Immersion Pulmonary Edema in dive accidents

[Bubbletrubble]

Bubbletrubble, I'm aware that relationships do not prove causality, so NO risk factors have been PROVEN to be associated with IPE. That would be true of any research where there is no control group and variables that are manipulated - a lot of research that is still valid in showing relationships.

Just because risk factors are not *proven* does not mean we should disregard them. The associations are still helpful in evaluating our risk and how we may be able to mitigate the risk. It certainly doesn't hurt.

I don't understand how risk can be evaluated without any proven risk factors.

I'm happy to concede that associations/correlations may be suggestive, particularly when backed by a physiological rationale.

At this point, all you can do is take what you are referring to as "risk factors," see where there is overlap with what we know to be health-promoting factors (for other medical reasons), and say: "Well, if one controls this subset of health-promoting factors appropriately, then it might decrease risk of IPE."
That doesn't sound very convincing to me at all. Nevertheless, if it encourages people to control the health-promoting factors (for other medical reasons), then I suppose it might be worth it.

 

[DandyDon]

I'm really not understanding the reason for the debate here. None of us lay divers will ever be able to diagnose an IPE in any dive emergency, so for us the response would be the same for any in-water incident of somewhat similar circumstances: Get the diver to the surface, out of the water, and into CPR - and since this is water related, compressions-only are not a consideration; CPR with rescue breathing at least until we can get the victim to trained medical help. Or am I wrong here...?

 

[InTheDrink]

+1 that establishing positive buoyancy would have been the first thing that should have been done irrespective of what the issue was. I remember being fairly fixated on that prior to getting to the surface. Thankfully my instructor was too.

@bubble: thanks for letting us know that PPV isn't always a good thing. In my case I believe it saved my life but I hadn't even considered that it might not always be the appropriate course of action.

@don: glad to hear you're dwelling on a sign for catastrophic event. Let's hope you never have need of it! I'm considering getting a FFM with comms as an additional safety measure.

Anyhow, I'll stop hijacking this thread now, although some interesting points are being raised.

John

 

[Jax]

I'm really not understanding the reason for the debate here. None of us lay divers will ever be able to diagnose an IPE in any dive emergency, so for us the response would be the same for any in-water incident of somewhat similar circumstances: Get the diver to the surface, out of the water, and into CPR - and since this is water related, compressions-only are not a consideration; CPR with rescue breathing at least until we can get the victim to trained medical help. Or am I wrong here...? .

I don't want to say you are "wrong" Don, but the "latest" training says just get on the 100-compressions per minute CPR. Then slap on O2. The problem is that people are backing away from mouth to mouth because of fear of disease. What if they don't have O2?

It's really-really-really important, in my first-aid-only-trained mind, to get air in the victims' lungs.


Here's the conundrum: If you are on a boat speeding towards shore, you will probably not feel a pulse and will jump into CPR!! (Source - During ERD, we got ON a Baywatch boat, with a CPR-dummy. We were told to take the vitals from a perfectly healthy person as the boat "tore off" towards "the shore". Not ONE of us could get a pulse, even with a stethoscope. So, we are told, get to the CPR. Yet . . . the victim needs air / O2 in his/her lungs.

 

[Jax]

+1 that establishing positive buoyancy would have been the first thing that should have been done irrespective of what the issue was. I remember being fairly fixated on that prior to getting to the surface. Thankfully my instructor was too.

@bubble: thanks for letting us know that PPV isn't always a good thing. In my case I believe it saved my life but I hadn't even considered that it might not always be the appropriate course of action.

@don: glad to hear you're dwelling on a sign for catastrophic event. Let's hope you never have need of it! I'm considering getting a FFM with comms as an additional safety measure.

Anyhow, I'll stop hijacking this thread now, although some interesting points are being raised.

John

NO! Please don't stop . . . take it to [url]http://www.scubaboard.com/forums/basic-scuba-discussions/405481-immersion-pulmonary-edema-ipe-unknown-cause-known-killer.html[/URL]

 

[DandyDon]

I don't want to say you are "wrong" Don, but the "latest" training says just get on the 100-compressions per minute CPR. Then slap on O2. The problem is that people are backing away from mouth to mouth because of fear of disease. What if they don't have O2?

Uh, that does not apply to swimmers, divers, or young kids for that matter. I am aware of the compressions-only campaign, but I hope they are not training that for water related Cpr?

I wouldn't worry about mouth diseases but I understand it can get very messy. Do you carry one of DAN's pocket masks? I carry a large one in my dive bag for any water outing, but got a couple of small ones too I try to keep handy.

 

[markmantei]

Uh, that does not apply to swimmers, divers, or young kids for that matter. I am aware of the compressions-only campaign, but I hope they are not training that for water related Cpr?

Don, below is a quote from Bubbletrouble in another thread...

@davetowz: The American Heart Association is very clear about the circumstances under which conventional CPR with rescue breaths should be administered instead of Hands-only CPR. Conventional CPR with rescue breaths is recommended in the following cases:

• All infants (up to age 1)
• Children (up to age 8)
• Adult victims who are found already unconscious and not breathing normally
• Any victims of drowning, drug overdose or collapse due to breathing problems.

I bold-faced the situations relevant to the general diving public.
Since those situations commonly occur in dive-related incidents, conventional CPR with rescue breaths is strongly preferred in dive rescues.

I had seen the "exceptions" (potential drowning victims, and young children) before, I had though it was a Red Cross statement, but when I went to find it, the only exception that Red Cross mentions (that I could find) is children, which is a big oversight on their part, IMO.

The following is a link to a press release from the American Red Cross in 2010... American Red Cross Statement on Compression-Only CPR

 

[Jax]

Honestly, I've been trained on the protections and masks and everything since the 80's. If someone needs air NOW, they need it NOW.

I have convinced myself that I don't have the luxury of finding a mask to use it . . . I just pray that God is looking out for me.

 

[Thalassamania]

Valveless snorkels (simple J tubes) can often make a good substitute for a pocket mask.

 

[DandyDon]

These are easy to carry: https://www.diversalertnetwork.org/store/home.aspx?id=20