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Ok Flame me, I feel like bitchin'; > People, > Due to a number of requests here is the Australian Oxygen > Table, note that the following is taken from 'The Diving Emergency > Handbook' Revised third edition (ISBN 0 9590306 0 3) by John > Lippmann & Stan Bugg, mainly because I asked John if I could > copy the details to the techdiver list. John's information > is exactly the same as in 'Diving & Subaquatic Medicine' > and at least this way I have the author's permission. > > Please note - any errors are mine. > > Start of quote. > > EMERGENCY RECOMPRESSION TREATMENT IN THE WATER, USING OXYGEN. > > Note 1. > This technique may be useful in treating cases of decompression > sickness in localities remote from recompression facilities. > It may also be of use while suitable transport to such > a centre is being arranged. > > Note 2. > It should only be used in treating cases displaying skin > manifestations and/or pain at or near a joint as the only > symptoms of decompression sickness. > A number of posters have commented on using IWR for neurological symptoms; here recommended against. Are different procedures used for neurological symptoms? What if the patient begins to develop symptoms during treatment? > Note 3. > In planning it should be realised that the therapy may take > up to 3 hours. The risks of cold, immersion and other > environmental factors should be balanced against beneficial > effects. The diver must be accopanied by an attendant. What can the attendant actually do for the patient, in the experience of IWR users? Can he switch the patient from high O2 to low O2 (air) in the event of convulsions? Can he deal with any medical problems which develop - unconsciousness, panic, acute pain, vomiting, eaten by sharks? > > EQUIPMENT: > > The following equipment is essential before attempting this > form of treatment. > > 1. Full face mask with demand valve and surface supply system > or helmet with free flow. > > 2. Adequate supply of 100% oxygen for patient & air for attendant. > > 3. Wetsuit for thermal protection. Drysuit? > > 4. Shot line with at least 10 metres of rope marked in 1 metre > increments ( a seat or harness may be rigged to the shot). > What is the recommended maximum sea state for this sort of thing - I would have thought it is much more sensitive to minor pressure changes than non clinical decompression. > 5. Some form of communication system between patient, attendent > & surface. > Are rope bells and tugs considered efficient? > METHOD: > > 1. The patient is lowered on the shot rope to 9 metres breathing > 100% oxygen. > > 2. Ascent is commenced after 30 minutes in mild cases, or 60 minutes > in severe cases, if improvement has occurred. These times may > be extended to 60 minutes & 90 minutes respectively if there > is no improvement. > How does the attendant assess the patients improvement; or is it entirely subjective? How much improvement is improvement? What about switching from O2 to air (25:5 mins) to avoid chronic O2 toxicity? > 3. Ascent is at the rate of 1 metre every 12 minutes. > > 4. If symptoms recur remain at depth a further 30 minutes before > continuing ascent. > > 5. If oxygen supply is exhausted, return to the surface, rather > than breathe air. DO NOT LET THE PATIENT BREATHE AIR UNDERWATER. > Is there a reason for this? If O2 is so much better at depth, why is air worse? Ok, there will be elevated nitrogen present - does this outweigh the advantage of keeping the DCI lesion under compression? Is this the view of studied experience, or educated guesswork? > 6. After surfacing, the patient should be given one hour on oxygen, > one hour off, for a further 12 hours. 25:5 mins? Why hour to hour? > > End of quote. > > John is in the process of revising the handbook and told me that the > latest thinking on oxygen toxicity is that it may occur in some > people at oxygen partial pressures greater than 1.5 ATA. This is *new*? Also please > note that medical authorities in the US strongly recommend that > in-water recompression using either air or oxygen never be attempted. > Obviously why John left the information out of 'Deeper into Diving'. > > Well I hope that answers your questions on the Australian view of > in-water recompression using oxygen - certain well known diving > doctors here are all for it in the correct circumstances. > > By the way if you have an questions or comments for John Lippmann > I can pass them on, just be aware that he is in a constant revision > cycle on his books to ensure that they incorporate the latest > changes in diving medicine knowledge and so may not get back to > you quickly. > > ------------------------------------------------------- > Zyg Poliniak | Phone: 61-3-252-3072 (B/H) > | Fax: 61-3-252-7390 (B/H) > Melbourne | Email: <zyg@ac*.ne*.au*> > Australia | Email: <100353.1605@co*.co*> > > > -- > Send mail for the `techdiver' mailing list to `techdiver@opal.com'. > Send subscription/archive requests to `techdiver-request@opal.com'. hmm, I hope I didn't sound too picky, but I hope there's a lot more information than that available to anyone planning on setting up for IWR. (Or, nightmare of nightmares, is that the extent of knowledge in chambers, too.... :-( ). Jason. Och fuch it... The only thing about advocating for the devil is he never pays his fees....
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