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Subtle symptoms may develop into more serious
ones later and mild symptoms should NOT be ignored. The files at
DAN are full of divers who had minor problems initially. Research
is now going on to try to link onset with outcome."
This past March a diver on one of our boats took a DCS hit. I was awaken
at about midnight concerning a diver with a shoulder pain. She looked
sleepy (who wouldn't at midnight?) She suggested she had pulled her neck
muscle putting on her dry suit, something she had done before.
She was immediately started on O2 and a the boat captain advised to moved
to connect ship-to-shore to consult a diving physician, just in case. The
MD said it was probably nothing, but we might as well bring her on in, just
in case. (I also started her consuming H2O at regular intervals)
I got one of the nurses (RN) up. Heck, if I'm going to be up all night,
I'm going to want some company. Vital signs were to be taken & recorded
every 30 mins, even though she looked ok. A billion questions were asked
and logged on a plastic slate with a grease pencil. I was treating this
like a full blowen case of DCS.
After 30 mins on O2, tingling in her right arm was gone. I knew she was
hit. I just didn't know how bad. Another 15 mins later and she had to
urinate. Bladder control meant her lower spine was still functioning.
This was a good sign.
I wanted to evac by helicopter. OK, I've only seen this done on TV, 911
or Rescue of something. It would have made a great entry into my diving
journal, but we had 25+ knot winds. Not a safe condition for helicopters.
Besides, she didn't look bad at all.
She stayed on O2 for the 5-1/2 hr ride back to the harbor. Another call
ahead had an ambulance waiting. She came off O2 only to walk from the
boat to the ambulance, then back on O2. (worth noting: the ambulance
techs didn't think anything was seriously wrong, and wanted to take her
to a local hospital just to be checked. It was made clear to them that
she was was to proceed immediately to the (waiting) chamber, and that she
was to remain on O2 the whole time.) Another hour ride to the chamber
where a physiologist and a neurologist were waiting. By the time they
they arrive, she couldn't stand, had her right side semi-paralyzed, had
trouble remembering her name and couldn't repeat 6 random letters.
She went for 1 six hour chamber ride. This resolved the physical (type I)
symptoms. Another 1-1/2 hr ride helped with *most* of the neurological
(type II) symptoms. The next day, a third 1-1/2 hr ride resolved 99% of
the type II symptoms. (the neurological exam alone is another 3hr ordeal)
Three rides over two days and $10,000 later, and she's considered a
successful recovery, no noticeable permanent damage. (However, DAN's
underwriter probably isn't as happy)
Her profile: first dive to 45 ft for 35 minutes
2-1/2 hr surface interval
second dive to 60 ft for 35 minutes
So, why did she get bent?
1) She had intentionally dehydrated herself to avoid having to urinate
while diving her new neoprene dry suit.
2) She was over weighted on the first dive, so she removed so weight. She
was under weighted on the second dive. When, on the second dive, she did
have to urinate, she started for the surface, lost control of her ascent,
and covered the 60ft ascent in about 10 seconds.
Diagnosis: type I, muscular hit, and type II (frontal) cerebral hit.
First symptoms showed up at about 2:30pm, 30 minutes after she surfaced
from the second dive. She didn't call attention to he problem until 12am,
9-1/2 hrs later! The suggestion about not ignoring minor problems can't
be over-emphasized.
Oh yeah, she is a very experienced diver with 8+ years of safe/frequent
diving.
-Joseph Crunk
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