Spontaneous Pneumothorax

[Duke Dive Medicine]

This is controversial, really, I live in a "no sea" city so I guess I am not very much willing to trust just the surgeon, although he is great, but may be lacking experience on this, this guidelines are any good? you are proposing differently to them
Pneumothorax and Diving
Thak you for any comments

Hi Andres,

Medical clearance to dive, like most areas of medicine, is an constantly evolving field. As such, there will be different opinions on the suitability for diving of patients with issues like spontaneous pneumothorax. Even the criteria for initial medical evaluation for diving differs from region to region.

The statement I made above is what we typically tell our own patients. To borrow from the American lexicon, "your mileage may vary". A brief search of Pubmed returned a number of recent articles on recurrence of spontaneous pneumothorax. A few are linked below:

Contralateral recurrence of primary spontaneous pneumo... [Chest. 2007] - PubMed - NCBI
Role of Blebs and Bullae Detected by High-Re... [Ann Thorac Surg. 2012] - PubMed - NCBI
Staple line coverage with a polyglycolic ac... [J Nippon Med Sch. 2012] - PubMed - NCBI
Preventing recurrence of spontaneous pneumothorax... [Surg Today. 2010] - PubMed - NCBI

Best regards,
DDM

 

[AndresNOB]

That was an excellent answer Dr! But, my concern is that besides being a Dr myself, I am a diver (or should I say all the way around?) so what I am trying to get is clearance to dive. I very much apreciate your experience, therefore, and understanding this is not a medical consultation, and just a board opinion, I'd like a way to contact you by mail or personally (allthougn I live in Argentina) for you to analyse further my particular case, and the see if you find a way to "bend" tour rule a litle bit for me, here´s my e mail abesedovsky@hotmail.com
Thank you in advance (very much)
Andres

 

[Duke Dive Medicine]

Email sent.

 

[AndresNOB]

Didn't get it, Doctor. please recheck the email spelling or try abesedovsky@gmail.com

 

[Duke Dive Medicine]

Email re-sent.

 

[Kharon]

DR.,

Supposing a spont pneumo at 60 feet (or 30 feet, or 130 feet) - if you had a McSwain dart or a 14 gauge needle with you, would you puncture the chest cavity while still submerged or wait till surfacing?

 

[TSandM]

How would you EVER make the diagnosis underwater? There are many causes of chest pain that are not pneumothorax, and once you have placed a needle you have committed the patient to treatment of the pneumothorax you caused with it.

Having a pneumo underwater is really bad news, which is why this is STILL considered an absolute contraindication to diving. Of course, no one can stop someone who is certified from diving if they want to, but the risk assessment is such that no physician would okay it, and I suspect no instructor would take someone with that history as a student.

 

[Kharon]

How would you EVER make the diagnosis underwater?

Diagnosis is no problem for someone who has had one or more.

Having a pneumo underwater is really bad news, which is why this is STILL considered an absolute contraindication to diving. Of course, no one can stop someone who is certified from diving if they want to, but the risk assessment is such that no physician would okay it, and I suspect no instructor would take someone with that history as a student.

My Primary OK'd it and I had no problem getting certified.

I'd still like an answer. It would seem to me opening the chest cavity on ascent would allow the excess air to bleed off and removing the needle just before surfacing would prevent any water invasion. I would think surfacing before inserting the needle would do a great deal of damage to the lung, trachea, and possibly heart.

 

[Duke Dive Medicine]

I'd still like an answer. It would seem to me opening the chest cavity on ascent would allow the excess air to bleed off and removing the needle just before surfacing would prevent any water invasion. I would think surfacing before inserting the needle would do a great deal of damage to the lung, trachea, and possibly heart.

How would this scenario evolve? A diver with a known history of spontaneous pneumothorax goes diving with a buddy who carries a 14 gauge angiocath in a waterproof case, the diver drops a lung, the diver and buddy make the diagnosis while underwater, the buddy removes the diver's equipment because it sits right over the midclavicular line, stabilizes him so he keeps still for the procedure, locates the appropriate landmark, punctures the chest wall, evacuates the air ensuring that no water enters the chest when the diver inspires, stablizes the catheter, and gets the diver safely to the surface?

 

[Kharon]

How would this scenario evolve? A diver with a known history of spontaneous pneumothorax goes diving with a buddy who carries a 14 gauge angiocath in a waterproof case, the diver drops a lung, the diver and buddy make the diagnosis while underwater, the buddy removes the diver's equipment because it sits right over the midclavicular line, stabilizes him so he keeps still for the procedure, locates the appropriate landmark, punctures the chest wall, evacuates the air ensuring that no water enters the chest when the diver inspires, stablizes the catheter, and gets the diver safely to the surface?

Nope. I dive mostly solo. I would make the diagnosis (believe me I can tell the difference between a partial and a complete pneumothorax and even the aproximate extent), punch the needle through my chest (and whatever insulation I might be wearing) where they cut to put in the tube, ascend slowly taking my finger off the needle periodically on an inhale to allow air to bleed. Not pleasant but probably better than dying. My other option would be to head deeper and call it a day when I ran out of air.