Do you know about Immersion Pulmonary Edema? You should...

[Add Helium]

“It is a beautiful sunny day. The ocean is calm and there is no current. In short: a perfect day to plunge into the sea and dive the Spiegel Grove. The water is comfortable at 81 degrees and the visibility is over 100 ft. We are a team of four divers on rebreathers and it is going to be an easy dive.

About 35 minutes into the dive, I start coughing. First it only happens intermittently but over time, the coughing increases. I am beginning to notice mild wheezing when I breathe out. Because it feels harder to exhale, I reassess my loop volume, but everything checks out fine. I am less interested in the dive now and am becoming more interested in what is happening to me.

With my next cough, I get a slight metallic taste in my mouth. My chest feels tighter and the wheezing is worse. Not wanting to alarm my buddies, I am signaling that I am going up but that I am okay. I make it out of the wreck and swim toward the up-line. Breathing is more and more laborious. I bail to open-circuit just in case there is something wrong with my unit. Breathing from the regulator, however, is not relieving my symptoms. I am constantly coughing and with it, bring up metallic tasting liquid. Putting all of my signs and symptoms together, I conclude that I am in pulmonary edema."

Read more...

 

[sander8]

Is IPE less likely with a drysuit? There is no immersion in water, nor a cold shock on entry. The pressure increase from immersion is still a factor. Physiologically, drysuit immersion seems quite different. Has anyone done a differential study of dry vs. wet diving?

 

[TSandM]

To my knowledge, the only people systematically collecting information on this malady are the folks at Duke.

Reading the essay, it occurred to me that one of the things a person suspected they have IPE might do is push their ppO2 to the highest level possible, compatible with an adequate gas supply to reach the surface. Although WOB is increased greatly, and may account for the majority of the subjective dyspnea, the patients I've read about who have survived have all been hypoxemic on the surface, perhaps enough to awaken hypoxic drive. It might reduce the panic factor in the water, and as diffusion is greatly hampered, I doubt the CNS would see a high enough ppO2 to make toxicity likely.

 

[InTheDrink]

Just musing off hand, a lot/most of the IPE incidents I've heard about in last couple of years have been on CCR.

I know of IPE incidents on OC, but looking here, RBW, The Dive Forum, YD and some other unposted incidents I've heard about in last 2 yrs - all CCR.

Not that my knowledge is in any way exhaustive, just seems like there might be some pattern worthy of exploration.

John

 

[TSandM]

We had one a couple of years ago in a recreational OC diver here in Puget Sound, and I don't believe denisegg was on CCR, either.

 

[Barracuda2]

The Article brought back some very unpleasant memories for me; however, I'm back on the horse and doing fine. I had a heart ablation that cut the circuit that caused atrial flutter which means I'm off the meds I was on when I had my incident. No conformation, but I would bet anything that the beta blocker I was on caused my IPE hit.

 

[InTheDrink]

We had one a couple of years ago in a recreational OC diver here in Puget Sound, and I don't believe denisegg was on CCR, either.

Like I said, I know of other incidents on OC, but from the reports I've read over last couple of years, CCR does seem to be a bit of a recurring theme. It's just an observation and may not have anything to do with anything.

Stress/task loading & medication/beta blockers have cropped up several times also but given the substantially larger number of OC divers Vs CCR it does seem curious that CCR divers, anecdotally at least, seem to be somewhat over represented in the incidents I've heard about in last couple of years. This may of course be biased by the boards I read and that most of my diver friends dive CCR.

But I still think there's more to it than just that.

@Dr Moon, are there or have you any plans to publish your findings to date? Would make very interesting reading even if firms conclusions can't be made.

Thanks,
John

---------- Post added June 15th, 2013 at 08:09 PM ----------

The Article brought back some very unpleasant memories for me; however, I'm back on the horse and doing fine. I had a heart ablation that cut the circuit that caused atrial flutter which means I'm off the meds I was on when I had my incident. No conformation, but I would bet anything that the beta blocker I was on caused my IPE hit.

Is your account written up anywhere? Anyhow glad you're back in the saddle and doing well.

John

 

[Dsix36]

Damn, this is just great. I was finally getting over my phobia of Jaws and now I have to worry about drowning in my own lung fluids.

Next you will tell me that getting hit by a power boat is a possibility.

<smile>

 

[steveharriss]

Been on a boat where a CCR diver bolted to the surface from 25m due to IPE. Didn't look great from my perspective :-( Glad to hear you made it out of the water OK

 

[dreamdive]

Like I said, I know of other incidents on OC, but from the reports I've read over last couple of years, CCR does seem to be a bit of a recurring theme. It's just an observation and may not have anything to do with anything.

Stress/task loading & medication/beta blockers have cropped up several times also but given the substantially larger number of OC divers Vs CCR it does seem curious that CCR divers, anecdotally at least, seem to be somewhat over represented in the incidents I've heard about in last couple of years. This may of course be biased by the boards I read and that most of my diver friends dive CCR.

But I still think there's more to it than just that.

@Dr Moon, are there or have you any plans to publish your findings to date? Would make very interesting reading even if firms conclusions can't be made.

Thanks,
John

---------- Post added June 15th, 2013 at 08:09 PM ----------



Is your account written up anywhere? Anyhow glad you're back in the saddle and doing well.

John

Hey John,

you would have to contact Dr.Moon directly, as he may not be following this post. I have provided the contact information in the article. If you go to scholar.google and conduct a lit search looking for Moon, IPE, you should get the most relevant of his published studies. Let me know if I can assist you further.

As to CCR divers representing a greater number this may be due to reporting bias. As I mentioned, it is known in the military and in other sports as well.

thank you for your interest.

Claudia R

---------- Post added June 15th, 2013 at 06:46 PM ----------

To my knowledge, the only people systematically collecting information on this malady are the folks at Duke.

Reading the essay, it occurred to me that one of the things a person suspected they have IPE might do is push their ppO2 to the highest level possible, compatible with an adequate gas supply to reach the surface. Although WOB is increased greatly, and may account for the majority of the subjective dyspnea, the patients I've read about who have survived have all been hypoxemic on the surface, perhaps enough to awaken hypoxic drive. It might reduce the panic factor in the water, and as diffusion is greatly hampered, I doubt the CNS would see a high enough ppO2 to make toxicity likely.

I would not follow this as a recommendation! In the hospital the most a patient with pulmonary edema sees is a PPO2 of 1. Recommending to push your PO2 to unsafe levels in a "suspected" or otherwise case of IPE puts you at risk for other issues. Stay on safe limits and decrease your workload as much as possible.