Teenager with DCS, mother in denial, treatment delayed

[ginti]

I have not seen soft-sided chambers in HBOT (HyperBaric Oxygen Treatment) centers. Most that I have seen are rigid one-person "torpedos" that are limited to 2 ATA or less.

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Most either have acrylic tubular hulls or have very large view ports to reduce claustrophobia and allow the operator to observe the patient for OxTox Symptoms. AFAIK, soft-sided chambers are primarily used for air-evac and very remote operations.

You are quite correct that the vast majority of these chambers are less than ideal for DCS treatment, bordering on inappropriate. Multi-place chambers are important to allow for an inside tender since DCS patients may not be conscious and to do neuro exams at treatment depth. In addition, DCS treatment chambers should have a minimum operating depth of 165'/50M.

The one I have been to here in France was actually quite big, for several people; I don't have any photos, unfortunately...

EDIT: here you are: Chambre hyperbare : Lyon sous pression

 

[Akimbo]

The one I have been to here in France was actually quite big, for several people; I don't have any photos, unfortunately...

A much smaller number of multi-place chambers are used for HBOT, but all that I know of are hard-sided (steel or aluminum). Scheduling normal HBOT patients (burn, gangrene, etc) is harder because not all treatment periods are the same.

I suppose that patients can be locked in and out through entry (outer) locks, but most HBOT centers prefer the single patient torpedos, at least in the US. Torpedos are also easier to sanitize between treatment. There is some reluctance to keep the tender (inside attendant) under pressure for so long, day after day.

It is easy to understand why hospitals are reluctant to treat bent divers. What do they do with all the patients that are scheduled for an hour or two at 20'/6M — keep them in a hospital bed for an extra day? Divers with DCS have an inconvenient habit of showing up on weekends and at late hours. DCS Treatment can last from a 2:15 at 60'/18m for a simple Table 5 to a Table 6a for almost 6 hours to a max depth of 165'/50m. There are longer and deeper treatment tables but it is very rare to used them except in commercial diving operations.

You would go broke just treating divers, and some say treating divers at all. It is becoming increasingly apparent that DCS treatment is not compatible with healthcare systems, outside of major dive resort areas anyway.

 

[ginti]

@Akimbo I was actually going to ask the question but you provided the answers before I even asked thanks for the explanation!

 

[John the Pom]

Interesting. I never gave this subject much thought because I used a computer from the beginning. But I've always been a little hazy on the concept of "bottom time" as opposed to dive time. Sure, on a square-ish profile like a wreck dive from a boat it seems clear enough; even if you drop to the sand and work your way up to the top of the wreck, your bottom time ends when you start up the anchor line. But most of my dives aren't like that--most of the time, there's stuff to see and linger over at least most of the way to the safety stop depth. My favorite local night dive is at Veteran's Park in Redondo Beach. We usually surface swim out to about the end of the pier (which still puts us in only about 20-30 feet of water), then follow the slope down into the canyon. Sometimes we go to the monument (60-65 ft); sometimes to the sailboat (80-90 ft), sometimes just out into the abyss (we stop at 130 but one can easily go deeper.) Twice when going to the sailboat, I've actually incurred one minute of deco while I was already on the way back to shore. And I was pretty far along on the way back, too; it wasn't as though I waited until my NDL counted all the way down before turning the dive. Both times, I began swimming straight back up the slope toward shore with at least 5 minutes remaining. But I've discovered that, if I don't want to come up off the bottom to where I can't even see it, and I don't want to go into deco, I need to turn the dive with more like 10 minutes NDL remaining. (Of course, both times the 1 minute of deco disappeared before I reached the stop depth, and by the time time I hit 30 feet I was back to 99 minutes NDL. The safety stop countdown begins at 20 feet, and even though I don't stop, the timer clears before I get to 15 feet.) So what the heck even is bottom time vs. ascent? And how do you properly account for it without a computer?

It certainly limited your diving, if you stuck to your training. We were taught not to go repeatedly shallower and deeper, base our calculations on a rectangular profile using the maximum depth reached, know our planned depth and NDL before we descended, etc. It meant that you missed out on bottom time, but it tended to push you towards conservative diving.

 

[John the Pom]

Using twin independent doubles where one has to switch regs to balance out the pressures is an accident waiting to happen at the best of times! And especially so at depth!!

I watched a person die swapping regs at depth, when he mistakenly switched to o2.

And then a close relation of mine almost died / got bent real bad from exactly what you describe above, that is although he thought he was switching regs he kept, 'seemingly' (as I wasn't there), putting the same one back in his mouth. When that cylinder ran out, and being obviously incapacitated in the 50-60m zone on air, he tried to ascend, passed out, and floated back down where another diver/s found him. They got up him up and back on the boat missing all his deco and 'seemingly' dead, manage to get some life back into him by the time the chopper arrived, and long story short, it turned out to be a case where they thought he would not survive, but he proved them wrong although his diving was over for some years, and his deep diving days were over, period. But now we digress from the thread at hand..

@Dr Simon Mitchell, thanks for the answer re the IWR kit photo, and Miria says to say hi!

This was the old days, when only commercial divers and the military used mixed gasses, and, apart from some very specialist stuff, the breathing mixture was controlled from the surface, not by the diver.

My friend was involved in the recovery of a diver who died doing something very similar to what you describe, which, speaking as an engineer, clearly violates basic safety principles. That was around the time I decided that amateurs doing deep dives beyond 50m without the kind of surface support available in the Navy wasn't for me.

In the incident I described, nothing bad happened because we dived a strict buddy system. The person who became badly narced was diving with an experienced buddy who spotted right away what was happening and took steps to correct it.

 

[SubMarineBiologist]

Really? What agency is that? There's no mention of this procedure at all in my PADI OW manual. In fact, there's no discussion of what to do if you suspect DCI.

I was taught at PADI OW level the symptoms of DCS and what to do if you suspect DCS (O2 administration and get to a chamber!)

 

[SubMarineBiologist]

FWIW - A buddy who teaches PADI referred me to Chapter 5 of the PADI Open Water manual on this. We didn't have time to discuss, he just told me suspected DCS sickness response is covered in Chapter 5. Take a look there and see if it tells you anything. I have no idea what it say as I'm not a PADI instructor, LOL

Yup, within section 5 it's all there.

 

[mstevens]

Look up requirements to be a chiropractor,

I did! Did you?

pre med degree

No such thing, really. Of the 204 people in my medical school class, a majority had biology degrees, but we had all sorts: English, engineering, nursing, architecture, German literature, and at least one art history among classmates I got to know well.

and then a PhD, yup sounds like pseudo science to me.

I once came into proximity with a therapist who used the term "doctor" because of her Ph.D.. That degree turned out to be in Forestry Management, and a Ph.D. isn't necessarily of much use in other fields. All the chiropractors I know (in the US) have D.C. degrees. None has a Ph.D. (One has an M.D. earned later and keeps the D.C. secret).

I just checked 3 US chiropractic schools' websites. They require 30 undergraduate hours, though not necessarily an undergraduate degree. They say that's 3 years of undergraduate. I took 28 credit hours one undergraduate semester.

Those chiropractic school websites say it takes 3 years to complete chiropractic training. That means that, for people who do all their training in sequence right after high school, chiropractors are out practicing while medical students are just starting their 2 years of clinical training before their 3-5 year residencies and whatever fellowships they might do. So, about half the number of years, on average (3+3 vs 4+4+3 to 5), compared with physicians.

Yes. Definitely sounds like pseudoscience.

There is some evidence that chiropractic can help with certain types of back pain. However, chiropractors seem unable to reach consensus on things such as which images show "lesions" and the evidence that chiropractic can't treat diabetes, gout, hypertension, or DCS is overwhelming.

I will say that the chiropractor in this story is the first person who did anything sensible (after he stopped mucking about with manipulations) by referring the kid to urgent medical care.

Do a little research into some of those homeopathic stuff. Some of it actually works, others don't.

Literally none of it works. All homeopathic remedies of one form (liquid, tablet, whatever) are exactly identical to all other homeopathic remedies of that form. By definition, they've been diluted beyond the limits of what's mathematically possible (the water of which they're made would have more constituents of dinosaurs than their supposed ingredients).

Are you perhaps mixing homeopathic up with naturopathic? I had a patient do that once, who ended up using cinnabar (homeopathy for tremors) and because she took non-homeopathic doses (i.e., some) of the cinnabar (mercury ore) ended up with worse mercury poisoning. Turns out she, like many in the area, had high mercury levels in her well water and the initial tremor was likely due to that.

This is, by the way, radically different from osteopathy. That involves "osteopathic manipulation" but thorough medical training as well. All my PCP's in recent years have been osteopaths.

 

[mstevens]

Raw honey works as a antibiotic ointment in place of neosporine.

That's naturopathy. Not homeopathy. Not all naturopathic remedies, work, but many do.

 

[BlueTrin]

Literally none of it works. All homeopathic remedies of one form (liquid, tablet, whatever) are exactly identical to all other homeopathic remedies of that form. By definition, they've been diluted beyond the limits of what's mathematically possible (the water of which they're made would have more constituents of dinosaurs than their supposed ingredients).

Isn’t there evidence that the placebo effect exists, for things which are mostly symptoms modulated by the brain (pain management, some types of fatigue/insomnia, …)