Immersion Pulmonary Edema in dive accidents

[markmantei]

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.

Agreed. As bad as some of the "stuff" coming from the mouth might be, I don't believe it would stop me from administering life-saving care. Having a mask stored on a dive boat in a first aid kit would be one thing, but the idea of lugging a mask around for that rare occasion was just too much for me. I'll have that same trust in God should I need to and perform mouth-to-mouth to the best of my ability.

 

[DandyDon]

Agreed. As bad as some of the "stuff" coming from the mouth might be, I don't believe it would stop me from administering life-saving care. Having a mask stored on a dive boat in a first aid kit would be one thing, but the idea of lugging a mask around for that rare occasion was just too much for me. I'll have that same trust in God should I need to and perform mouth-to-mouth to the best of my ability.

I've done mouth to mouth a couple of times, before the advent of layman compressions. Just did it. Wasn't bad. I always have a large bandana in my pocket if needed.

Did you see the pocket mask I posted? I carry one with plastic gloves and a packet of antiseptic wipes in a ziplock in my car, another set in my computer bag. The larger mask I carry in my dive bag.

 

[markmantei]

Don't take this the wrong way, but I carry too many keys on my keyring and don't want to add anything else. I travel a fair amount and I've gone from big 17" notebooks down to a 10" netbook just to shed weight, adding a bunch of stuff there is a no-go as well. Adding a moderatly sized first-aid kit to the truck is something I should have already done. Maybe I'm just lucky, but I cannot remember even witnessing an event where having gloves or a mask would have been nice. I'm not saying no one should carry these items, it just a question of risk vs effort for me.

And as far as the mouth-to-mouth, like you said from your experience, I didn't anticipate it being bad all of the time, just that it's a possibility (maybe more so if were talking IPE).

 

[Jax]

Each and every person has to make a choice for him- or her-self just how far to go.

For me, personally, I probably would take that extra time to use a mask if I saw a Herpes sore.

Otherwise. . . I don't know if I could live with myself if someone died and I was just squeamish.

 

[Thalassamania]

It is not a matter of squeamish, it is a question of risk management. Whenever I teach CPR I tell my students to decide what they are going to do and not do, and under what circumstances, and decide it now ... not in the heat of the moment, and stick by whatever rule you make for yourself.

 

[markmantei]

For me, personally, I probably would take that extra time to use a mask if I saw a Herpes sore.

Yes, some choices are easy, but what if there was no mask readily available? There is no right or wrong answer. As you both Jax and Thalassamania have said, each person must decide for themselves what risks they can live with.

While I think the discussion is good, I also think it has strayed pretty far from the accident, so if anyone wants further discussion a new thread may be in order...

 

[Blue Sparkle]

	Title: Immersion pulmonary oedema.
	Author: Mitchell, S
	Abstract: Pulmonary oedema of immersion is a rare complication of scuba diving..... The condition may be precipitated by the increase in pulmonary capillary hydrostatic pressure that occurs on immersion, coupled with the imposition of a pressure gradient between mouth pressures and hydrostatic pressure at the chest in the upright diver...

Link: Immersion pulmonary oedema.

I was just reading through this thread for the first time, and I have a question about the section of this article excerpt that I emboldened.

Before I ask though, let me clarify that I realize we're talking about degrees of risk here, and that if the answer to my question is "yes" that doesn't mean I'm never going to be vertical in the water. I'm mostly just curious about the principle.

Does what they are saying imply that there is more risk (albeit perhaps minimally more) to a diver who is vertical in the water, vs. horizontal? If so, does this have to do with the effort of breathing through a regulator at the different angles, or something else? (I'm vaguely recalling the illustrations I've seen showing the relative positions of lungs vs. regulator.)

 

[TSandM]

If the lung are below the regulator, the reg will be delivering gas at an ambient pressure lower than that inside of the airways. That means the diver will have to generate more negative pressure to draw that gas down into the lower portion of the chest. A more negative pressure in the alveoli changes the dynamics to favor fluid exudation out of the capillaries and into the airspaces. If there is already any kind of process that's encouraging that fluid movement, having to draw against inadequate pressure will make it worse.

 

[Blue Sparkle]

TSandM,

I think that's what I was tenuously grasping but couldn't quite get enough mental grip on to express clearly. I appreciate your explanation.

 

[Duke Dive Medicine]

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.

Jax,

I don't want to belabor the point, but this is incorrect information. The latest training for trained rescuers is just like the previous training, that is, 30 compressions to two breaths. "Compressions-only" CPR is for untrained rescuers only, that is, people who have not had a CPR class or been trained to get vitals on a speeding Baywatch boat.

Also, the term "slap on O2" is misleading. I asked you about it in the other thread and, as near as I could tell, you were saying that you were trained to put a high-flow O2 mask on a patient undergoing chest compressions. This, too, is incorrect. For a trained rescuer, proper administration of CPR involves providing compressions and ventilations, not compressions and high-flow oxygen via mask.

John (IntoTheDrink)'s incident highlights the importance of rescue breathing, which the divemaster gave him via a pocket mask. This needs to be differentiated, however, from "positive pressure ventilation", which, as BubbleTrubble has already explained, should be reserved for trained and experienced rescuers. Re mouth-to-mouth ventilations: the gross factor may put some people off, but so far, there has not been a reported incident of disease transmission as a result of direct mouth-to-mouth contact during resuscitation.