Caustic Cocktails - First Aid / Treament

Fort Collins Bob · 3rd May 2007, 18:11

Hello Everyone,

What first Aid and Treatments can be giving a CCR Diver having been
burned by a Caustic Cocktail ?

I would be asking this question in reference to diving in very remote
locations where medical Treatment could be delayed.

Are there medications that can be used to help with the swelling that
are said to be a complication from this ?

Thanks to all.

Loneshark · 3rd May 2007, 18:29

Quote: (Originally Posted by Fort Collins Bob)

Hello Everyone,

What first Aid and Treatments can be giving a CCR Diver having been
burned by a Caustic Cocktail ?

I would be asking this question in reference to diving in very remote
locations where medical Treatment could be delayed.

Are there medications that can be used to help with the swelling that
are said to be a complication from this ?

Thanks to all.

I would suggest milk, if it was ingested, however if you are "very" remote, this may be an issue? Not sure there is any specific 1st aid treatment other than drinking/rinsing with copious ammounts of fresh water. If you have inhaled a caustic cocktail, I would think the only treatment would be at a hospital..... I would give O2 in the mean time.
If there is swelling associated with it, you could try a steroid, such as hydrocortisone, or as a last ditch an adrenaline injection, which you may have available if kitting up for a remote site....?
Just a thought and I can't recommend them though. Any Doc's out there?

***Decodiver*** · 3rd May 2007, 19:05

Drink Coke.

diveladydive · 3rd May 2007, 19:57

Allow me to quote Mark Drekker, owner of Fill Express on this topic. Mark has a background in chemistry, & his sister, Lisa, worked as a chemist.

Mark, I’m thanking you in advance for permission to quote.

“Peri, you asked how the chemistry of Coke works to neutralize the rebreather absorbent... So here is a bit of high school chemistry (a bit oversimplified but adequate for this explanation)....

The absorbent mixed with water will produce mild alkaline solution which can be neutralized by mild acid solution.

Acid or alkaline is measured using the pH scale which can have a value between 0 (very corrosive acid, say sulfuric acid) and 14 (very corrosive alkaline, say sodium hydroxide aka lye). The value 7.0 is said to be neutral (pure water has a pH of 7.0).

The pH of regular carbonated soft drinks is about 2.5 and diet soft drinks for whatever reason are not quite as acidic with pH's around 3. The soft drinks that have a 'smoother' taste with less 'bite' like Mountain Dew are slightly less acidic... Pepsi is slightly less acidic than Coke... but we are talking very small differences... for the purpose of washing absorbent out of your mouth they will all work equally well.

Mix a equal amount of acid and alkaline together and they will 'neutralize' each other.... i.e. a liquid with a pH of 3 (7-4) and a liquid with a pH of 11 (7+4) that mixed together in equal amounts would produce a liquid with a pH of 7. Note that just because it's neutral pH does not mean it's safe to drink... there are plenty of very nasty things you could drink that have near neutral pH.

Here are some pH values of common substances...

Soda lye 14.0
Ammonia water 11.6
Milk of magnesia 10.5
Baking soda 8.0

Sea water 7.36 – 8.21
Human blood 7.35 – 7.45
Distilled water 7.0
Human saliva 6.3 – 6.6
Milk 6.5

Tomato & tomato juice 4.2
Grapefruit juice 3 – 3.3
Orange juice 3 – 4
Apple juice 2.9 – 3.3
Vinegar 2.4 – 3.4
Lemon juice 2.3

Stomach fluids 1 – 3
Sulfuric acid 0.3
Hydrochloric acid 0.1

Most carbonated beverages like Coke contain three different mild acids... carbonic acid from the CO2 bubbles, citric acid for flavor and phosphoric acid to give it that ‘bite’... there is nothing particularly magic about Coke itself (and pays no attention to all those Coke myths... Coke will NOT dissolve nails or teeth). Instead of Coke you could use ANY mild acid with about the same Ph from the list above, but of course some acids taste much better than others... besides Coke you could use any other carbonated beverage, apple juice, or even vinegar in a pinch... I mention vinegar because nearly all commercial dive boats have vinegar on board to treat stings.

One last note... don't drink whatever you use, just swish it around in your mouth and spit it out.”

As far as the ER/EMT situation is concerned, prior to learning this, I took a very bad laryngeal hit on a prototype Titan during pool drills. Suffice to say that the lye was not neutralized until my instructor, Tom Mount, left the hospital & came back with a homeopathic remedy & baking soda. Tom also saved my life that day, as to my ENT's knowledge, unlike the trachea, the larynx does not re-open from that type of injury quickly enough to live through. Tom used acupressure at the scene.

I was signaling to be trached when Tom open my airway, which was entirely shut down, with his technique. We found out later that traching a caustic is probably on the worst-to-do list, outside of dying because you didn’t try everything: By traching me, the lye would have entered the bronchioles & I wouldn’t be here to write this.

I carry coke or another soda in a squeeze bottle, & needed it recently for a very mild hit- which may not have been so mild if not immediately neutralized. That was a no-stop training dive; now imagine the effect with a nice-sized deco obligation to fulfill.

Hope this helps...

Loneshark · 3rd May 2007, 21:47

[quote=diveladydive;113122]Allow me to quote Mark Drekker, owner of Fill Express on this topic. Mark has a background in chemistry, & his sister, Lisa, worked as a chemist.

Thanks for that! Very informative!

You live and learn.....

diveladydive · 3rd May 2007, 22:42

[quote=Loneshark;113145]

Quote: (Originally Posted by diveladydive)

Allow me to quote Mark Drekker, owner of Fill Express on this topic. Mark has a background in chemistry, & his sister, Lisa, worked as a chemist.

Thanks for that! Very informative!

You live and learn.....:o

More than welcome, & thank Mark, actually :-) He was kind enough to answer my email about Coke. Tom Mount told me about that- he found out after I'd had the bad hit. Mark is n2diving.

gibbogeo · 4th May 2007, 00:24

Quote: (Originally Posted by Decodiver)

Drink Coke.

I washed my mouth with soda water, then i drank milk, lemon juice and coke (one after the other).

I fully recovered from the burning in 24 hours.

But the mix i had in my stomach had crazy effects...

sensor330 · 4th May 2007, 00:26

Quote: (Originally Posted by Fort Collins Bob)

Hello Everyone,

What first Aid and Treatments can be giving a CCR Diver having been
burned by a Caustic Cocktail ?

I would be asking this question in reference to diving in very remote
locations where medical Treatment could be delayed.

Are there medications that can be used to help with the swelling that
are said to be a complication from this ?

Thanks to all.

While Rebreather diving in the Navy we have a bottle of lime juice in the boat to neutralize the caustic cocktail. After that not much you can do without medical attention.

Gene_Hobbs · 8th May 2007, 18:26

NATO Multinational Guide to Diving Medical Disorders. ADivP-02(A)/ MDivP-02(A)

Quote:

0818. Caustic Cocktail
c. Treatment
(1) Remove Diver from the water. Remove the set as quickly as possible.
(2) If the diver is suspected of having swallowed a cocktail give copious drinks of fresh water. Salt water may be used to rinse out the mouth but should not be swallowed, since it may induce vomiting and cause further burning.
(3) Wash all contaminated external surfaces liberally with fresh or salt water.
(4) Caustic burns to the eye should be treated by washing the eye with large volumes of water for at least 20 minutes. If necessary, the eyelids should be held open while this is done. Refer to an eye unit, casualty department or Medical Officer immediately.
(5) A caustic cocktail readily provokes panic, especially in inexperienced divers. This may result in a rapid ascent and breath-holding (to avoid inhaling further alkali). Consequently, divers who as the result of a caustic cocktail, make a rapid ascent to the surface should be observed carefully for 12 hours following the dive for evidence of pulmonary barotrauma or neurological decompression illness and should be seen by a Medical Officer before diving is resumed.

Diver Dude · 8th May 2007, 18:40

I drank Pepto Bismo...a lot of it. It took some of the burning sensation away. I was good after 24 hours

3rd May 2007, 18:11	#1 (permalink)
Fort Collins Bob Always Learning. Current Rebreather/s: Ouroboros Other Rebreather/s: Join Date: Apr 2006 Location: Fort Collins Colorado Posts: 112	Caustic Cocktails - First Aid / Treament Hello Everyone, What first Aid and Treatments can be giving a CCR Diver having been burned by a Caustic Cocktail ? I would be asking this question in reference to diving in very remote locations where medical Treatment could be delayed. Are there medications that can be used to help with the swelling that are said to be a complication from this ? Thanks to all. __________________ Best Regards all ------------------------------------------- Bob Fridell Ouroboros #46 Fort Collins, Colorado
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3rd May 2007, 18:29	#2 (permalink)
Loneshark New Member Current Rebreather/s: Other SCR Other Rebreather/s: Other SCR Join Date: May 2006 Location: Hull East Yorks Posts: 62	Re: Caustic Cocktails - First Aid / Treament Quote: (Originally Posted by Fort Collins Bob) Hello Everyone, What first Aid and Treatments can be giving a CCR Diver having been burned by a Caustic Cocktail ? I would be asking this question in reference to diving in very remote locations where medical Treatment could be delayed. Are there medications that can be used to help with the swelling that are said to be a complication from this ? Thanks to all. I would suggest milk, if it was ingested, however if you are "very" remote, this may be an issue? Not sure there is any specific 1st aid treatment other than drinking/rinsing with copious ammounts of fresh water. If you have inhaled a caustic cocktail, I would think the only treatment would be at a hospital..... I would give O2 in the mean time. If there is swelling associated with it, you could try a steroid, such as hydrocortisone, or as a last ditch an adrenaline injection, which you may have available if kitting up for a remote site....? Just a thought and I can't recommend them though. Any Doc's out there? __________________ www.lonesharkproductions.com
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3rd May 2007, 19:05	#3 (permalink)
*Decodiver* Administrator Current Rebreather/s: Other CCR Other Rebreather/s: Other CCR Join Date: Jan 2005 Location: Geneva Posts: 2,197	Re: Caustic Cocktails - First Aid / Treament Drink Coke. __________________ CCR/OC Trimix Instructor Trainer CCR Training to Mixed Gas in Switzerland, France, UK & Germany on Megalodon/COPIS-Megalodon/KISS/Sport KISS/Ouroboros/rEvo/Inspiration/Evolution/Sentinel www.zerogravitydiving.com Rebreather World Terms & Conditions
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3rd May 2007, 19:57	#4 (permalink)
diveladydive New Member Current Rebreather/s: Optima Pelagian Other Rebreather/s: Megalodon Optima Titan Pelagian Join Date: Jan 2007 Location: Southeastern Florida Posts: 50	Re: Caustic Cocktails - First Aid / Treament Allow me to quote Mark Drekker, owner of Fill Express on this topic. Mark has a background in chemistry, & his sister, Lisa, worked as a chemist. Mark, I’m thanking you in advance for permission to quote. “Peri, you asked how the chemistry of Coke works to neutralize the rebreather absorbent... So here is a bit of high school chemistry (a bit oversimplified but adequate for this explanation).... The absorbent mixed with water will produce mild alkaline solution which can be neutralized by mild acid solution. Acid or alkaline is measured using the pH scale which can have a value between 0 (very corrosive acid, say sulfuric acid) and 14 (very corrosive alkaline, say sodium hydroxide aka lye). The value 7.0 is said to be neutral (pure water has a pH of 7.0). The pH of regular carbonated soft drinks is about 2.5 and diet soft drinks for whatever reason are not quite as acidic with pH's around 3. The soft drinks that have a 'smoother' taste with less 'bite' like Mountain Dew are slightly less acidic... Pepsi is slightly less acidic than Coke... but we are talking very small differences... for the purpose of washing absorbent out of your mouth they will all work equally well. Mix a equal amount of acid and alkaline together and they will 'neutralize' each other.... i.e. a liquid with a pH of 3 (7-4) and a liquid with a pH of 11 (7+4) that mixed together in equal amounts would produce a liquid with a pH of 7. Note that just because it's neutral pH does not mean it's safe to drink... there are plenty of very nasty things you could drink that have near neutral pH. Here are some pH values of common substances... Soda lye 14.0 Ammonia water 11.6 Milk of magnesia 10.5 Baking soda 8.0 Sea water 7.36 – 8.21 Human blood 7.35 – 7.45 Distilled water 7.0 Human saliva 6.3 – 6.6 Milk 6.5 Tomato & tomato juice 4.2 Grapefruit juice 3 – 3.3 Orange juice 3 – 4 Apple juice 2.9 – 3.3 Vinegar 2.4 – 3.4 Lemon juice 2.3 Stomach fluids 1 – 3 Sulfuric acid 0.3 Hydrochloric acid 0.1 Most carbonated beverages like Coke contain three different mild acids... carbonic acid from the CO2 bubbles, citric acid for flavor and phosphoric acid to give it that ‘bite’... there is nothing particularly magic about Coke itself (and pays no attention to all those Coke myths... Coke will NOT dissolve nails or teeth). Instead of Coke you could use ANY mild acid with about the same Ph from the list above, but of course some acids taste much better than others... besides Coke you could use any other carbonated beverage, apple juice, or even vinegar in a pinch... I mention vinegar because nearly all commercial dive boats have vinegar on board to treat stings. One last note... don't drink whatever you use, just swish it around in your mouth and spit it out.” As far as the ER/EMT situation is concerned, prior to learning this, I took a very bad laryngeal hit on a prototype Titan during pool drills. Suffice to say that the lye was not neutralized until my instructor, Tom Mount, left the hospital & came back with a homeopathic remedy & baking soda. Tom also saved my life that day, as to my ENT's knowledge, unlike the trachea, the larynx does not re-open from that type of injury quickly enough to live through. Tom used acupressure at the scene. I was signaling to be trached when Tom open my airway, which was entirely shut down, with his technique. We found out later that traching a caustic is probably on the worst-to-do list, outside of dying because you didn’t try everything: By traching me, the lye would have entered the bronchioles & I wouldn’t be here to write this. I carry coke or another soda in a squeeze bottle, & needed it recently for a very mild hit- which may not have been so mild if not immediately neutralized. That was a no-stop training dive; now imagine the effect with a nice-sized deco obligation to fulfill. Hope this helps... __________________ *Complacency: Self-satisfaction especially when accompanied by ignorance of actual dangers or deficiencies.* *Success: A journey in which the improbable becomes possible, leading to surprising levels of achievement.* *Dr. Peri M. Blum* *Instructor, IANTD* *Member, Board of Advisors, IANTD* *www.supremedivers.com* *561-901-9715* The opinions expressed herein are those of the author and the author’s alone. Last edited by diveladydive : 3rd May 2007 at 20:05.
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3rd May 2007, 21:47	#5 (permalink)
Loneshark New Member Current Rebreather/s: Other SCR Other Rebreather/s: Other SCR Join Date: May 2006 Location: Hull East Yorks Posts: 62	Re: Caustic Cocktails - First Aid / Treament [quote=diveladydive;113122]Allow me to quote Mark Drekker, owner of Fill Express on this topic. Mark has a background in chemistry, & his sister, Lisa, worked as a chemist. Thanks for that! Very informative! You live and learn..... __________________ www.lonesharkproductions.com
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3rd May 2007, 22:42	#6 (permalink)
diveladydive New Member Current Rebreather/s: Optima Pelagian Other Rebreather/s: Megalodon Optima Titan Pelagian Join Date: Jan 2007 Location: Southeastern Florida Posts: 50	Re: Caustic Cocktails - First Aid / Treament [quote=Loneshark;113145] Quote: (Originally Posted by diveladydive) Allow me to quote Mark Drekker, owner of Fill Express on this topic. Mark has a background in chemistry, & his sister, Lisa, worked as a chemist. Thanks for that! Very informative! You live and learn.....:o More than welcome, & thank Mark, actually :-) He was kind enough to answer my email about Coke. Tom Mount told me about that- he found out after I'd had the bad hit. Mark is n2diving. __________________ *Complacency: Self-satisfaction especially when accompanied by ignorance of actual dangers or deficiencies.* *Success: A journey in which the improbable becomes possible, leading to surprising levels of achievement.* *Dr. Peri M. Blum* *Instructor, IANTD* *Member, Board of Advisors, IANTD* *www.supremedivers.com* *561-901-9715* The opinions expressed herein are those of the author and the author’s alone.
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4th May 2007, 00:24	#7 (permalink)
gibbogeo Gilberto Bonaga, Italy Current Rebreather/s: Classic Kiss Dolphin Home Build Other Rebreather/s: Dolphin Home Build Join Date: Sep 2005 Location: italy Posts: 318	Re: Caustic Cocktails - First Aid / Treament Quote: (Originally Posted by Decodiver) Drink Coke. I washed my mouth with soda water, then i drank milk, lemon juice and coke (one after the other). I fully recovered from the burning in 24 hours. But the mix i had in my stomach had crazy effects...
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4th May 2007, 00:26	#8 (permalink)
sensor330 Custom Title Allowed! Current Rebreather/s: Megalodon Other Rebreather/s: Not Bought Yet Inspiration Classic Join Date: Feb 2005 Location: Victoria, British Columbia, Canada Posts: 581	Re: Caustic Cocktails - First Aid / Treament Quote: (Originally Posted by Fort Collins Bob) Hello Everyone, What first Aid and Treatments can be giving a CCR Diver having been burned by a Caustic Cocktail ? I would be asking this question in reference to diving in very remote locations where medical Treatment could be delayed. Are there medications that can be used to help with the swelling that are said to be a complication from this ? Thanks to all. While Rebreather diving in the Navy we have a bottle of lime juice in the boat to neutralize the caustic cocktail. After that not much you can do without medical attention.
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8th May 2007, 18:26	#9 (permalink)
Gene_Hobbs Resident bibliophile Current Rebreather/s: Not Bought Yet Other Rebreather/s: Not Bought Yet Join Date: Sep 2006 Location: Durham, NC, USA Posts: 122	NATO Multinational Guide to Diving Medical Disorders. NATO Multinational Guide to Diving Medical Disorders. ADivP-02(A)/ MDivP-02(A) Quote: 0818. Caustic Cocktail c. Treatment (1) Remove Diver from the water. Remove the set as quickly as possible. (2) If the diver is suspected of having swallowed a cocktail give copious drinks of fresh water. Salt water may be used to rinse out the mouth but should not be swallowed, since it may induce vomiting and cause further burning. (3) Wash all contaminated external surfaces liberally with fresh or salt water. (4) Caustic burns to the eye should be treated by washing the eye with large volumes of water for at least 20 minutes. If necessary, the eyelids should be held open while this is done. Refer to an eye unit, casualty department or Medical Officer immediately. (5) A caustic cocktail readily provokes panic, especially in inexperienced divers. This may result in a rapid ascent and breath-holding (to avoid inhaling further alkali). Consequently, divers who as the result of a caustic cocktail, make a rapid ascent to the surface should be observed carefully for 12 hours following the dive for evidence of pulmonary barotrauma or neurological decompression illness and should be seen by a Medical Officer before diving is resumed. __________________ http://rubicon-foundation.org/ Home of the Rubicon Research Repository. For help getting started with the Repository, please visit our FAQ page. PLEASE support our work. "Oxygen is addictive and deadly. Everyone who uses it will eventually die" --RW Hamilton, PhD 1991
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8th May 2007, 18:40	#10 (permalink)
Diver Dude New Member Current Rebreather/s: Dolphin Other Rebreather/s: Dolphin Join Date: Apr 2005 Location: USA, CONNECTICUT Posts: 18	Re: Caustic Cocktails - First Aid / Treament I drank Pepto Bismo...a lot of it. It took some of the burning sensation away. I was good after 24 hours
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