Five Things I Learned Dealing with a DCS Emergency

[Gilldiver]

Joel Silverstine made up a presentation years ago "Bends is not a Dirty Word."

Nitrox, Wreck, Trimix, Technical Diver

Bends is Not a Dirty Word
A Realistic Look at Decompression Illness
by Joel D. Silverstein

This slide presentation is available for your use for educational purposes. It was created in 1994 and has been updated throughout the years. It examines the topic of decompression illness in recreational divers. It is the result of the worked done at the City Island Chamber facility during 1994-1996.

 

[TSandM]

Oh, if that's the case, your dad was a very lucky man. We lost an accomplished cave diver in a mine a couple of years ago, because he got an embolism from a previously unknown obstruction in his lung.

 

[pdenoble]

.... whether I felt that the potential free radical damage from O2 treatment was enough of a problem to justify withholding O2 ...

It would be interesting to know how many days in a row ....

you folks had been diving, although this type II hit was a fast tissue issue.

From your account, the ascent rate was controlled and a shallow stop was done (and the midportion of the dive amounted to a prolonged deeper stop). I wonder if your father's insurance would cover a transcranial Doppler study to evaluate for PFO? (I'd be interested in doing this, were I him, because large PFOs are starting to be implicated in stroke risk as well as DCS.)

Again, thanks for the well written and thorough account.

You should not warry about free radical damage at atmospheric pressure for a short time.
I have not yet seen the evidence for blaming multi-day diving for DCS.
However, I would be interested in the total number of dives done and total number of DCS hits experienced before considering PFO test. As it turned out, this case was most likely cerebral arterial gas embolism. The PFO may be the path for paradoxical embolism if dive resulted with bubbles. I would like to look at the dive profile to estimate the risk of DCS, but from the description it seemed pretty inocuous dive. This favors treating physician's conclusion (hopefuly supported bu some findings) that the source of gas emboli was the lung barotrauma.

 

[arkstorm]

To make the record clear, the treating doctor's conclusion of lung barotrauma was arrived at via deduction considering my father's age and 45 years of heavy smoking. There were no findings to support it.

 

[TSandM]

You should not warry about free radical damage at atmospheric pressure for a short time.

I believe there is ongoing research as to the role of O2 free radicals in ischemia-reperfusion injuries, and the possible utility of scavengers. If the "bubble as embolism" theory is correct, this would be a type of ischemia-reperfusion injury.

I have not yet seen the evidence for blaming multi-day diving for DCS.

I'm too lazy to go to Rubicon and look up citations, but I believe it is almost universally believed that multiple sequential days of diving results in cumulative load in the slower tissues -- which is why the recommendation of time to fly is longer if you have done multiple dives/multiple days. Those hits tend to be Type I, however, unlike this one.

 

[Ayisha]

Thank you for pointing out the necessity of having oxygen on board for emergencies. It is also adviseable to have more than one bottle of oxygen available in case of more than one victim or for a site that is far away from help and more than one bottle is needed before help arrives.

Something that came out in the last couple of years was also that the oxygen tank should be known to be working, filled and useable.

 

[farsidefan1]

I took a dcs hit in Coz last yr.treated by dr. Piccolo. I also did not "violate" my computer. 4 dives that day. Took all the safety stops etc. I read that persons with a pfo were 5 times more likely to take an unprovoked dcs hit. I had that checked and yup, I had a pfo which I had closed Dec 23rd. I'm 58 and somewhat overweight (down 15 lbs since my "event" and still dropping ) although I was in pretty good cardio shape (swam 1.5 to 2 miles 3 times a week for the month prior to trip). I'm off to Cocoview in June where in spite of the mostly shallow dives I will use nitrox on all dives and limit myself to 3 dives per day (unless I'm tempted above that which I can bear). Perhaps your father should check out the pfo question and consider exclusive nitrox and a more "relaxed" diving schedule. I certainly don't plan on ending my diving. Just too much fun. But I am going to bypass my usual "every dive possible" schedule from here on out (boy I hate saying that). I'm close enough in age to your father to be able to understand that we aren't ready to "pack it in" just yet. Still got places to go and things to see.

 

[Eff]

... I was actually asked yesterday, at a tour of a hyperbaric facility, whether I felt that the potential free radical damage from O2 treatment was enough of a problem ...

Could you elaborate a bit?

All I have ever heard about free radicals is something about a skin creme on a commercial, to something about causing cancer, and something about antioxidants.

Does this have something to do with O2 loadings over time (can't remember the term, something pulmonary), or something to do with cancer, or neither (my guess is this)?

I tried searching Google and Rubicon, and my head promptly exploded.

I read that persons with a pfo were 5 times more likely to take an unprovoked dcs hit. I had that checked and yup, I had a pfo which I had closed Dec 23rd.

Been doing some research on that too (PFO). Never knew that could be repaired - how did you have it done, if you mind me asking?
How were you diagnosed? Two methods I have ever heard of involve 1) Injecting microbubble saline in the blood, then using some sort of ulrasonic sonar (?) to look for bubbles ... somewhere downstream of the lungs I think. The other method was 2) being sedated and having an ultrasonic sonar (?) shoved down your throat or something to image the heart directly?





Sorry about all the questions; just trying to wrap my head around all the the big diving health concerns. And thanks again.

 

[drrich2]

My first fear would've been stroke. An abrupt marked sensory &/or motor deficit without clear explanation in an elderly person tends to raise the possibility. And I see no reason such a thing couldn't happen during or just after a dive. Considering that with stroke you want to get to the E.R. & a head CT ASAP, from what I recall (not something I deal with day-to-day!), I wonder when & how with an event like this someone makes the call DCS rather than stroke & points the patient at a hyperbaric chamber rather than a traditional hospital E.R.

At what point was stroke 'ruled out?'

Also let's remember that when stroke symptoms resolve within 24 hours, it's often called a transient ischemic attack (TIA), which can suggest high risk for future stroke, so fairly quick symptom resolution doesn't rule out stroke-related problems.

I'm glad your Dad recovered and that things went down well. I'd just hate for a future stroke victim to get steered wrong.

Richard.

 

[TSandM]

In general, most strokes will follow fairly well-defined patterns of deficit, because a specific part of the brain is involved. Showers of bubbles, on the other hand, can show multiple areas of deficit, like in this man who had motor AND sensory symptoms in his leg, as well as losing his vision. There is no one place in the brain that can do all those things, so this pretty clearly was not your usual ischemic stroke.

There certainly could be more subtle findings that wouldn't be as clear-cut, but we generally don't treat subtle findings with clot-busting drugs (the only effective treatment -- and it's of controversial effectiveness -- for stroke), so hyperbaric oxygen is unlikely to hurt the patient, and if it's DCS, it will help.

But this is why an examination by a medical professional IS called for in such cases.