Skin bend?

[Duke Dive Medicine]

Is it possible that it appeared earlier on and you only just noticed it 10 hours after the dive? Did it appear after a hot shower? Little speckles doesn't sound much like skin bends but without a photo it's hard to tell.

 

[DevonDiver]

I've seen a skin bend once for real. It was sudden onset - visible as soon as the casualty removed his wetsuit. It was accompanied by other DCS symptoms.

It was a mottled rash on the torso. It looked like these:

 

[Duke Dive Medicine]

Andy, yours looks more like cutis than a type I skin bend. What other symptoms did the diver have?

 

[DevonDiver]

Those pictures were from a google search, but pic #3 is very close. It was definitely a 'hit'.

The diver I mentioned was my buddy on a tech dive (Air, with 32% and 100% O2, to a depth of 70m with 25 minutes BT). It was the first dive on day 3 of a 3-day expedition.

On exiting the water (ladder exit) he removed his harness and immediately suffered the 'chokes'. He then undid his wetsuit and the marbled/mottled skin rash was evident on his torso. The rash become more distinct over the next 5-10 minutes. As the diver attempted to walk back from the 'wet area' of the boat, he suffered immediate and debilitating fatigue, along with weakness in his knee.

We were on a tech liveaboard at the time, 24 hours from land/chamber, so he was put onto pure O2 for several hours, and hydrated, during which the conditions resolved quite swiftly. He was monitored by a dive medic technician that was on the boat. As his condition was resolving, the decision was made not to arrange a helo evacuation (difficult in that region).

By the time we made made it back to land, his symptoms had entirely gone, except for lingering muscle soreness ("like the worst work-out I ever had"). Subsquent consultation with a diving medicine doctor cleared him and no chamber treatment was required.

He got a bad hit, but I was fine. Our dive profiles were identical and we were both fit, healthy and hydrated before the dive. We were both experienced tech divers/instructors and neither of us had DCI before. We concluded that the most likely cause was an extended period of deco hang... during which he had over-tightened his adjustable harness (I had a 'Hog' harness that is pretty loose) and he had also not stimulated/exercised his arms enough during the long hang. This may have resulted in insufficient off-gassing from his arms (hence the immediate hit on removing his kit).

Here's a photo of the skin bend. It was taken after approx 45mins on O2 and had resolved considerably by that time...

 

[Duke Dive Medicine]

Great shot, Andy. It looks a lot like cutis marmorata, which we differentiate from type I skin bends because it looks different and is usually accompanied by more severe DCS symptoms like your buddy. It looks a lot like a patient we consulted on who had cutis and chokes but did not survive. I had posted a photo but then thought better of it in case the guy's buddy looks here, but if you PM me your email I can send it to you. Your buddy is very lucky in a couple of ways. Frequently DCS symptoms come back with a vengeance after resolving on O2 if the diver isn't treated.

 

[boulderjohn]

Previous diving? Diving at high altitude? Fast ascent rate?? Fly immediately afterwards? Call DAN and talk to them but I would have dived that plan. VPlanner shows:

Decompression model: VPM - B

Just as an FYI, according to Deco for Divers, a flaw in the VPM-B algorithm is that it tends to be overly conservative for NDL dives like this.

 

[Kern]

Just as an FYI, according to Deco for Divers, a flaw in the VPM-B algorithm is that it tends to be overly conservative for NDL dives like this.

I think you're talking about the 1st version of VPM. The flaw, pressure gradient allowed, was fixed in the VPM-B revision, by taking Boyles Law into account.

If Deco for Divers suggests that VPM-B doesn't scale well from NDL through to hypoxic decompression dives, I think the author got it wrong.

 

[SEVEETS]

Thanks again, all... Spoke with a few experienced divers and the dm, who all felt it was not a hit plus the lack of even being close to the pics so I reckon I am fine bit will keep aware

 

[Bubbletrubble]

@SEVEETS: Were you wearing a wetsuit over the affected area or was it exposed to the water during the dive? Where were you diving? Is it possible that you were stung by some sort of stinging creature (jellyfish, fire coral, etc.)? Can you think of any garment or personal item that was in contact with area in question? In particular, think about what you did in the 10 hours following the dive. Did you brush up against something (encrusted rope, etc.)? Were you leaning against something on the boat ride back to shore?

With a rather benign profile (with respect to DCS) and a tiny, localized rash not involving the trunk/other parts of the body, I'd be looking at other possible causes...

 

[wedivebc]

Great shot, Andy. It looks a lot like cutis marmorata, which we differentiate from type I skin bends because it looks different and is usually accompanied by more severe DCS symptoms like your buddy. It looks a lot like a patient we consulted on who had cutis and chokes but did not survive. I had posted a photo but then thought better of it in case the guy's buddy looks here, but if you PM me your email I can send it to you. Your buddy is very lucky in a couple of ways. Frequently DCS symptoms come back with a vengeance after resolving on O2 if the diver isn't treated.

Are you referring to the picture on post 14 or the pictures from post 12? Because I have looked like the above pic on several occasions