There's a lengthy thread on this in the "Scuba Related Court Cases" forum.
Woman sues five-star holiday resort for £50,000
- Thread starter ScubaToneDog
- Start date
Please register or login
Welcome to ScubaBoard, the world's largest scuba diving community. Registration is not required to read the forums, but we encourage you to join. Joining has its benefits and enables you to participate in the discussions.
Benefits of registering include
- Ability to post and comment on topics and discussions.
- A Free photo gallery to share your dive photos with the world.
- You can make this box go away
iamrushman
Contributor
thanks..I'll head over there....
Hello,
This is a very interesting case.
Taking the newspaper story at face value, a few points to come out of the discussion.
Is this a coincidental non-diving-related problem? I think that the fact that there were two events which both occurred virtually immediately after dives essentially rules this out.
Is this decompression sickness (formation of bubbles from dissolved gas) or arterial gas embolism (introduction of bubble to the arterial circulation by lung over-pressurisation)? It is almost certainly one or the other, but it does not fit the typical pattern of either particularly well.
The main argument against DCS is the non-provocative nature of the dives coupled with the short latency of the symptoms (clearly described as occurring immediately at the surface on the first occasion; a bit more vague on the second). It is possible to see venous gas emboli (VGE) after a 10m dive, but usually after a dive a lot longer than these, and it typically takes longer after the dive for the bubble formation process to become established. Nevertheless, if she did form VGE and if she has a readily shunting PFO or pulmonary shunt, then these bubbles could enter the arterial circulation and all the symptoms reported are plausibly linked to such an event. In particular, symmetrical paraplegia (leg weakness), symmetrical sensory symptoms in the legs, and ongoing bladder problems are all highly suggestive of spinal injury, and spinal injury is more likely to be caused by DCS than pulmonary barotrauma.
The main arguments against lung barotrauma are the lack of any precipitating circumstance (like a rapid panic ascent) in either dive, the occurrence on two separate dives, and (to some extent) the apparent spinal distribution of her predominant permanent symptoms (mild paraplegia and sensation loss in her legs). For symmetrical weakness of both legs to be caused by bubbles going to the brain it would require the same region of both sides of the brain to be similarly affected by different bubbles whilst leaving other areas of the brain unaffected, which seems unlikely. Paraplegia, sensory deficits in the legs and bladder problems with no other ongoing manifestations is more typical of DCS affecting the spinal cord. Having said that, the onset of symptoms immediately on surfacing, especially brain symptoms like visual loss (such as occurred on the first occasion), is more typical of arterial gas embolism caused by pulmonary barotrauma. It is possible she has a gas trapping lesion in her lungs which would make her vulnerable to this even on a normal ascent.
There is a lot of information missing that would help us untangle this issue. She has obviously had a cerebral MRI (there is a picture of her having one). Does this show brain lesions compatible with her symptom distribution? If not, that would point us toward a spinal problem, and DCS. Does she have a PFO (easy enough to test for)? Does she have normal lungs? A high resolution CT scan would sort that out.
What is the most important message to come out of this case? Notwithstanding the arguments that can be made about which of the dysbaric problems was responsible for Amy's symptoms, one thing is almost certain: it was one or the other of them, and given that, the course of action for those running the dives is indisputable. They should have discussed her case with a diving emergency service hotline immediately. When faced with a diver who becomes sick after diving, do NOT try to second guess or rationalise the symptoms. DCS is a great imitator: it can look like many other things. But let someone with experience in seeing sick divers and interpreting their symptoms be the judge of what should happen. That is the safest thing for you and the patient.
Simon M
This is a very interesting case.
Taking the newspaper story at face value, a few points to come out of the discussion.
Is this a coincidental non-diving-related problem? I think that the fact that there were two events which both occurred virtually immediately after dives essentially rules this out.
Is this decompression sickness (formation of bubbles from dissolved gas) or arterial gas embolism (introduction of bubble to the arterial circulation by lung over-pressurisation)? It is almost certainly one or the other, but it does not fit the typical pattern of either particularly well.
The main argument against DCS is the non-provocative nature of the dives coupled with the short latency of the symptoms (clearly described as occurring immediately at the surface on the first occasion; a bit more vague on the second). It is possible to see venous gas emboli (VGE) after a 10m dive, but usually after a dive a lot longer than these, and it typically takes longer after the dive for the bubble formation process to become established. Nevertheless, if she did form VGE and if she has a readily shunting PFO or pulmonary shunt, then these bubbles could enter the arterial circulation and all the symptoms reported are plausibly linked to such an event. In particular, symmetrical paraplegia (leg weakness), symmetrical sensory symptoms in the legs, and ongoing bladder problems are all highly suggestive of spinal injury, and spinal injury is more likely to be caused by DCS than pulmonary barotrauma.
The main arguments against lung barotrauma are the lack of any precipitating circumstance (like a rapid panic ascent) in either dive, the occurrence on two separate dives, and (to some extent) the apparent spinal distribution of her predominant permanent symptoms (mild paraplegia and sensation loss in her legs). For symmetrical weakness of both legs to be caused by bubbles going to the brain it would require the same region of both sides of the brain to be similarly affected by different bubbles whilst leaving other areas of the brain unaffected, which seems unlikely. Paraplegia, sensory deficits in the legs and bladder problems with no other ongoing manifestations is more typical of DCS affecting the spinal cord. Having said that, the onset of symptoms immediately on surfacing, especially brain symptoms like visual loss (such as occurred on the first occasion), is more typical of arterial gas embolism caused by pulmonary barotrauma. It is possible she has a gas trapping lesion in her lungs which would make her vulnerable to this even on a normal ascent.
There is a lot of information missing that would help us untangle this issue. She has obviously had a cerebral MRI (there is a picture of her having one). Does this show brain lesions compatible with her symptom distribution? If not, that would point us toward a spinal problem, and DCS. Does she have a PFO (easy enough to test for)? Does she have normal lungs? A high resolution CT scan would sort that out.
What is the most important message to come out of this case? Notwithstanding the arguments that can be made about which of the dysbaric problems was responsible for Amy's symptoms, one thing is almost certain: it was one or the other of them, and given that, the course of action for those running the dives is indisputable. They should have discussed her case with a diving emergency service hotline immediately. When faced with a diver who becomes sick after diving, do NOT try to second guess or rationalise the symptoms. DCS is a great imitator: it can look like many other things. But let someone with experience in seeing sick divers and interpreting their symptoms be the judge of what should happen. That is the safest thing for you and the patient.
Simon M
OP
The resort attorney commented on a different description of events. I wonder if she had a hand in the "rationalizing".
Similar threads
