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

[RonFrank]

These types of conditions are not a bad thing to discuss, but lets face it, without medical training there is little any of us can do beyond basic rescue techniques. This is one reason diving is dangerous, there is no fast access to rescue personal. If a distressed diver is very lucky there is a medic on board that is highly skilled. Otherwise we just roll the dice....

 

[vladodessit]

Hey, Vlad, how about you ask your friend to click that link at the bottom of the OP and have him talk to Duke Diving Medicine?

I think I will. I know it wasn't any "incident" or "medicine" thread, guess had more of a question if any more experienced divers thought it was possible to inhale water through breather without realizing it. Enough to be close to collapsing from flooded lungs.

 

[Bombay High]

Much more common than Immersion Pulmonary Edema (IPE) is High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE)

There are certain identifying symptoms that tell you if you are going to suffer from either. Good to get familiar.

IPE I think is a really long shot. I would be interested in how many people are really affected (or have ever been affected) by it.

 

[Jax]

That is the point of this thread. It seems more and more people are reporting IPE, and it leads some to question if some of these "got separated, found dead (drowned)" reports aren't really IPE. The postmortem indications look an awful lot like drowning. (I seem to remember reading this.)

Then you look at the ones where the unconscious person was pulled aboard, and they did CPR all the way in . . . . what if they had also [-]pushed[/-] masked and bagged with 100% O2? Would that have made a difference?


Please read some of those links. Someone who tends to a triathlon every year says there are around half of a dozen swimmers that just swim to the bank and get out. He remembers them coughing. Do we know? How would we know if someone isn't alerted to be there?

 

[Duke Dive Medicine]

No initial change

For me, the first step would be slapping on the O2 and monitoring.

If the person is coughing up stuff, and still getting air in, then just monitor and pray.

If the person seems to be losing the fight to breathe, I'd be having someone on the pulse continuously, and absolutely make sure that rescue breathing (bag, or mouth to mouth) is ready to jump in. Upon loss of consciousness, rescue breathing commences as the pulse is monitored.

As I was trained, you go to chest compressions immediately that there is no pulse. . . . 100 times a minute. But if there were any suspicion of IPE, I would make the rescue breathing of equal priority. Circulating oxygen-deprived blood isn't doing much.

Jax,

I think what some of the other posters are saying is that you can't diagnose IPE in the field; for example, TSandM made the excellent point about pneumothorax. You also can't differentiate between IPE and cardiogenic pulmonary edema with or without an immersion component. What you'll see in the field is somebody with difficulty breathing, possibly severe and progressive, who may or may not be coughing up clear or blood-tinged foamy sputum. While it's good to be aware of IPE, don't get away from basic first aid and CPR, because those are the tools you're going to be working with for the most part. Keep in mind that in the field, you're usually treating the symptom, not the disease, because you likely haven't diagnosed anything. Remember the basics: monitor breathing and pulse, place the diver on oxygen if needed, be ready to assist ventilations and perform chest compressions, and above all, seek advanced medical care immediately.

Also, since you just posted, what is "pushing O2"?

 

[Jax]

Absolutely the basics!

One thing about placing the diver on oxygen if needed -- we're to put them on oxygen immediately.

As for evac to advanced care - that was stressed incredibly. "Get 'em out of your hands and into the system as fast as you can!" Good words.

 

[Ayisha]

Great research, Jax! We could have pooled our resources on IPE had we known...
Great response from the medical moderators as well!

 

[Jax]

Jax,

Also, since you just posted, what is "pushing O2"?

Sorry -- using some old terminology from way back . . . in this case, I meant using a bag on the victim. I've noticed all the DAN kits seem to have bags.

The big thing in combat medic was to fix the ABCs (Airway, Bleeding, Cardiac), push the fluids (IV) and get 'im out of there.

 

[tc]

Actually I don't think any of the DAN oxygen kits come with BVM's. They do sell them so users have probably just added them.

 

[Jax]

:shocked2: Well, I learned something . . . .