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Hank: My guess is that you just plugged the depths and times into the deco program and let it do its calculations which on the surface seems like a good way to assess the dives but cant account for several important factors. My guess is that this diver did NOT spend X minutes at Y feet as the logbook of the computer may suggest. The diver may have been doing a multi-level dive and the computer algorithm accounted for this by adjusting the NDL accordingly. These logbooks report the maximum depth achieved during the dive. Therefore, while it may say 100 feet for 50 minutes, the diver may have bounced to 100 feet and spent the rest of his/her time at 40 feet. If you punched a 100ft dive for 50 min into your algorithm, it will probably give you about 45 min of deco time (just a guess, hold your fire) Therefore, this may not be the best way to assess the dive profiles. I'm not saying one should rely blindly on one's dive computer (i.e. on several of the dives the safety stop was negligible. During multi dive outings, one should always consider reasonable safety stops..etc..), just that things are not always what they seem. I am curious however, how the hyperbaric fellow and the primary physician arrived at the conclusion that it was a DCS hit when recompression therapy did not provide any relief. Any info, suggestions etc.? Regards, -Joe On Tue, 11 Jun 1996 GarlooEnt@ao*.co* wrote: > Esat > just for the hell of it i ran this n the DECOM program(which i consider as > an acceptable > deco program). > the results were that your diver should have done a 5 min stop at 10fsw on > the first dive > (she did 4@15*); she should have done 4min @10fsw on dive 2 she did 3 ; on the > 3rd dive she should have done 11 @ 10fsw she again did 3min. > > i don't know what she used to come up with the hang times since you don't > explain that. > > it would have been my guess that she had at least a skin hit after dive 2. > the location of the hit is not unique. we have seen this on our boat in the > past. the fact that she was getting over her period would seem somewhat > significant to me. > > you probably should have treated her with o2 on the first & definitely on the > second day. > i don't think i would have advised her to dive the 2nd day. > > even though i am no MD it would seem logical to me that the problem might > have been brought on by something she did in relation to her dive > profile(????) > what did you think??? > > dive on & on hank > YOU WROTE---- > > Subj: Report on a medical occurrence > Date: 96-06-10 18:49:13 EDT > From: atikkan@ix*.ne*.co* (EE Atikkan) > To: cavers@ge*.co*, DC-scuba@hi*.co*, techdiver@terra.net, > quietfrogmen@bt*.co*, scuba-tr@vm*.eg*.ed*.tr* > > > > > > > I am reporting on an interesting occurrence related to diving. > > On the first day of diving on a recent trip (approximately 24 hours > after having deplaned) a female diver (experienced, dives year > around, age ca. 40) completed 3 dives in warm water (26-27 deg > C). > Computer: Legend (Buhlman) > Conditions: close to ideal flat calm, good viz current, but > dive was a 'drift dive'. > Dive 1 90ft 22 min slow ascent followed by 3 min stop @ > 15ft. > SIT - 36 min > Dive 2 60ft 30 min 3 min stop. > SIT - 35 min > Dive 3 60ft 30 min, ..3 min stop > > Following the dives, within 2 hours, diver was noticed to not be > 'self'. Inquiry produced two signs: > 1. An ocular disorder mimicking those experienced in past > independent of diving. > 2. Tenderness in breast to the extent that they were > uncomfortable/sore. Diver was on the last day of her menses. > (at that point, no visible signs noticed. Showered & donned > supportive bra. Complete relief in approx 2-3 hrs) > > The next morning diver did two more dives of 60 ft of 40 min > each with SIT = > The same pattern of dives were completed in the afternoon. > Details of all for dives of that day follow. . > 60 ft for 30 min..3 min stop > SIT - 38 min > 56 for 32 , 3 min stop > SIT 2hr 35 min > 59 for 30 , 3 min stop > SIT 37 > 61 for 25 - minimal stop > > After 2nd dive, breasts were very painful > After last dive, noticed that Breasts were swollen with patchy > > redness and visible veins. > Diver recalls no relief of pain during last 2 dives (while under > pressure). > Ocular disorders did recur, lasted 30 min. > > When S&S were present early the third morning the question of DCI > with lymphatic involvement was raised and DAN contacted. DAN > counseled diver to seek hyperbaric medical consult, though they > had not heard of such an occurrence. > > Patient was treated at a hyperbaric facility on USN Table 6 with > no relief. Patient was discharged with a potential for contact > dermatitis being the cause of the problem. Although an > additional chamber ride was mentioned directly after the first, > it was not addressed during subsequent conversation with > physician. In addition, no further medical consult with a > dermatologist or other specialist was suggested. Patient was > advised to take anti-inflammatory medication. > > Patient took ibuprofen and aspirin as advised > > Patient did not dive for balance of trip and flew back > (commercial airliner) approximately 100 h following the first > dive of the trip. > > The S&S subsided over the next several days with final relief 6-7 > days after first dive > > Further consults initially were not firm, but physician handling > case upon arrival at city of residence (was not a hyperbarisist) > sought a telephone consult with a hyperbaric fellow (originally > said he was sure it was contact dermatitis). Based on the > opinion of the latter, who had never seen or examined the > patient, the final diagnosis at the follow-up facility was: > > Type II DCS with skin & lymphatic involvement. > > Thus, though two physicians had originally decided that this was > not DCS, the final diagnosis was exactly that! > > An exact science it is not! > > Esat Atikkan > > > > > > -- > Send mail for the `techdiver' mailing list to `techdiver@terra.net'. > Send subscription/archive requests to `techdiver-request@terra.net'. > > > ----------------------- Headers --------------------------------
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