Industrial Oxygen - Hypothetical Scenario

[fsardone]

Around here you need to have a prescription for medical oxygen.
But my supplier told me he fills all bottles from the same LOX tank then according to the intended use bottles and paperwork (and pricing) differs.
I asked him if he would supply me with industrial/welding filled in bottles in which he made high vacuum first and he agreed on condition I remind him when I place the order. No surcharge.
Guess what I use for my rebreather bailout nitrox … emergency oxygen tank …
Just saying.

 

[iain/hsm]

Supposed a diver in a remote location was suffering from a decompression Illness and all you had available was industrial oxygen... could you, should you, would you administer it to the diver?
Discuss.

Not yet I wouldn't. Your prime purpose would be to decide first the symptoms in order to ascertain an appropriate treatment and for that you need to first to access which of the two categories your diver is suffering.
Either its a Type 1 or Type 2 bend having first discarded the usual sprains and bruises etc.
If however the signs are pretty obvious for a serious type 2 then your oxygen cylinder will be of little use and I would suggest Valium as a better alternative with morphine for the final back up support.

If a mild type 2 then your oxygen would be most beneficial if its volume is sufficient to provided say 40 LPM at an elevated RMV (repetitive minute volume) until the Valium kick's in for the trip back.

I would also assume by now you have recovered all the divers out the water and be making your way back to your home port while the local recompression chamber and transport would be waiting at your remote location to receive the patient.

I trust by now you can see that the quality of the oxygen administered has no consequence to a successful outcome.

And bears testament to sound planning for remote diving and serious consideration in having a small transportable recompression chamber on board. Where with a mild type 1 bend the treatment is over before you arrive back at port and even on the most serious type 2 you have the diver under pressure within 3 minutes of him/her arriving on deck.

Around 40% of bends manifest in around an hour and 60% within 3 hours
with 98% within 25 hours

Most bends are treated well with a recompression chamber but the time taken to get there is the problem I have only seen a couple of folk die while in a chamber, another guy died before he got in,
all had a long ride to the chamber from the dive site, A couple of folk I knew have been paralysed one in particular on the RMS Lusitania told me he lay on the deck for 20 minutes waiting for the helicopter by then he felt his legs had gone. We spoke only a couple of weeks before about a small chamber 200Kg and the price of a reasonable family car. A little, too little too late.

Oxygen helps but is of little benefit on its own, by the time you are using it in anger no one cares if it's industrial or not. Iain

 

[PfcAJ]

Not yet I wouldn't. Your prime purpose would be to decide first the symptoms in order to ascertain an appropriate treatment and for that you need to first to access which of the two categories your diver is suffering.
Either its a Type 1 or Type 2 bend having first discarded the usual sprains and bruises etc.
If however the signs are pretty obvious for a serious type 2 then your oxygen cylinder will be of little use and I would suggest Valium as a better alternative with morphine for the final back up support.

If a mild type 2 then your oxygen would be most beneficial if its volume is sufficient to provided say 40 LPM at an elevated RMV (repetitive minute volume) until the Valium kick's in for the trip back.

I would also assume by now you have recovered all the divers out the water and be making your way back to your home port while the local recompression chamber and transport would be waiting at your remote location to receive the patient.

I trust by now you can see that the quality of the oxygen administered has no consequence to a successful outcome.

And bears testament to sound planning for remote diving and serious consideration in having a small transportable recompression chamber on board. Where with a mild type 1 bend the treatment is over before you arrive back at port and even on the most serious type 2 you have the diver under pressure within 3 minutes of him/her arriving on deck.

Around 40% of bends manifest in around an hour and 60% within 3 hours
with 98% within 25 hours

Most bends are treated well with a recompression chamber but the time taken to get there is the problem I have only seen a couple of folk die while in a chamber, another guy died before he got in,
all had a long ride to the chamber from the dive site, A couple of folk I knew have been paralysed one in particular on the RMS Lusitania told me he lay on the deck for 20 minutes waiting for the helicopter by then he felt his legs had gone. We spoke only a couple of weeks before about a small chamber 200Kg and the price of a reasonable family car. A little, too little too late.

Oxygen helps but is of little benefit on its own, by the time you are using it in anger no one cares if it's industrial or not. Iain

Oxygen as Definitive Treatment

Can oxygen first aid be considered a definitive treatment for post-dive symptoms? Our experts weigh in on this treatment option.

dan.org

Oxygen certainly helps. Benzos and opiates might help with discomfort but aren’t going to do anything to actually solve your problem.

 

[bakodiver391]

There is evidence that an Ibuprofen solution administered with saline intravenous drip is of benefit for type 2 treatment. I don't know if it is official policy but some of the top hyperbaric doctors do it.

 

[iain/hsm]

Oxygen as Definitive Treatment

Can oxygen first aid be considered a definitive treatment for post-dive symptoms? Our experts weigh in on this treatment option.

dan.org

Oxygen certainly helps. Benzos and opiates might help with discomfort but aren’t going to do anything to actually solve your problem.

On a mild pain or suspected type 1 bend I grant you oxygen at the surface is useful prior to a medical assessment and possible subsequent hyperbaric treatment, but to explain deeper the valium and morphine comment I made was reflecting on much more serious cases that occur without the help of a recompression chamber.

The case I was specifically thinking about was a young girl diving off Vaavu Atoll an advanced amateur scuba diver with her boyfriend on an arranged diving holiday with a scuba dive travel company on her 3rd dive of the day off MV Sea Spirit. Surfaced bent two days after arriving and died less than 12 hours later without being treated in a chamber. In these cases the valium and morphine are a sad but pain free exit strategy.
The specific details in this case was the delay in arranging transport from the Vaavu Atoll to Bandos Island and not before the tour firm had assured the girls dive insurers go ahead for the 40 mile trip to collect her was agreed. By the time she arrived on Bandos in the evening she was sedated and then sent over to the main hospital in Male another six miles away. Where she died. Sitting on her own an advanced diver knowing full well the consequences of her deteriorating condition waiting to die. Any idea what the morphine dose should be.
I know what the chamber treatment tables would be.

 

[Wookie]

On a mild pain or suspected type 1 bend I grant you oxygen at the surface is useful prior to a medical assessment and possible subsequent hyperbaric treatment, but to explain deeper the valium and morphine comment I made was reflecting on much more serious cases that occur without the help of a recompression chamber.

The case I was specifically thinking about was a young girl diving off Vaavu Atoll an advanced amateur scuba diver with her boyfriend on an arranged diving holiday with a scuba dive travel company on her 3rd dive of the day off MV Sea Spirit. Surfaced bent two days after arriving and died less than 12 hours later without being treated in a chamber. In these cases the valium and morphine are a sad but pain free exit strategy.
The specific details in this case was the delay in arranging transport from the Vaavu Atoll to Bandos Island and not before the tour firm had assured the girls dive insurers go ahead for the 40 mile trip to collect her was agreed. By the time she arrived on Bandos in the evening she was sedated and then sent over to the main hospital in Male another six miles away. Where she died. Sitting on her own an advanced diver knowing full well the consequences of her deteriorating condition waiting to die. Any idea what the morphine dose should be.
I know what the chamber treatment tables would be.

I’d get skin hits on particularly strenuous working dives, crepitis and the whole bit. Oxygen relieved the pain, but I must say, I never tried NSIADs.

 

[iain/hsm]

I’d get skin hits on particularly strenuous working dives, crepitis and the whole bit. Oxygen relieved the pain, but I must say, I never tried NSIADs.

The older you get they all become strenuous dives. I can recommend you Domeboro for the ears and
menthol vapour crystals in a mug of boiling water with your head under a hot towel for the nasal passages. Just don't drink it after.
When I worked in the Norway sector North Sea for Stolt Nielsen Seaway divers would be given a hot woolen hat by the rig nurse. I never did work that one out.

 

[GiraffeMarineSalvage]

On a mild pain or suspected type 1 bend I grant you oxygen at the surface is useful prior to a medical assessment and possible subsequent hyperbaric treatment, but to explain deeper the valium and morphine comment I made was reflecting on much more serious cases that occur without the help of a recompression chamber.

The case I was specifically thinking about was a young girl diving off Vaavu Atoll an advanced amateur scuba diver with her boyfriend on an arranged diving holiday with a scuba dive travel company on her 3rd dive of the day off MV Sea Spirit. Surfaced bent two days after arriving and died less than 12 hours later without being treated in a chamber. In these cases the valium and morphine are a sad but pain free exit strategy.
The specific details in this case was the delay in arranging transport from the Vaavu Atoll to Bandos Island and not before the tour firm had assured the girls dive insurers go ahead for the 40 mile trip to collect her was agreed. By the time she arrived on Bandos in the evening she was sedated and then sent over to the main hospital in Male another six miles away. Where she died. Sitting on her own an advanced diver knowing full well the consequences of her deteriorating condition waiting to die. Any idea what the morphine dose should be.
I know what the chamber treatment tables would be.

I have no suitable words about the people ensuring they would be paid before emergency transport... But I just learned a ton from a recent scubaboard thread with a video about in water recompression as a potential option in a situation like you refer (Simon Mitchell - Should divers treat DCS in-water?) so it's hopefully ok to mention it here...

As to the original could/should/would I use industrial O2 question, I agree with prior comments on the purity being the only practical consideration BUT I would also add the strong caveat that responding to an unanticipated medical emergency is legally very different than being perceived as preparing for a potential medical emergency with non-medical supplies... ie the price of medical oxygen stored in solid gold tanks (if there were such a thing...) would be trivial compared to the cost in court of a jury hearing "the boat was so inadequately prepared for a diving emergency they only kept industrial oxygen onboard..." lawyer pauses for dramatic effect and then concludes "Just imagine what other cost savings safety measures were skipped!" Personally I doubt most judge instructions to a jury or the jurors themselves would see choosing to use industrial oxygen much different than a tragic delay of transportation to a chamber until insurance coverage is confirmed... (Not stated as either medical or legal advice of course...)