Treatment for a bend that is resolved by O2 on the boat...

***schford*** · 3rd August 2005, 16:00

I was chatting to some one at the dive centre today and they said that they had a very minor bend that they treated with o2 on the boat for 1 hour and it went away.

Now I was just wondering and was hoping one of our Medical folks could let me know whether they should have gone to the chamber.

If it was me I would have....

Stuart

Mark Chase · 3rd August 2005, 18:29

There was a television program and an article about perl divers using a hose stuck in their mouth to breath oil contaminated gas from to dive down for the shiney grit balls. I particularly liked the chap who sat on the anchor on the trip back 6m below the boat because he was bent.

They didnt have decompresion chambers there so the team of hyperbaric doctors were using ambient presure 02 admin to treat the divers. They found it worked rather well but in the more severe cases not as well as recompresion.

ATB

Mark Chase

Odin · 3rd August 2005, 18:46

and wwas the casualty examined for residual suymptoms?

My thoughts are if you go on O2 'cos you think you've a problem/potential problem then you need expert check out!

next dive could prove er.. interesting? otherwise!
paul

ROB DAVIE · 3rd August 2005, 19:26

You guys are on the right track. If you are bent, you need O2. If you feel better with the O2, that is great! You need to go to the chamber, have the hyperbaric medicine folks check you out, and let THEM decide if you need to go in the pot as well.

Don't ever leave the last step out. We do know our business, and we don't want you having residual symptoms.

Rob
DMT
Assoc. Member UHMS

ReikiMaster · 7th August 2005, 22:23

Cannibals have the right idea, get em in the the pot!

ROB DAVIE · 7th August 2005, 22:25

Quote: (Originally Posted by ReikiMaster)

Cannibals have the right idea, get em in the the pot!

Richard Harris · 8th August 2005, 04:19

Let me start by saying that I advocate getting the right advice from an expert at the time and every case is different, but:

What a great question Stu and one that makes diving physicians lose a lot of sleep! When I worked on the end of the DES phone in Australia a typical call might come in from Pago Pago in the middle of nowhere saying " I have a guy here who just did 30mins at 15m and now he has a numb right hand, feels really tired and has a headache. He has DAN insurance but we will take about 14hrs to get him via boat then plane to St Hyperbarics. What shall we do? (BTW it's the first day of his $20k dive trip and he would rather stay put)!

So of course I ask all the right questions but it's all a bit vague and I can't examine him myself which makes it even trickier. Is the guy a sensible and experienced diver or is he a total fruitloop who panics every time he gets a runny nose? Maybe he gets migraines and all his symptoms are caused by that. Maybe he has severe spinal DCI and no-one has noticed he isnt moving his arm at all (dont laugh, it happens). I know that mild cases like this might go away especially with some good first aid, but what if I delay organising the evacuation and in 4 hours he CAN'T move his arm? I don't want this guy to get worse, I don't wish to spend the next 24hrs sweating about my decision and I sure don't wish to get sued for making the wrong call, so I tell them to start first aid, recommend they organise the evac and sleep well knowing that I have done everything a thorough doc should do.

But I have probably wasted $40 000 dollars of DAN's money for an uneccessary evacuation because many times this guy will get better by himself. The problem is, you just don't know.

Also we haven't mentioned the possible long term effects of untreated mild DCI - again, a great unknown.

babar · 8th August 2005, 07:34

Absolutely

Certainly in local diver, who won't require a prolonged transport.
one, diver without symptoms can have recurrence of their symptoms

two, the problem of the bends is not simply mechanical obstruction of blood by bubbles. There is a complex cascade of effects that is triggered when these bubbles are recognized by the body as 'foreign.'

three, this inflamatory cascade can be halted, or at least attenuated by exposure to hyperbaric oxygen.

So, yes, if that divers story was consistant with a real hit, he should have received evaluation by a hyperbaric doc. If that doc had been me, I would have treated him.

Quote: (Originally Posted by Richard Harris)

Let me start by saying that I advocate getting the right advice from an expert at the time and every case is different, but:

What a great question Stu and one that makes diving physicians lose a lot of sleep! When I worked on the end of the DES phone in Australia a typical call might come in from Pago Pago in the middle of nowhere saying " I have a guy here who just did 30mins at 15m and now he has a numb right hand, feels really tired and has a headache. He has DAN insurance but we will take about 14hrs to get him via boat then plane to St Hyperbarics. What shall we do? (BTW it's the first day of his $20k dive trip and he would rather stay put)!

So of course I ask all the right questions but it's all a bit vague and I can't examine him myself which makes it even trickier. Is the guy a sensible and experienced diver or is he a total fruitloop who panics every time he gets a runny nose? Maybe he gets migraines and all his symptoms are caused by that. Maybe he has severe spinal DCI and no-one has noticed he isnt moving his arm at all (dont laugh, it happens). I know that mild cases like this might go away especially with some good first aid, but what if I delay organising the evacuation and in 4 hours he CAN'T move his arm? I don't want this guy to get worse, I don't wish to spend the next 24hrs sweating about my decision and I sure don't wish to get sued for making the wrong call, so I tell them to start first aid, recommend they organise the evac and sleep well knowing that I have done everything a thorough doc should do.

But I have probably wasted $40 000 dollars of DAN's money for an uneccessary evacuation because many times this guy will get better by himself. The problem is, you just don't know.

Also we haven't mentioned the possible long term effects of untreated mild DCI - again, a great unknown.

Richard Harris · 8th August 2005, 21:05

Quote: (Originally Posted by babar)

Certainly in local diver, who won't require a prolonged transport.
one, diver without symptoms can have recurrence of their symptoms

........

So, yes, if that divers story was consistant with a real hit, he should have received evaluation by a hyperbaric doc. If that doc had been me, I would have treated him.

If the guy is diving off the metropolitan coast and the only charge is the taxi ride and the chamber ride, I doubt whether many people would have a problem with treating this diver, (even though the story of a numb hand, a headache and fatigue is explained by other things apart from diving). Because there is no specific blood test for DCS we can often (usually!) never be completely sure, so err on the safe side and possiby overtreat some cases to rather than miss some genuine ones.

The diver in Pago Pago did receive evaluation by a hyperbaric doc (the doc on the DAN emergency line), and then he has to decide whether to commence the evacuation procedure at great expense, inconvenience and most importantly significant delay to definitive treatment. Given the information accessible over the phone, I don't think the decision is at all easy and in fact the UHMS Remote DCI Worshop indicated that many physicians would take a wait and see approach (with good first aid of course).

ROB DAVIE · 8th August 2005, 23:22

"Harry",

Thank you for a great report, and comments from someone who has been at that critical decision-making point many times!

We appreciate your contribution!

Rob Davie

3rd August 2005, 16:00	#1 (permalink)
*schford* Despotic Overlord Current Rebreather/s: Megalodon Sport Kiss Other Rebreather/s: Join Date: Jan 2005 Location: London, UK Posts: 3,562	Treatment for a bend that is resolved by O2 on the boat... I was chatting to some one at the dive centre today and they said that they had a very minor bend that they treated with o2 on the boat for 1 hour and it went away. Now I was just wondering and was hoping one of our Medical folks could let me know whether they should have gone to the chamber. If it was me I would have.... Stuart
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3rd August 2005, 18:29	#2 (permalink)
Mark Chase I go down for ages Current Rebreather/s: Classic Kiss Other Rebreather/s: Inspiration Classic Join Date: Jan 2005 Location: Kent Posts: 2,700	There was a television program and an article about perl divers using a hose stuck in their mouth to breath oil contaminated gas from to dive down for the shiney grit balls. I particularly liked the chap who sat on the anchor on the trip back 6m below the boat because he was bent. They didnt have decompresion chambers there so the team of hyperbaric doctors were using ambient presure 02 admin to treat the divers. They found it worked rather well but in the more severe cases not as well as recompresion. ATB Mark Chase __________________ Is it supposed to make that noise ? I took my unit to the dive shop and demanded they bolt on every thing that would fit. Join my elite diving teem and get a Tshirt "Doing It Chasey"Hammerhead Eccr Advanced Diving System
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3rd August 2005, 18:46	#3 (permalink)
Odin Egbert - the Deco Dancer Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Feb 2005 Location: U.K Posts: 141	and wwas the casualty examined for residual suymptoms? My thoughts are if you go on O2 'cos you think you've a problem/potential problem then you need expert check out! next dive could prove er.. interesting? otherwise! paul
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3rd August 2005, 19:26	#4 (permalink)
ROB DAVIE Administrator Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Feb 2005 Location: HOUSTON, REPUBLIC OF TEJAS Posts: 1,120	You guys are on the right track. If you are bent, you need O2. If you feel better with the O2, that is great! You need to go to the chamber, have the hyperbaric medicine folks check you out, and let THEM decide if you need to go in the pot as well. Don't ever leave the last step out. We do know our business, and we don't want you having residual symptoms. Rob DMT Assoc. Member UHMS __________________ [SIZE=2]"CC Rebreathers will become a viable part of tech diving [U]WHEN PIGS FLY[/U]!!"--GI3[/SIZE]
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7th August 2005, 22:23	#5 (permalink)
ReikiMaster CK #21 Current Rebreather/s: Classic Kiss Other Rebreather/s: Join Date: Feb 2005 Location: Reading Berkshire Posts: 168	Cannibals have the right idea, get em in the the pot!
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7th August 2005, 22:25	#6 (permalink)
ROB DAVIE Administrator Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Feb 2005 Location: HOUSTON, REPUBLIC OF TEJAS Posts: 1,120	Quote: (Originally Posted by ReikiMaster) Cannibals have the right idea, get em in the the pot! __________________ [SIZE=2]"CC Rebreathers will become a viable part of tech diving [U]WHEN PIGS FLY[/U]!!"--GI3[/SIZE]
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8th August 2005, 04:19	#7 (permalink)
Richard Harris Dr Harry Current Rebreather/s: Classic Kiss MK 15.X Other Rebreather/s: Join Date: Jul 2005 Location: Adelaide, South Australia Posts: 123	To treat or not to treat Let me start by saying that I advocate getting the right advice from an expert at the time and every case is different, but: What a great question Stu and one that makes diving physicians lose a lot of sleep! When I worked on the end of the DES phone in Australia a typical call might come in from Pago Pago in the middle of nowhere saying " I have a guy here who just did 30mins at 15m and now he has a numb right hand, feels really tired and has a headache. He has DAN insurance but we will take about 14hrs to get him via boat then plane to St Hyperbarics. What shall we do? (BTW it's the first day of his $20k dive trip and he would rather stay put)! So of course I ask all the right questions but it's all a bit vague and I can't examine him myself which makes it even trickier. Is the guy a sensible and experienced diver or is he a total fruitloop who panics every time he gets a runny nose? Maybe he gets migraines and all his symptoms are caused by that. Maybe he has severe spinal DCI and no-one has noticed he isnt moving his arm at all (dont laugh, it happens). I know that mild cases like this might go away especially with some good first aid, but what if I delay organising the evacuation and in 4 hours he CAN'T move his arm? I don't want this guy to get worse, I don't wish to spend the next 24hrs sweating about my decision and I sure don't wish to get sued for making the wrong call, so I tell them to start first aid, recommend they organise the evac and sleep well knowing that I have done everything a thorough doc should do. But I have probably wasted $40 000 dollars of DAN's money for an uneccessary evacuation because many times this guy will get better by himself. The problem is, you just don't know. Also we haven't mentioned the possible long term effects of untreated mild DCI - again, a great unknown. __________________ "Harry" www.divedoc.net
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8th August 2005, 07:34	#8 (permalink)
babar Curmudgeon Current Rebreather/s: Evolution Sport Kiss Other CCR Other Rebreather/s: Inspiration Classic Inspiration Vision Evolution Other CCR Join Date: Apr 2005 Location: Southern California Posts: 417	Absolutely Certainly in local diver, who won't require a prolonged transport. one, diver without symptoms can have recurrence of their symptoms two, the problem of the bends is not simply mechanical obstruction of blood by bubbles. There is a complex cascade of effects that is triggered when these bubbles are recognized by the body as 'foreign.' three, this inflamatory cascade can be halted, or at least attenuated by exposure to hyperbaric oxygen. So, yes, if that divers story was consistant with a real hit, he should have received evaluation by a hyperbaric doc. If that doc had been me, I would have treated him. Quote: (Originally Posted by Richard Harris) Let me start by saying that I advocate getting the right advice from an expert at the time and every case is different, but: What a great question Stu and one that makes diving physicians lose a lot of sleep! When I worked on the end of the DES phone in Australia a typical call might come in from Pago Pago in the middle of nowhere saying " I have a guy here who just did 30mins at 15m and now he has a numb right hand, feels really tired and has a headache. He has DAN insurance but we will take about 14hrs to get him via boat then plane to St Hyperbarics. What shall we do? (BTW it's the first day of his $20k dive trip and he would rather stay put)! So of course I ask all the right questions but it's all a bit vague and I can't examine him myself which makes it even trickier. Is the guy a sensible and experienced diver or is he a total fruitloop who panics every time he gets a runny nose? Maybe he gets migraines and all his symptoms are caused by that. Maybe he has severe spinal DCI and no-one has noticed he isnt moving his arm at all (dont laugh, it happens). I know that mild cases like this might go away especially with some good first aid, but what if I delay organising the evacuation and in 4 hours he CAN'T move his arm? I don't want this guy to get worse, I don't wish to spend the next 24hrs sweating about my decision and I sure don't wish to get sued for making the wrong call, so I tell them to start first aid, recommend they organise the evac and sleep well knowing that I have done everything a thorough doc should do. But I have probably wasted $40 000 dollars of DAN's money for an uneccessary evacuation because many times this guy will get better by himself. The problem is, you just don't know. Also we haven't mentioned the possible long term effects of untreated mild DCI - again, a great unknown. __________________ Babar Evolution Plus Sport kiss
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8th August 2005, 21:05	#9 (permalink)
Richard Harris Dr Harry Current Rebreather/s: Classic Kiss MK 15.X Other Rebreather/s: Join Date: Jul 2005 Location: Adelaide, South Australia Posts: 123	Quote: (Originally Posted by babar) Certainly in local diver, who won't require a prolonged transport. one, diver without symptoms can have recurrence of their symptoms ........ So, yes, if that divers story was consistant with a real hit, he should have received evaluation by a hyperbaric doc. If that doc had been me, I would have treated him. If the guy is diving off the metropolitan coast and the only charge is the taxi ride and the chamber ride, I doubt whether many people would have a problem with treating this diver, (even though the story of a numb hand, a headache and fatigue is explained by other things apart from diving). Because there is no specific blood test for DCS we can often (usually!) never be completely sure, so err on the safe side and possiby overtreat some cases to rather than miss some genuine ones. The diver in Pago Pago did receive evaluation by a hyperbaric doc (the doc on the DAN emergency line), and then he has to decide whether to commence the evacuation procedure at great expense, inconvenience and most importantly significant delay to definitive treatment. Given the information accessible over the phone, I don't think the decision is at all easy and in fact the UHMS Remote DCI Worshop indicated that many physicians would take a wait and see approach (with good first aid of course). __________________ "Harry" www.divedoc.net
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8th August 2005, 23:22	#10 (permalink)
ROB DAVIE Administrator Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Feb 2005 Location: HOUSTON, REPUBLIC OF TEJAS Posts: 1,120	"Harry", Thank you for a great report, and comments from someone who has been at that critical decision-making point many times! We appreciate your contribution! Rob Davie __________________ [SIZE=2]"CC Rebreathers will become a viable part of tech diving [U]WHEN PIGS FLY[/U]!!"--GI3[/SIZE]
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