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Hi Joseph, >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. Denial would probably be a normal reaction to DCS, I guess.. >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) Just out of curiosity, how were you able to get a diving MD? >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 blown case of DCS. I've never been involved with a DCS case before. At this point, were you still uncertain? Were you relying on positive responses to DCS symptoms, or/and going on intuition (something that I have discovered can often be rather accurate). I'm not trying to suggest that I wouldn't have done the same had I been you, knowing what you know. But just how far into the evacuation were you when you "were sure" that this was DCS? I want to know what to look for (though I realize that different people are affected differently to some degree). >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. By now, DCS suspicion was confirmed - lucky for her you knew before this point that it was DCS. >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. Still, until the diving MD says 'she's clear' the most prudent course of action is to medevac the patient as rapidly and as safely as possible. If it had been calmer, I think I would have been of the mind to call in the heli, particularly with the 5.5 hr ride you mention. >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.) I attended a seminar at Underwater Canada where Dan Orr (from DAN) spoke of the need to liaise with community EMS and hospitals to make them aware of the special considerations which must be given to divers. They have some promo stuff, including a video tape detailing suggestions for EMS protocol revisions to accomodate diving accidents. I plan on taking great pains to familiarize our local EMS / hospital personnel with DAN and their liaison activities - just as an added step. > 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. 6.5 h in transit! Ouch. Funny how the symptoms appeard to manifest themselves rapidly sometime after 5:30 into transit. Although hindsight is 20-20, it's easy to see where the airevac would not have been a bad idea. >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) Good! That's the way we like to see it. >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) Tough. That's the service they want to provide, so let them. (So I'm not all that happy with insurance companies right now, as you can probably tell 8-) >Her profile: first dive to 45 ft for 35 minutes > > 2-1/2 hr surface interval > > second dive to 60 ft for 35 minutes Doesn't look too bad. First dive put her into the NAUI (USN derivative) Table's "g" designation. 2.5 h would see her go back to "d" and her last dive would [*OH NO*] put her past the no-deco zone by about 4 minutes. Not sure what four minutes either way would do (and I'd like to compare this with the DCIEM tables, just to compare). >So, why did she get bent? >1) She had intentionally dehydrated herself to avoid having to urinate >while diving her new neoprene dry suit. Not sure whether I would agree with that one, but then again, I am not her. >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. Hmm, fifty seconds shorter than it should have taken (assuming a 1 ft / sec ascent) It would appear that her dive exceeded at least one table, and the rapid ascent might have compounded the problem. I would wonder if she thought about trying to recompress in the water- she was asymptomatic for at least another half hour or so. I realize that it is easy for me to suggest this, having the benefit of the information you've given me. >Diagnosis: type I, muscular hit, and type II (frontal) cerebral hit. Ouch. >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. Here, here! >Oh yeah, she is a very experienced diver with 8+ years of safe/frequent >diving. To some extent, it shows the necessity of adopting the "When, not if" attitude when it comes to DCS - making the assumption that someday I will suffer from DCS and start planning for it now. Still, what you write gives plenty to think about... Pete -Joseph Crunk -- Send mail for the `techdiver' mailing list to `techdiver@santec.boston.ma.us'. Send subscription/archive requests to `techdiver-request@santec.boston.ma.us'.
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