Unknown Woody From “Dive Talk” DCS and Medical Journey

[L13]

We have bubbles right now sitting at our computers. They're just not big enough to matter

Only transient bubbles, due to localized lower pressures at the inlet side of the pump(heart) and a few other places due to localized lower pressure due to turbulence. They are collapsing as fast as they are formed.

 

[inquis]

this is showing the formation of bubbles that were detectable on ultrasound during an isobaric switch

Can't read it, but making some assumptions about the content... isobaric counter diffusion in the inner ear is dangerous because the tissue is nearly at critical saturation (at the M-value, which is well above ambient), and the additional nitrogen is the "straw that breaks the camel's back.

The position that bubbles are not stable at tissue pressures below ambient pressure does not preclude all bubble formation under isobaric conditions.

 

[Joneill]

This is very notmal.

I’ve heard 2-3 paramedics and ED nurses describe how they convinced themselves they they were fine for hours despite abvious major cardiac symptoms. One ended up in the cath lab getting ablation due to their racing heart, another in the cath lab getting stents.

If you told them the list of symptoms on duty they would have been getting a stretcher and the 12 lead. But when it was them?

So keep in mind that you are not going to be the best judge of ‘is this serious or not?’ If you think it is possibly bad run with that. Make a call.

Right - but, regardless of what the affected diver was saying, 2 other experienced divers also ignored the obvious signs of a more serious issue.

That is not good and should not be normal - hopefully, folks learn something here and push for professional medical treatment asap if they see that things are not right with a buddy post dive.

 

[L13]

Right - but, regardless of what the affected diver was saying, 2 other experienced divers also ignored the obvious signs of a more serious issue.

That is not good and should not be normal - hopefully, folks learn something here and push for professional medical treatment asap if they see that things are not right with a buddy post dive.

Unless, the signs may not actually have been that obvious. We were told in the Dive Medicine Q&A thread by DiveTalk fans that the description of Woodies symptoms were to be interpreted as "Woodie was tired after the dive and it's normal to breath O2 when tired after a dive." Maybe if that is normal for Woodie, the other two wouldn't have notice anything unusual during the hours before they took him to the hospital.

Actually, a number of people said breathing O2 after a dive was normal, and didn't merit a call to DAN. Some of them were regular posters on SB. Maybe you and I are outliers for believing that if it is serious enough to breathe emergency O2 it is serious enough to call DAN. Maybe we need to be sent to the re-education camp -- I mean training -- to learn the pravda way of understanding this incident.

 

[Jackie]

My hunch is that if a woman was there, they would have gotten to treatment sooner.
Even just an IV would have gone a ways to preventing shock or very low blood pressure,
Maybe because so many of us are mothers, we have a pretty good instinct and are accustomed to dealing with recalcitrant kids.
I get that woody was in denial, he had altered mental status. Gus wasn’t a genius nor was the other fellow. It was really on them to take care of Woody!
On evac plans, offered by credit cards or medjet. Not a great option either. I have had an evacuation. it’s not like MASH with the helicopter on the scene picking you up and bringing you to definitive care. It can take a few days for the company to work thru the hoops of their subcontractors and even customs and immigration. Bhutan insisted that our flight needed a Bhutanese navigator. As it turns out they are in short supply.
i did pay for my helicopter to get me out of the remote rural clinic with roving feral dogs.
Lots of dive destinations have weak infrastructures making it even more important to count on DAN.

 

[Joneill]

Unless, the signs may not actually have been that obvious. We were told in the Dive Medicine Q&A thread by DiveTalk fans that the description of Woodies symptoms were to be interpreted as "Woodie was tired after the dive and it's normal to breath O2 when tired after a dive." Maybe if that is normal for Woodie, the other two wouldn't have notice anything unusual during the hours before they took him to the hospital.

Actually, a number of people said breathing O2 after a dive was normal, and didn't merit a call to DAN. Some of them were regular posters on SB. Maybe you and I are outliers for believing that if it is serious enough to breathe emergency O2 it is serious enough to call DAN. Maybe we need to be sent to the re-education camp -- I mean training -- to learn the pravda way of understanding this incident.

At around 23 min into the video, Gus said he knew something was not right and it was pretty serious but, beyond oxygen they didn’t really act even though Woody was in a post-dive condition Gus had never seen before… and it was especially unusual given they described the dive as really calm/chilled.

I’m with you - I’d have called DAN and went straight to the hospital at that point - Better to be wrong and get sent home than risk it in my way of thinking.

 

[L13]

At around 23 min into the video, Gus said he knew something was not right and it was pretty serious but, beyond oxygen they didn’t really act even though Woody was in a post-dive condition Gus had never seen before… and it was especially unusual given they described the dive as really calm/chilled.

Yes, but with the correct secret DT decoder ring, that just means Woodie was tired and doing the normal breath O2 when tired thing that everybody with enough experience to comment knows about. At least as far as Gus or the dive guide could possibly know.

Remember, as non-DT fans, you and I don't have the experience to know how to interpret what Woodie and Gus say in the video.

I’m with you - I’d have called DAN and went straight to the hospital at that point - Better to be wrong and get sent home than risk it in my way of thinking.

But, I've been assured, by SB regulars not just DT fans, that it is normal to breath O2 for hours and not consider it an emergency. Or maybe that only applies to Woodie. I need to go back and review my O2 provider training, it is very confusing that I don't remember it that way.

 

[kimh]

I'm unsure if either of you has a subscription to science, but this might be an interesting paper. [“Venous Gas Bubbles: Production by Transient, Deep Isobaric Counterdiffusion of Helium Against Nitrogen”]

This paper is also in ResearchGate’s system:

https://www.researchgate.net/publication/22266868_Venous_Gas_Bubbles_Production_by_Transient_Deep_Isobaric_Counterdiffusion_of_Helium_Against_Nitrogen

You can request full-text of the paper from the original authors there (free). I’ve had success with that in the past, although they say it’s harder if you don’t have a researcher account, which I do. Might be worth a try. If you do have some kind of research affiliation, joining is free, and it can be pretty handy.

 

[L13]

This paper is also in ResearchGate’s system:

https://www.researchgate.net/publication/22266868_Venous_Gas_Bubbles_Production_by_Transient_Deep_Isobaric_Counterdiffusion_of_Helium_Against_Nitrogen

You can request full-text of the paper from the original authors there (free). I’ve had success with that in the past, although they say it’s harder if you don’t have a researcher account, which I do. Might be worth a try. If you do have some kind of research affiliation, joining is free, and it can be pretty handy.

Isobaric Counterdiffusion is a completely different thing. In this case Woodie was using air diluent, not trimix, and not changing the mix, so Isobaric Counterdiffusion is irrelevant.

 

[kimh]

Isobaric Counterdiffusion is a completely different thing.

I posted that only because @crofrog linked it earlier from Science, and someone else said they didn’t have access. <edit> I see now that this was you- you said you could only read the paper’s summary.