My Wifes IPE in Cozumel

[Griffo]

This event is very similar to the two IPE's I have witnessed. We now know a lot more about it than when these happened. Yes, the treatment is to keep sitting upright to keep the fluids at the bottom of the lungs (I think). I am glad that it was a good outcome, one of the ones I was involved was not, our friend died.

Sorry to hear about your friend, it must have been a harrowing experience. Yes I agree that it does seem to be far more recognised, although much more needs to be done imho to raise awareness. That's partly why I wrote this up, I think we need to keep reporting incidents so people are aware and more data can be gathered.

That was quite a write up. Thank you. I’m glad to hear that your wife has recovered, and that you recognized IPE as a possibility very quickly. The DAN article was very educational.

Immersion Pulmonary Edema - StatPearls - NCBI Bookshelf

Thanks for the article, it's actually really informative.

Thank you for the detailed report. It sounds like you had IPE at the top of mind immediately upon ascent, did your wife as well? Just wondering if that contributed to her calmly dealing with the situation or whether that was just nerves of steel.

I know that IPE popped into my head from the moment she first said "I can't breathe" on the surface. During the ascent I was completely focused on just getting her to the surface as quickly and safely as possible.Once the crackling and pink sputum were evident I was pretty convinced. I only knew about IPE from scubaboard, my wife had never heard of it.

We've discussed it a bit and agree that training kicked in big time. Both from the GUE side (the whole team diving ethos, communication, being able to ascend together face to face, controlling ascent speeds) and my rescue training (keep close enough to take control, get her buoyant on the surface, protect her airway, get the boats attention, how to de-kit her and get her up the ladder etc). I'm also glad I've done O2 and first responder etc. so I could monitor her on the boat.

From my perspective I know I kind of snapped into a different mindset, I don't know how to properly explain it. I never felt scared or anxious, I was just following the script if you will. I 100% put that down to Stress and Rescue training and Fundies. I wasn't until I got home that night that it actually hit me how close a call we'd had.

Scarily similar to my experience of IPE. Some of it verbatim. I wrote it up here a good few years ago. Pulmonary Oedema incident

Well done for getting out alive. Christ I remember like yesterday that feeling you had when hitting the surface and realising ‘I can’t breathe’. It’s not the best feeling in the world.

I can't even imagine, your incident seems much closer to disaster than ours. Glad to hear that you've recovered well, I assume you've had no re-occurrence and have continued diving?

 

[Griffo]

Felt like I was reading a page turning thriller. Discussed this with my dive buddy-spouse. We've been diving together for 27 years and I hope we respond as well as you two if the same thing happened. We did agree after reading that we will call the dive if we have to spend more than 10 minutes finning after the group unless there is a nice reef to stay on. Forget the group, enjoy the reef and just use our SMB when we're done. As to DM responsibilities, it's been strongly discussed on Scubaboard many times. I don't rely on them because they have multiple folks pulling them in different directions. If we can't keep up, we don't. I hate swimming hard, period. Lazy, I guess.
Thanks again for the great write up.

Rob

Yeah sorry if it's come across as us blaming the DM in any way. We don't, there's nothing he could have done to assist. I just found his actions a bit relaxed. He had one of his clients on the boat on O2 and the captain making the emergency signal but he at no stage seemed in any hurry to find out what the problem was. It may just be a cultural thing.

 

[chillyinCanada]

Yeah sorry if it's come across as us blaming the DM in any way. We don't, there's nothing he could have done to assist. I just found his actions a bit relaxed. He had one of his clients on the boat on O2 and the captain making the emergency signal but he at no stage seemed in any hurry to find out what the problem was. It may just be a cultural thing.

Regardless any other considerations, I can see why his apparent behaviour was disconcerting to you.

 

[InTheDrink]

Sorry to hear about your friend, it must have been a harrowing experience. Yes I agree that it does seem to be far more recognised, although much more needs to be done imho to raise awareness. That's partly why I wrote this up, I think we need to keep reporting incidents so people are aware and more data can be gathered.

Thanks for the article, it's actually really informative.



I know that IPE popped into my head from the moment she first said "I can't breathe" on the surface. During the ascent I was completely focused on just getting her to the surface as quickly and safely as possible.Once the crackling and pink sputum were evident I was pretty convinced. I only knew about IPE from scubaboard, my wife had never heard of it.

We've discussed it a bit and agree that training kicked in big time. Both from the GUE side (the whole team diving ethos, communication, being able to ascend together face to face, controlling ascent speeds) and my rescue training (keep close enough to take control, get her buoyant on the surface, protect her airway, get the boats attention, how to de-kit her and get her up the ladder etc). I'm also glad I've done O2 and first responder etc. so I could monitor her on the boat.

From my perspective I know I kind of snapped into a different mindset, I don't know how to properly explain it. I never felt scared or anxious, I was just following the script if you will. I 100% put that down to Stress and Rescue training and Fundies. I wasn't until I got home that night that it actually hit me how close a call we'd had.



I can't even imagine, your incident seems much closer to disaster than ours. Glad to hear that you've recovered well, I assume you've had no re-occurrence and have continued diving?

Dunno. Sounds similar. Not breathing is not breathing.

I was mainly concerned to raise awareness of this condition. Glad you did same.

Been diving around 50-100 dives per year. No recurrence. Thank ****.

Take care and be lucky

 

[Diving Dubai]

much more needs to be done imho to raise awareness.

I opened a thread ( Diver Guidance for Immersion Pulmonary Oedema IPO) on this a couple of months ago, although I now realise that in the US it's referred to as Immersion Pulmonary Edema (IPE)

There has been a push in the UK to publicise this more widely. Your wife's symptoms were textbook signals, so more divers need to be aware. See teh notes in my thread post

Further reading

DAN immersion-pulmonary-edema.

UK DMC Immersion Pulmonary Oedema

Edit: Last 2 articles were also referenced at the start of the thread but I think it's worthwhile highlighting them again

 

[Charred]

I've never heard of this before so I enjoyed the read.

To the OP: you spent a considerable amount of time on sinus issues. Was this relevant to the issue or were you venting a bit of frustration? I understand if the latter.

Do you believe getting semi-separated from the DM contributed to this?

Were the 33% nitrox tanks tested before the dive?

Were they tested afterwards for CO?

Lastly, you have not named the dive op. This is an unflattering report on the DM. Do you believe this contributed? If so I believe you have a duty to name the op.

Thank you for the write up.

 

[risc]

Thanks for taking the time to write this up. I think my OW training briefly mentioned IPE as a possible effect of a rapid ascent but no details on what it's actually like nor that it could happen on a normal dive profile.

 

[Lorenzoid]

Thanks for taking the time to write this up. I think my OW training briefly mentioned IPE as a possible effect of a rapid ascent but no details on what it's actually like nor that it could happen on a normal dive profile.

Apparently it has even happened to surface swimmers. From what I have been reading, I get the impression that ascent rate is not believed to be a factor.

 

[Diving Dubai]

Apparently it has even happened to surface swimmers. From what I have been reading, I get the impression that ascent rate is not believed to be a factor.

IPO/IPE is only now becoming better understood. But for sure the trigger or "strenuous exercise" could be fighting current or lots of finning.

According to the articles cited in this thread that: There is also evidence that IPO may be the commonest cause of death in amateur scuba divers

Also the same source (UKDMC) states that:

A survey showed that 1.4% of triathletes had one or more episodes of IPO/IPE Most triathletes that die during an event die during the swim, rather than during the cycle ride or run.

 

[Diving Dubai]

Thanks for taking the time to write this up. I think my OW training briefly mentioned IPE as a possible effect of a rapid ascent but no details on what it's actually like nor that it could happen on a normal dive profile.

From information in this thread

Causes of IPO
When we are immersed in water, the hydrostatic pressure causes compression of leg veins. As a result, blood that normally pools in the legs is pushed centrally into the chest. The increased central blood volume increases the pressure in the alveolar capillaries and may cause fluid to leak into the lungs and cause difficulty breathing and if not corrected can cause death.

It has been known for some time that high blood pressure carries increased risk of pulmonary oedema, which is why it forms one of the screening questions on a diving medical form. What was previously less understood is that very strenuous exercise could trigger IPO. This had previously been reported in military divers under extremes of training. That level of extreme exercise might arise in diving for example when attempting a rescue of another diver or fighting a current.