neurological status, most likely will not easily wake up due to large doses of Midazolam, Ketamine etc.
1.7 Ventilator oxygen 50%, PEEP 10.
2.7 Ventilator oxygen 45%, PEEP 10. When lowering the sedation moves his limbs and appears to use right hand when requested.
3.7 Two Asystole heart attacks this night. Due to this we fitted a pacemaker temporarily. Ventilator oxygen 65%, PEEP 12.
4.7 We are seeing Bradycardia and pacemaker activates at times. Ventilator Oxygen 45%, PEEP 12.
5.7 Still Bardycardia. Heart checked with ultrasound, everythings looks fine. Ventilator Oxygen 40%, PEEP 12. We conclude that heart attacks and bradycardia are caused by other parts of the body being in a very bad shape.
6.7 Ventilator Oxygen 35%, PEEP 12. Blood pressure getting too high.
7.7 Ventilator Oxygen 35%, PEEP 12. Tomorrow morning transfer to Kuopio Hospital.
8.7. Will be transferred with an intensive care unit to KYS (Kuopio Hospital). Ventilator Oxygen 35%, PEEP 12, oxidizing well.
9.7 Starting to get out of the ventilator, will be extubated after noon. In the beginning breathing was hard but started to get going well and does well with additional oxygen.
At this point I regained consciousness for the first time after the night of 26th and have been conscious after that. At KYS I was in intensive care for a few days more but still awake and did not require ventilator care after that. The Pacemaker was removed on 11th of July. After intensive care I was transferred to a general heart condition ward and there I started to train walking and eating etc. again. My motoric problems were caused by heavy doses of medicine given in the primary part of my sickness. Walking and other motoric actions were going well when I was released from the hospital but my lung x-ray was still bad and there were signs of heavy damage, but it was estimated to heal with time. In September I returned for another lung x-ray and my lungs looked normal and healthy! Before this I had taken a heart test and 24 hour EKG and got good results.
On the 14th of September I had a meeting with a cardiology professor that was familiar with diving medicine. He gave me a permission to start slowly diving again within recreational limits. Because my rehabilitation is still going on I will have a new meeting in December where we will take a so called “gas bubble”, ultrasound PFO to make sure there are no heart conditions. At this moment on the 2nd of October I’m starting to return to work. Somehow I feel that my mental recovery is a longer process than physical recovery. This has been a hard thing for me and my family (wife and two kids, 3 ja 1 year olds) but I guess it just gets better from here.
So this is it. Something big and serious came of out a small problem, that is to say my suit leaked and I got cold. I’m happy that I survived this, one expert named Ben Reyemants told me that he knows four similar cases from his carreer and I’m the only one to survive it. The doctors who treated me called it a small miracle that I have healed so well and there is no brain damage or other complications. Decompression sickness is a factor here, but that was not what almost killed me, it was pulmonary edema, ARDS and other lung complications.
Medical Diagnosis:
J80 – Adult Respitory problem
W84 – Other or Unknown respitory problem
T70.3 – Decompression Sickness
W94 – Exposure to high or low air pressure and pressure changes
For me personally this has raised many questions. How did this happen, what went wrong, what causes pulmonary edema, how completely opposite conditions at the same time (pulmonary edema and extreme drying adding up to extremely high hemoglobin), permeability problem and how to prevent these things in the future? I have gotten many thoughts and answers, but there is still much to think about. I’m glad that my diving insurance was up to date. You never think about how high price you might pay for that “one easy dive” you just feel like doing that day.
But I now have permission to dive within recreational limits and have already done so. I have to get used to this wonderful hobby again! That’s how you say it, put your head down and head towards new disappointments
!Safe dives to every single one of you and remember to prepare well. Do not downplay the risks of cold because I can now say from experience: Those Risks Are Real!
Regards
Jarkko Tuovinen
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