Spontaneous Pneumothorax

[danvolker]

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.

There are easier ways to commit suicide, and without causing the trauma to all the other divers on the boat that such an event would cause. I suppose if you really hate other divers, and really wanted to give a dozen or so other divers intense nightmares for life, your diving with the pneumothorax might be a smart way to accomplish this...

 

[Duke Dive Medicine]

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.

I truly can't decide whether we're being baited here but I'll go ahead and bite.

From the way you're describing your ability to sense the size of your pneumothoraces, it sounds like you've had several. IMO what you're proposing is pretty much like an epileptic skydiver putting a trampoline in his LZ. Please go back and read what danvolker said, and consider it carefully.

 

[TSandM]

If you've had multiple spontaneous pneumothoraces and somebody signed you off to dive, I'd love to hear that person's reasoning for approving it.

Tension pneumothorax is potentially lethal, and to that extent, you would be better off with an angiocath in your chest. Inserting it through your exposure protection almost guarantees that you will introduce foreign material into the chest cavity and set yourself up for an infection, but it beats being dead. Same for the almost unavoidable introduction of water into the chest cavity when you reach the surface. Honestly, I'm with DDM. The answer here is to avoid the issue in the first place, not come up with wild strategies for coping with it.

 

[cutlass]

Yes, having a conversion with your primary may prove most interesting.

A needle thoracostomy isn't a simple stab to the chest. For an average adult male, you're looking to punch-in something about 3-4mm in diameter to a depth of at least 4.5cm, likely much deeper. Even if you're stabbing through an established location of existing scar (which itself is pretty tough material), the angle is critical; first, to get past, over the top of a rib; second, not deflected so high as to stab large subclavian vessels; third, not deflected so central as to puncture large vessels or the heart itself. And during the struggle to do all this, the survival clock is counting down. But let's suppose we skip all this foreplay and head for the roof as soon as the pain of a popped bleb is felt. Then there's still the annoyance of a swim-in and transport to definitive care.... the clock keeps winding down.

Find another sport. There's plenty.

 

[Kharon]

First, no I'm not baiting. I had three SPT's in 1967 over a 2 week period. First was a partial, got tubed and a weeks rest. Second was pretty much a full, got tubed (poorly) and the third happened that evening with the tube in. Got tubed. Nothing since. If I remember correctly pleurodesis was done after the third.

I had no idea that a 14 ga needle was 3-4 mm. Not an option. Guess I'll just head deeper and enjoy a last dive IF it ever happens.

Another sport? Don't think so. If I hadn't seen this thread I would have kept diving, oblivious to the "danger". Moreover, the clock isn't only winding down it's nearly run out. I've reached the point in life where I'm tired enough to say enough is enough and too much is too much. One way or another I don't have many years left and I look forward to finally giving up the fight. Passing while I'm doing one of the few things left that brings me joy is fine with me.

Other divers? What about the word solo don't you understand. I've only ever been on a dive boat once in my life and that was one time too many. I don't hate other divers, wouldn't want to freak them out, I simply prefer the freedom that solo diving affords. I had wanted to go on a couple of live aboards (with the proper attitude) but have given that idea up (due to this thread) because it wouldn't be fair. Unless, of course, my primary says that I have nothing to worry about. The only time I don't dive alone is for Milfoil remediation - 15'-18' max depth - mostly 8'-10'. That's half an atm. at worst. About a 50% increase in volume. Even a full SPT would (probably) be surviveable, if uncomfortably.

 

[Duke Dive Medicine]

Kharon,

If you truly have a terminal disease, I'm all for having a say in how you go out. That information puts a bit of a different spin on things, as the advice we give divers with terminal conditions is basically to have at it if they're physically capable. We tell them in detail what could happen in the water, strongly advise them to have a close friend who knows about their condition as a dive buddy, and wish them godspeed.

FYI, a 14-gauge angiocath is not 3-4 mm in diameter, it's just over 2mm. Also, the proper insertion point for a needle decompression is the midclavicular line in the second intercostal space (between the second and third ribs). This is directly underneath the BC or backplate strap. You can't put an angiocath through either and expect it to function properly. Also, as cutlass pointed out, sticking a needle in the wrong place in the chest is at best extraordinarily painful and at worst can cause a lethal hemorrhage. Performing a needle decompression properly is difficult and the potential complications are serious. It should not be undertaken without the proper training and considerable practice. For you to do it on yourself, under water, with equipment in the way, would be next to impossible and is, in the eyes of a medical professional, mind-boggling to even consider. That's why the medical people here, myself included, were all a bit taken aback by your post.

Best regards,
DDM

 

[Kharon]

FYI, a 14-gauge angiocath is not 3-4 mm in diameter, it's just over 2mm. Also, the proper insertion point for a needle decompression is the midclavicular line in the second intercostal space (between the second and third ribs). This is directly underneath the BC or backplate strap. You can't put an angiocath through either and expect it to function properly. Also, as cutlass pointed out, sticking a needle in the wrong place in the chest is at best extraordinarily painful and at worst can cause a lethal hemorrhage. Performing a needle decompression properly is difficult and the potential complications are serious. It should not be undertaken without the proper training and considerable practice. For you to do it on yourself, under water, with equipment in the way, would be next to impossible and is, in the eyes of a medical professional, mind-boggling to even consider.

Yeah, obviously not something I could attempt even if I still wanted to, and believe me I DON"T. Got to give this a lot of thought and talk to my primary. I may end up selling my diving stuff and just keeping the snorkeling equipment. Possibly, I could keep my depths shallow 10'-15'. That way if the worst happened I might have a fighting chance. I seriously hate to give it up. Well I've got all winter to mull it over. I do appreciate all tthe information and comments.

 

[TSandM]

Kharon, all risk analysis is precisely that. Advice to avoid certain risks is usually based on the idea that someone has a long potential lifespan if the risk is avoided. When that isn't true, the risk analysis becomes completely different. I can remember someone with stage 4 breast cancer asking about the risks of diving while on chemo; she was not expected to survive her illness, and at that point, avoiding small risks seems pointless if doing so reduces the joy of living.

 

[Kharon]

Kharon, all risk analysis is precisely that. Advice to avoid certain risks is usually based on the idea that someone has a long potential lifespan if the risk is avoided. When that isn't true, the risk analysis becomes completely different. I can remember someone with stage 4 breast cancer asking about the risks of diving while on chemo; she was not expected to survive her illness, and at that point, avoiding small risks seems pointless if doing so reduces the joy of living.

I guess at this point the risk seems small since it's been 45 years and the 3 SPT's all occured over a couple of weeks then stopped. When they occured I had been heavily smoking cigarettes, which I immediately quit. I was also under a great deal of stress - taking Zoology from a professor know as "The Gator". Both incidents happened the day before a Zo exam.

I've engaged in severe physical exertion most of my life, for example, I both played and refereed high level soccer untill a few years ago. My biggest fear is the pain I would experience before passing. I've heard drowning isn't particularly pleasant or necessarily quick and heading for the surface seems out of the question from more than about 10' to 15'. In a lot of ways I wish I had never seen this thread. LOL.

 

[TSandM]

If it makes you feel any better, the lethal risk from an underwater pneumothorax is tension physiology. This is where the increased pressure in one side of the chest pushes the structures in the center to the other side, and kinks the veins that are bringing back blood to the right side of the heart. Inadequate blood return causes unconsciousness and even cardiac arrest. So if you did drown, you'd be unlikely to know it.