Immersion Pulmonary Edema (IPE) - unknown cause, known killer

[Jax]

Disclaimer: I am NOT a medical person. I ran this through some of the medical mods with differing reactions from "too much info" to
"more important to get training" to "it's ok as is."

Please get trained on CPR, Oxygen Provider, and Rescue Diver!

Immersion Pulmonary Edema (IPE), also known as Swimmers' Immersion Pulmonary Edema (SIPE), was considered rare but many are coming to believe that this affliction may be more common than possibly thought.

Official def:

Pulmonary edema has been reported in SCUBA divers, apnea divers, and long-distance swimmers . . . Pulmonary edema may cause seizures and loss of consciousness which in a water environment may become life threatening. ... Signs and symptoms including cough, fatigue, dyspnea, haemoptysis, and rales may occur within minutes of immersion. Contributing factors include hemodynamic changes due to water immersion, cold exposure, and exertion which elevate cardiac output, causing pulmonary capillary stress failure, resulting in expiration of fluid into the airspace of the lung. Previous history is a major risk factor. Treatment involves immediate removal from immersion and in more serious cases, hospitalization, and oxygen administration. Immersion pulmonary edema is a critical environmental illness of which triathletes, race organizers, and medical staff, should be made aware.[8]

The Bottom Line: The person is drowning as their lungs fill with fluid. Learn how to recognize IPE and provide first aid.

Symptoms -- As experienced by the affected diver, gathered from the stories cited below.

Needing to breathe . . . running out of breath

A cough that quickly comes more and more often

A need to get to the surface NOW

Coughing up a foam - could be but not necessarily red or pink . ..

Gathering loss of consciousness from lack of oxygen

Unconsciousness

Death if O² is not delivered to the lungs.
​

First Aid

Get O² in the victim's lungs ASAP! Let him or her cough out the gunk and get the mask back on.

[This need was recognized by the California Bay Watch First Providers, where every boat is now equipped with a Constant Positive Airway Pressure (CPAP) device. (Source - Baywatch personnel briefing the UofSoCal Emergency Response Diver Class.)]

How to:
Best choice is the CPAP.
2nd best choice is the Bag Valve Mask with O² attached. (See pic below.)
Administer O² with a non-rebreather mask.
Administer O² with anything you have
Administer Nitrox if that is all you have

OP's personal opinion: If the victim is losing / has lost conciousness, I will breath the O² myself and administer mouth to mouth.

Further information

[1]Divers' Alert Network (DAN) article
Divers Alert Network

[2]Divers' Alert Network (DAN) article
Alert Diver | Immersion Pulmonary Edema

[3]DeniseGG's Incident at Jackson Blue
http://www.scubaboard.com/forums/ac...eniseggs-incident-near-miss-jackson-blue.html

[4]"In the Drink" posted on ScubaBoard:
http://www.scubaboard.com/forums/accidents-incidents/395096-pulmonary-oedema-incident.html

[5]"In the Drink"s posting in Yorkshire Divers:
Pulmonary Oedema incident

[6]Another Yorshire Diver's story:
Probably another Immersion Pulmonary Oedema

[7]Another Yorkshire Diver's story:
Fun in Cornwall

[8]Immersion Pulmonary Edema in Female Triathletes
Immersion Pulmonary Edema in Female Triathletes
Full report: http://www.endurancetriathletes.com/sipe_case_report_carter-koehle.pdf

[9]Deadly SIPE
http://www.endurancetriathletes.com/deady_sipe.pdf

[10]Pulmonary Edema in Scuba Divers
Pulmonary Edema Associated With Scuba Diving*

[11]Swimming-induced pulmonary edema in triathletes
Elsevier

[12]Duke University is doing clinical trials:
Prevention and Treatment of Immersion Pulmonary Edema - ClinicalTrials.gov
Subjects Invited for Immersion Pulmonary Edema Study

 

[Jax]

This possibly could be an episode: http://www.scubaboard.com/forums/ac...ficer-died-chesapeake-dive-team-training.html

 

[Jax]

This possibly could be an episode: http://www.scubaboard.com/forums/ac...ficer-died-chesapeake-dive-team-training.html

Officer Timothy Schock was taking part in search-and-rescue training around 11:45 a.m. when he had difficulty breathing, according to a statement from Police Chief Kelvin Wright.

When Schock surfaced, he told his team partner, who was with him during the training, that he couldn't breathe, Wright wrote. Schock's partner immediately tried to give him his own respirator, "but under the stress and duress of the situation, Officer Schock pushed away the apparatus and went back under water," according to Wright.

Divers on shore helped get Schock back to the surface and onto land, where they performed CPR, according to Wright. Emergency crews from the Fire Department continued lifesaving efforts.

[speculation]

Note that they did CPR. The idea of CPR is to continue to circulate the blood in the body, because it is already carrying that life-giving oxygen.

BUT what if the guy has IPE? He has used up most all the oxygen in his blood! Without air in his lungs, without forcing out the fluids so the air sacs can transfer oxygen from the lungs to the blood, that precious oxygen doesn't make it to the organs and body.

[/speculation]

 

[VooDooGasMan]

Jax wont you be giving co2 by breathing yourself.

 

[Jax]

Jax wont you be giving co2 by breathing yourself.

True, but that is okay! We breath air at 21% o2, and expirate air at ~17% o2. There is plenty of o2 in our expirated air, and if that is all we have, that is all we have.

OP's personal opinion: If the victim is losing / has lost conciousness, I will breath the O² myself and administer mouth to mouth.

What I am saying here is that I will breathe the enriched air - if it is 100% O2, I will be filling the victim's lungs with ~95% oxygen.

My values are probably off, but in all these stories I've read, the victim survives WHEN they get out of the water, cough up the gunk, and getting air to the lungs.

Any medical opinion? ---> *I* believe that we go to CPR so fast these days, to meet the requirement to get blood circulating, that in these IPE cases, we miss getting air into the lungs.

 

[VooDooGasMan]

My first thought was the officer acted like a first time underwater breathing episode did not want any help , but instead of up he went down.

Dolphins also get bent as they are the worlds best free diver and I would almost say that they also would get ipe and co2 hits.

 

[Jax]

My first thought was the officer acted like a first time underwater breathing episode did not want any help , but instead of up he went down.

or, another way to state what you say, did not want the proffered help.

[speculation]

The victim had a working reg. He knew he had air. But he could not breathe! Insidiously, the lack of oxygen was already working on him, and he lost consciousness and went under.

[/speculation]

 

[VooDooGasMan]

Well Divers should get a tube installed in lungs with a quick disconnect and a fitting to reduce pressure, and then we can administer both at the same time.

 

[Jax]

With thanks to TDS' gbgdiver:

This is a test with an individual who deliberately undergoes Hypoxia - having less oxygen in your system than you need.




Link for faster: hypoxia - YouTube

 

[Jax]

Well Divers should get a tube installed in lungs with a quick disconnect and a fitting to reduce pressure, and then we can administer both at the same time.

That's what we have anesthesiologists for.