I am justwondering if the hyperbaric physician did the right thing..

[2red]

A patient complaining of bilateral (both) knee pains, post diving, was brought to ER. He claimed he took a rapid ascent. The Physician on call in the Hyperbaric medicine immediately ordered for IV fluids, blood sample extraction for analysis etc. The guy was in real pain. It took about an hour before he was taken to the chamber. I was taught inthe EMS and also from a DM that patients like these need to be taken for decompression fast. :06:

 

[Laurence Stein DDS]

Hi 2red,

I have has the "pleasure" of being treated in a recompression chamber. So I have some experience to draw some conclusions from.

I'm sure you are taught to try to recompress as quickly as possible but putting someone into the chamber isn't like putting bread in a toaster. You don't just pop a patient in. Some chambers are large enough for an attendant as well and they have to be available. Everything has to be in place before treatment begins. An hour isn't very long...except to the patient in pain.

Actually, one hour from the time the ER physician sees the diver till the diver is in recompression is actually fairly fast. I'm assuming the diver was conscious, alert with a chief complaint of the painful knees.

His symptoms were consistent with but not limited to a non-neurologic DCS. While in pain, he was not suffering from a condition that was immediately life threatening. Time was available for proper evaluation and pre-treatment protocols.

When I was treated, it easily took an hour of exams, paperwork, contacting DAN, blood work, preparing to enter the chamber etc.

If the chamber was not manned 24/7, staff may have had to been called in. Even if the chamber was immediately available, 1 hour to entry after being admitted to the ER is actually pretty quick.

In some hospitals, the chamber does double duty as a HBOT treatment facility. If there were patients already in the chamber, a delay would have been encountered just clearing the chamber out.


Laurence Stein, DDS

 

[pipedope]

If they started O2 right away then I don't see anything obviously wrong.

Was a 5 minute neurological exam done early? If so what were the results?

In the absense of neurological or other life threatening symptoms there is no reason to 'rush' the person into the chamber. It is better to do it right than to do it fast.

This shows one nice thing about commercial diving, we can have a bent diver in the chamber VERY quickly.

 

[2red]

Neurologically, he was stable, alert and conscious. Except for being irritable, (i bet because of pain) he was stable. No O2 was administered.
Anyway, he was discharge about a month later with no neurological deficit.

 

[Laurence Stein DDS]

Er...what are we missing here?

Why was he in the hospital for a month? Certainly not just for recompression.

Laurence Stein, DDS :11:

 

[2red]

yup, he was admitted to the hospital, for recompression.

 

[CBulla]

Was he brought in on an ambulance? I know SOP for our county when I rode on meat boxes was everyone got O2, even if it was just on nasal canuals. It served a double duty of demonstrating to the patient that we were doing something (calmed them down) and in the cases where it really was needed, helped get that extra oxygen to them.

 

[Saturation]

yup, he was admitted to the hospital, for recompression.

For ONE MONTH? That's pretty unusual. Only severe, life threatening cases are there that long.

 

[Duane S.]

Was he really in for a month or was that a typo?

Would need more info on this case to make a better determination of appropriate treatment. However for you recreational divers an hour wait is not very long. That being said, a patient suffering from DCS should be pressed down in a chamber as quickly as possible. My main concern is that while intense pain will most definately cause irritability in most people, it is quite possible that it may have been a symptom of CNS DCS; which is significantly more of a problem than pain only bends.

I'm currious if the physician did a neuro-muscular examination? In one third of cases of pain only bends, there are also more serious symptoms which because they are not painful may not be mentioned but would require additional treatment.

 

[Laurence Stein DDS]

Would need more info on this case to make a better determination of appropriate treatment.

2red and Duane S.,

IMHO, I don't believe it is possible or appropriate for this board to render an opinion as to whether treatment was appropriate or timely. No one was present at this treatment and even if they were, they were not the treating physicians or EMTs.

Any information is after the fact and third party. While it might seem to be useful to speculate, it can only lead to further misinformation, upset feelings and possibly unjust accusations.

Respectfully,

Laurence Stein, DDS