What Factors Influence Chamber Rides?

[Cacia]

I would like to know the medical factors (symptoms, timeline, etc) and any political or insurance pressures/ realities you have knowledge about.

How does the consumer/ diver assess these from a health consumer perspective?

thanks

 

[jeckyll]

I think the factors here in Canada may be different than in the US. I often hear about the rides being taken as I dive with some folks in the industry and it seems a number of them turn out to be 'preventative'.

 

[Cacia]

yes...I have seen that also. So...as we know more, maybe those will become less prevalent?

 

[Dr Deco]

Hello catherine96821:

Probably the major factors influencing the use of hyperbaric treatment are:

1. The presentation of the signs and symptoms of the diver,
2. The “dose” of inert gas (i.e., the dive profile(s),
3. The time interval between the dive(s) and presentation at the chamber.

Signs and symptoms

Certainly it is clear that the medical problems must resemble those associated with DCS. These would include weakness, numbness, painful joints, etc. The worst would be complete loss of consciousness.

Many things can cause the lesser problems (pain, numbness), the most common being simply hauling gear [before and after the dive] and straps that pinch nerves.

The “dose” of inert gas

Examination of many dive profiles will indicate that the load of inert gas is too small and DCS is virtually impossible. Dives of twenty minutes at forty feet, for example, is not going to put much nitrogen into tissues. Longer, deeper dives [and repetitive dives] would increase the probability of DCS.

A too-rapid ascent could indicate that pulmonary barotrauma is paying a role and gas loads would be secondary.

Duration to Repress

The best result from hyperbaric therapy is expected when the interval between dive and repress is not longer than about five hours. After a duration of time, edema [fluid accumulation in tissue] replaces the gas phase [bubbles] and pressure no longer will squeeze anything. The hyperbaric oxygen that is administered during repress is beneficial at this point.

Other Points

Hyperbaric therapy is virtually without risk of side effects when performed properly, and thus it is often administered even when cases are doubtful. The limiting factor in this case is that the therapy is not cheep.

Dr Deco :doctor:

 

[Cacia]

Thank you very much for your reply!

So...if you had better insurance, would you see a more conservative treatment, in general? For example...my neighbor came home from Palau and was put in the chamber five days later.

And depth of 200 feet on air would not necesarily "buy" you a ride if it was a bounce?
(seperate case)
I am wondering at what point cost of transport weighs in, and who decides?

If someone states they have joint pain, is this ever discerned to be psychosomatic upon clinical exam? Say the shoulder was aching, could the physician discriminate exertional pain from DIC symptoms, or would this just be one more symptom that he would put in the context of the entire incident?

At what point out, time wise, post dive would recompression no longer be indicated?

I think we have all seen instances where family members or SO must press for treatment in other situations, especially since managed care and capitation has become the norm. What, if any, could the consumer be advised to do if you think chamber treatment is desired but is not offered, and yet you do have some type of insurance?

I realize this might be a loaded question but I think in most medical situations patients have a better sense of when treatment is not going as expected. Long labors, bleeding in an ER for hours, untreated chest pain...I am curious to know if there are any absolutes in the treatment protocol or criteria that physicians use.

And lastly, if a person is uninsured is it ever likely that recompression would be denied, in an American ER?...has any medical proffesional heard of it denied in a foreign ER, and under what circumstances? (need to have authorized reimbursement, cash up front etc)

 

[Dr Deco]

Hello catherine96821:

I cannot give answers to the questions because I believe they will vary around the country and the world. I will attempt to guess, however. I am certain that others would have different experiences.

If you had better insurance, would you see a more conservative treatment?

People are always will to be more accommodating if you can pay for their services. That is why divers are always advised to have medical insurance (DAN sells such a thing). "He who dances must pay the piper."

Anything that is elective is influenced by the ability to pay. Medical personnel have bills the same as the person who sells groceries.

Many times, “up front” payment is required. A medical air transport facility will not move you [and expend the cost for fuel] if there is no chance that you will be able to pay. They would be “stuck” with a bill of thousands of dollars.

There are many situations where the ability to pay must be balanced against “individual choice,” and the need for treatment. Many motorcyclists (and auto drives) do not like to wear helmets or seat belts. They end up in the emergency room and often some third party must “eat” the cost. I personally believe that is irresponsible to expect another to cover the cost when I do not exercise preventative measures.

A depth of 200 feet on air would not necessarily "buy" you a ride if it were a bounce?

I believe that a 200-foot bounce would be sufficiently gas loading.

If someone states they have joint pain, is this ever discerned to be psychosomatic upon clinical exam?

If the gas loads were sufficient, one could not rule out DCS. Chamber treatment would then depend on availability and the ability to pay. DCS is most likely mistaken for muscle exertion that a problem that is “all in the head.”

At what point out, time wise, post dive would recompression no longer be indicated?

Chamber treatment [hyperbaric oxygen] is always of some utility, but the expectation of good results would go down after a couple of days. Neurological problems are generally treated daily until the patient shows no further improvement.

What, if any, could the consumer be advised to do if you think chamber treatment is desired but is not offered,

I would have the patient call DAN and have the medical staff speak directly to the local medical provider.

I am curious to know if there are any absolutes in the treatment protocol or criteria that physicians use.

There are few absolutes in the “science and art” of medicine. Some individuals are better diagnosticians than others. You can endeavor to be an informed patient. I know what you mean and have what I call “Powell’s Principle.” It states, “It is best to know the diagnosis before you seen the physician.” For most people, that clearly would be very difficult.

If a person is uninsured, is it ever likely that recompression would be denied, in an American ER?

If the patient has a life-threatening condition, e.g., dying of massive gas embolism, I believe that they would be treated. I do not know ablout foriegn countries.

Addendum

These are my observations over the decades. I am, however, a researcher and not a clinician. Clinical readers might wish to add their comments to mine.

Dr Deco :doctor:

 

[Cacia]

Thank you very much.

I was under the impression that 200 feet would get you a chamber ride also.

I have insurance, always have, even though I get very confused about if my insurance company would cover me anyway. It is inexpensive enough that I opt for it. If it became more expensive, or they failed to provide service of a chamber, or if I had significantly less money, I would need to sort this out.

The letter on the DAN site about the guy who went to 200 feet had me very curious that maybe there was information missing, or some new protoccol for diagnosis and recompression.....some advanced ultrasound doppler study or something....

Thanks for the information!

 

[Dr Deco]

Hello catharine96821:

I read the article on the DAN website and will make the assumption that insufficient data is provided. Apparently when one factors in the stops using a full description of the dive profile, as DAN apparently did, it was clear to them that DCS is not probable.

Since we do not have the dive profile, it appears to be a harrowing experience.

Dr Deco :doctor:

 

[victor]

Catherine
There will be no room in the chambers in the UK as they will all be full of recovering football players.

Smith is spending three hours a day in the pressurised facility in St John’s Wood, North London, which is believed to reduce recovery time by increasing the amount of oxygen in the body. By breathing pure O2 as opposed to the 21 per cent found in regular air, more oxygen is disolved into the body’s tissues and inflammation is reduced.

http://www.mk-news.co.uk/sport/mk d...oneys route to recovery in oxygen chamber.lpf

It won't be long before you will need to book your ride 6 months in advance.