Quality of initial diagnosis and treatment

[drbill]

I was diving Catalina last weekend. Had just surfaced and went over to talk to an instructor friend of mine who had just completed an intro. As I came closer, I noticed that his face and speech were distorted. I said "You look terrible." His response was "thanks for confirming how I feel."

It looked fairly obvious to me that he had suffered a stroke or a cerebral embolism. Half his mouth drooped, his speech was slurred and he was disoriented and tired. I had a stroke years ago while working with the Cousteaus on Alycone so I was familiar with the symptoms.

I told him what I thought and he went to see the paramedics right away. I didn't see him until the next day. The paramedics had sent him to our local hospital, a new visiting doctor at the hospital had sent him to the mainland to get a CAT scan and the doctor at the VA Hospital had tried to talk him into recompression since he alone agreed with my diagnosis.

It disturbed me that no one gave him oxygen until well after he was on the mainland. No one until the VA identified the nature of the problem. This concerned me since we host tens of thousands of divers a year in our waters. Normally our paramedics are quite good, but this is the second diving accident I've been "involved" in where oxygen was not administered. I would think this is standard practice.

Dr. Bill

 

[DocVikingo]

Indeed it is standard practice to begin the administration of 100% 02 immediately upon noting such signs & symptoms. Given that your friend is an instructor, one would hope that he had grasped his situation and demanded 02.

In any event, it appears that the paramedics dropped the ball on this one. You may wish to share your observations with the management of that paramedic unit in case training is needed.

As for the local hospital, one would think that being situated near a major scuba mecca would imply some level of understanding of DCI. However, truth is the average ER/physician has next to zero knowledge of diving medicine.

Best regards.

DocVikingo

 

[Saturation]

Couldn't concur more with DV. If any consideration for injury related to diving must be made, even with a completely bogus complaint, you can't hurt the situation by breaking out 02 and work out the details later.

 

[drbill]

Many thanks to both DocVikingo and Saturation. I will be talking to the individual who oversees the paramedic/EMT operations to determine their policy and see why oxygen was not given. It is possible the dive instructor refused it... he can be pig-headed on occasion, but he's a nice guy. In the other case it wasn't even offered (my buddy thought she had a DCS hit which I didn't concur with but we played it safe by calling them in).

Dr. Bill