My DCS Incident...

[Kendall Raine]

The ER docs were in consultation with the DAN medics. They drew blood and the doctor said I was bent based on the both the bloodwork and physical symptoms. My knee cap was a solid red color and this was while wearing light hiking pants. If you have ever seen Stilton cheese then you know the type of deep mottling that was on my forearm. I also had deep muscle aches, a sinus type headache and visible shakes. The dive medics on the chamber had no doubts either. Any one symptom alone I could dismiss as something else; all together meant an ambulance ride.

When I was on the ferry I was telling myself over and over, "it couldn't be", not on such a relaxed dive. Yet I could feel myself getting worse and worse. There comes a point where denial is surpassed by the facts and I got there pretty quick.

As Sherlock Holmes said, "Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth".

Blood work? Not challenging the diagnosis, but can you tell me what they saw in your blood that confirmed DCS? I didn't know examination of blood was a dispositive marker. Presence of inert gas bubbles in blood is definitely not dispositive of DCS, BTW.

 

[shadragon]

Blood work? Not challenging the diagnosis, but can you tell me what they saw in your blood that confirmed DCS? I didn't know examination of blood was a dispositive marker. Presence of inert gas bubbles in blood is definitely not dispositive of DCS, BTW.

That I could not tell you as I never asked. I assume a blood gas analysis, but that is a guess and I would have to defer to more knowledgeable people.

 

[Kendall Raine]

That I could not tell you as I never asked. I assume a blood gas analysis, but that is a guess and I would have to defer to more knowledgeable people.

OK. Thanks.

For what it's worth, the blood gas theory doesn't make sense to me. Presence of venous inert gas bubbles suggests deco stress but has very weak positive correlation to DCS. As such, Doppler results-typical means of detecting venous bubbles-are a poor predictor of impending DCS. This is extensively covered in hypobaric/hyperbaric literature.

Examination of dissolved inert gas in blood similarly inconclusive.

Complement system activation-elevated white count/platelet aggregation-could suggest deco stress, but again inconclusive for DCS.

The challenge is DCS isn't caused by venous gas, either free phase or dissolved. Venous bubbles transiting to arterial side via shunt is another matter. DCS is caused by bubbles in tissue. Unless, there is some marker found in blood which matches up with cellular damage caused by DCS I can't see where analysis of blood chemistry would serve to do more than possibly eliminate other, non-DCS, causes. I'll ask around and report back.

Skin bends typically manifests in the thoracic area, not at joints or in limbs. That doesn't mean you didn't present with skin bends, just curious. The muscle aches could be bends, but could also be otherwise. Typically frank DCS pain is joint localized, progressive and asymetric.

Tremors are not a typical skin hit symptom, either.

Finally, your exposure was trivial. Again, doesn't prove anything one way or the other.

As I said at the outset, I think you did exactly the right thing and you were given the correct care. It was very cool of you to post of your experience and I'm glad everything worked out.

Best regards and safe return to diving,

 

[ronski101]

I think I am going to go drink a glass of water

 

[Aussie_pro]

Thank you for posting the information about your dive and everything that you had to go through. What an experience. I am glad that you are ok and everything in the end worked out well. I'm a DMC and well I have heard of other DCS cases up to this point, haven't hear a lot in detail. I knew a lot about it before but it helps to know what goes on in chambers etc. ... or at least from my stand point because I have never been told of read anything on it....
Thanks again.
AP

 

[downdeep]

Once or twice a day sounds like a misprint...??

You'd have to be a camel.


This post made me cry.
An undeserved hit is at the top of my list of creepy things that give me nightmares.

To your continued health.

 

[DandyDon]

You'd have to be a camel.


This post made me cry.
An undeserved hit is at the top of my list of creepy things that give me nightmares.

To your continued health.

I later added....

I haven't seen the brochure in a few years. I think the instructions may have been to drink enough that you'd pee clear once or twice a day.

 

[Kendall Raine]

That I could not tell you as I never asked. I assume a blood gas analysis, but that is a guess and I would have to defer to more knowledgeable people.

FYI, I asked some knowledgeable people. I was looking for evidence of a DCS related blood marker. This was the closest they came up with. It relates to AGE and not, apprently, interstitial DCS:


"Engl J Med. 1994 Jan 6;330(1):19-24.

Elevation of serum creatine kinase in divers with arterial gas embolization.Smith RM, Neuman TS.

Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine.

BACKGROUND. Arterial gas embolism due to pulmonary barotrauma and the resultant cerebral gas embolism are catastrophic complications of diving. Previous studies have only rarely noted evidence of gas embolism to noncranial sites.

METHODS. Among 142 persons with diving-related injuries evaluated between January 1982 and July 1991, we identified 29 who had arterial gas embolism and who underwent biochemical studies indicative of muscle injury. Of the 29 patients, 4 were excluded because cardiopulmonary resuscitation had been performed and 3 were excluded because the duration of their dives met or exceeded standard limits set for dives not requiring staged decompression. The outcome at the time of hospital discharge in the remaining 22 patients was correlated with clinical factors and the results of biochemical studies. We also studied 22 subjects after uncomplicated dives and 11 patients who had sustained blunt trauma.

RESULTS. All the patients with diving-associated gas embolism had elevated serum creatine kinase activity (normal, < or = 175 U per liter); the values were markedly elevated (> 900 U per liter) in 14. The MB isoenzyme of creatine kinase was detected in the serum of 13 of 20 patients in whom it was measured and was > or = 4 percent of total creatine kinase activity in 6 patients. In three patients electrocardiography showed myocardial injury. Changes in serum creatine kinase activity of similar magnitude were not present in the subjects who had uncomplicated dives or in the patients with blunt trauma. Thirteen patients recovered fully, four had minor residual neurologic deficits, three were severely impaired, and two died. Logistic-regression analysis revealed a significant correlation between peak serum creatine kinase values and clinical outcome.

CONCLUSIONS. Biochemical evidence of muscle injury is frequently found after diving-associated arterial gas embolism. The correlation between serum creatine kinase activity and outcome suggests that serum creatine kinase is a marker of the size and severity of arterial gas embolism."

 

[rjk75]

I originally posted this on my local SCUBA forum in PDF form with screenshots of my DC download included. I could not post them on the forum here. If you want to see a copy PM me with an email and I can send you the JPG.

Shadragon, glad to hear you're okay and glad to read your account of what happened.
It sounds like you were treated properly although the delays (not being critical now) and
the mottling would've scared me more probably.

How can I get a copy of your DC jpg?

And BTW, I've never seen "mottling" although I had an idea of what it was.
Here's a link with some pics:

http://health.allrefer.com/health/skin-color-patchy-info.html

Best regards,

RJK75

 

[Spady]

Kendall,

Interesting abstract about elevated CK and DCS. Although an elevated CK is not specific, it would be kinda cool if the folks at DAN attempted a prospective study to look at this some more. You'd have to be at a major hyperbaric center with alot of patients with DCS to do it, but I assume they see as much of it at Duke as anyone else.

Spady