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You do not do the spike because the damgage is already there and you will worsen the insult, add to it, increase the recompresion time, further stress the whole system, and raise the tox risk and other obvious risks. You do not want to get somebody to where they need even more deco/reco and then not be able to do it for some other reason. You need to just give the bubles time to eliminate, and that should be done at the shallowest depth possible. Just holding the ppo2 up and of course breaking will allow time for the bubbles to dissipate and at the same time get oxygen to the tissues that are beeing blocked and are damaged. Hunsueker will post on protocall or put in on our website. We do not need to argue with some British know it all who just finished his IANTD deep air course and is now an expert. In the case of paralysis or other cns hit, you really want to keep it as shallow as possible. This is all well understood in modern reco/deco, and what we have here is a bunch of personae non aqua who do not actually dive coming on here regurgitating baloney they got from other idiots or outdated sources. Better information has been available for years. One of thes bozons even quoted the Navy dive manual of all things. When was that written, 1955? How about the Richie Pyle stuff - too funny. This is a disgrace that these strokes are even on here, are talking, and are yapping like the lapdogs they so clearly are at me and others who have an endless track record of actually doing these things very successfully and knowing what we are talking about. The WKPP has more proceedures than anyone but the oil industry, and the fact that the Navy Spec Warfare people and doctors come to study us is a lot more telling abvout hte awuatity of what I have put together and demonstrated over the years than the "information" that these neophytes from the UK or elsewhere have dredged up from antiquated sources and egregious bullshitters on the dive lists . Steve wrote: > > George, > > If you are referring to your post that I pasted below on this email, I have > a couple of questions about it. > > 1) In the case where you take a hit, how deep do you start IWR? Is there a > formula to use, or just when the pain disappears? What schedule do you > follow? > > 2) Pyle was talking about doing a deep spike to squeeze the bubbles smaller. > Do you believe in this? If so, how deep? > > I guess I've reread your post below many times, and I've got a much better > understanding of what's going on, I'm just looking for something more > concrete, such as descend 20' past where the symptomes disappear, and ascend > following the schedule you were following for the dive, but double the time > at the 20' stop. Something like that. That's why I was wondering if you > had written protocol available. > > ----- Original Message ----- > From: Trey <trey@ne*.co*> > To: Steve <se2schul@uw*.ca*> > Cc: gazela <gazela@ba*.ne*>; <techdiver@aquanaut.com> > Sent: Monday, February 14, 2000 8:16 PM > Subject: Re: In water recompression. (FWD) (FWD) (fwd) > > > I already did a huge one on that to the list using the > > krivine@sa*.ne* account. I am sure it was on techdiver. The > > "protocol" varies greatly, only the safety aspect has a protocol, and I > > went over all of that in that post. Maybe one of the geeks can find it > > for us, or I can get back on that other machine and see if it was saved. > > > > ---------------------- > IWR post from GI > ---------------------- > To answer the above, let's first start with a couple of assumptions, > and then break it up a little. Let me get Karen's permission for this, > and have her check in her girl scout book for the proper legal > ramifications first, or we can just go on and take our chances here. > She can then tell me a better way that she has never had any experience > with once she has time to research this and straighten me out. > > The first assumption is that the worst thing the "omitter" has > effectively done is move up the last 20 feet and out of the water too > fast. By this I mean that if any of us do this at any point in any deco > proper or improper, we are foaming out that last pressure gradient that > NO amount of deco will remove. Only a slow ascent to the surface will > allow that last bit of gas to come out in solution. Jumping up 20 feet > will bring it out in bubble form, no matter what. > > So now the guy is out and foaming, but only the doppler knows this - > he is asymptomatic. We know from our doppler experience and endless > studies that this bubbling will actually INCREASE with time after the > diver is out of the ater, and will peak some 20 minutes to an hour > later, and hold at that level for up to hours. > > Note - in our divers, especially me, the opposite occurs -the > bubbles are totally gone in 30 minutes. This may make some of the divers > out there want to consider the merits of physical fitness as it applies > to their diving, and to consider that a well-executed decompression > leaves a minimum of gas from which bubbles can form and grow later - > fact of life. > > Now, we have two choices - do nothing ( which includes breathing > oxygen on the surface ), or tell him to go back and do some deco , and > then ascend slowly. I would go back and do the deco. But now we have > another problem. If he suddenly overwhelms his lung filter and takes a > CNS hit either by shunting in the capillary beds of the lungs or by the > increased right over left pressure caused by the bubbles in those beds > forcing open a PFO, he will not be safe by himself, and could convulse > or black out. A good buddy could get him back up, square him away and > find a way to get him back down, but now he really needs oxygen .It > starts getting complicated. I would still do it, but it takes two or > more divers . > > If you had a full face mask, and oxygen, then it gets easier, but > then we are talking no suspect here to start with, right? But if he is > now getting bent ( questions two and three), then we move on and act for > sure. If we have the other equipment, then we are ready for more serious > solutions and have done more serious dives to require this, or we have > just not done it properly but have the tools to correct it. > > Now we have to look at the profile - how deep , how long, how > serious could this omission be? How deep do we have to get this guy to > reduce the bubbles to where we can get them into solution or at least > managable enough to offgas through the lungs or get small enough to pass > by way of the circulatory system to the lungs where we can work on them > with oxygen. > > Generally, if you can keep the guy alive, and stay on him, and that > goes for a may-be-nothing situation to a real blowout, getting him down > and getting him on oxygen ( or the correct max PPO2 gas for the depth) > are both a must if he is going to not be brain damaged. > > The general best bet in the three situations you describe are to > take your chances by going back in, finding the starting point that is > reaonable and will not take to long to ascend from, and redoing that > part of the deco, with special emphasis on taking the last 30 to 20 feet > very slowly all the way up. Paralysis and other situations need to be > recomprssed and with a high PPO2 involved and more than one buddy . I > would hold them there until the Coast Guard or Helicopter ambulance > shows up and the chamber is lit and ready. If it were me, that would be > the way it would go. Acting fast on a screwed up deco can prevent things > getting this far out of hand. Occasionally, however, you are going to > get a person with a PFO or other shunt who will build bubbles after a > dive and go down on you well after he is long out of the water, and then > you have a real tough call. We now he need oxygen, but will > recompression do any good? Actaully, yes, and it it s very likely that > it will not take much more than ten to twenty feet of depth to do it. > > A usual caveat with in water breathing of high PPO2 gases is watching > for the tox, but again, we are talking buddy situations only - you NEVER > send a guy back to do his omitted deco or IWR without a buddy on him. > > Pain hits are not so big of a deal as an annoyance and a dive trip > ruiner as they are not going to go away completely. For one, the bubble > traped most likely seeded much deeper , and only grew to pain size > later. You can tell the depth at which it shrinks when the pain goes > away, and do the math to figure how deep it reasonably cound have seeded > at. It is a waste of time to go back to that depth since the damage is > done and you will feel the pain of the damage long after the bubble has > been reabsorbed. The better bet is to reduce it somewhat and give it a > chance to diminish ( they generaly grow first, but you have > receompressed it somewhat) and then try to overcome it with oxygen in > the slow ascent. It ( the injury site) WILL still hurt, but you have > solved two problems - you have reduced the bubble , and you have gotten > oxygen to the injury site. These injuries are really not that big of a > deal, but they are annoying, and will recur if you keep insulting them, > just like any injury, and the body tends to shunt off the injury and > angiogenisis around the site takes place , putting smaller capillaries > in place to shunt the blood flow, and these tend to trap bubbles more > easily on the next occasion, and account for the repeated injury of the > same site as well as the proclivity to get wacked more easily and more > often - a pure fact of physiology. Best to do deco correctly to start > with. > > I hope this helps as a starting point. > > I will also say this - with any of these injuries, especially any > paresthesis , paralysis, weakness, or cns symptoms of any kind, the > hyperbaric oxygen administered repeatedly over an extended time frame, > as in for some time evey day, is a must, and the earlier on it is > administered, the better the chances of success. There are also drugs > you can carry that are meant for use with spinal and brain injuries, but > this is a different story, and I know we will hear from the weenies if > we drag that one out. I would not hesitate to use them myself, however. > > This is a good enough beginning, I am sure there are plenty of people > who have something to say about this. Let's keep it to not attacking me > by the assholes and try to make this one productive for once. -- Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'. Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'.
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