WKPP - Dealing with O2 tox protocols

Janos · 31st August 2006, 07:56

Also I think that there was some clarification issued earlier this year, and that GUE now recommend that if they have a reg in their mouth, then you shouldn't remove it, even to switch to a lower F.O2 gas.

However I'm not DIR trained but I'm sure someone who is will be along shortly to correct me if I'm wrong.

Janos

[Now all we need is for someone to come along and suggest that Rebreather World is not the correct place to discuss DIR procedures and the symmetry will be complete

]

abowie · 31st August 2006, 08:36

Sorry guys, this is all pie in the sky.

I've seen various "protocols" for underwater seizures. I doubt that they're based on anything more than opinion and wishful thinking.

My job involves managing people's airways; I'm an anaesthetist (anaesthesiologist to the Americanos).

It's akin to having a protocol for saving someone from a tiger and starting it with:

1. Remove victim from tiger's mouth.

It's simply not that easy.

db8us · 31st August 2006, 08:49

Quote: (Originally Posted by abowie)

It's simply not that easy.

So this means: Forget about it ?
As an anaesthesist you also know about emergency procedures.
The most important thing on an accident scene is that someone STARTS with acting:
-you there secure this place with lights etc
-You there go and call the number XXX and tell then 2 people unconcious
- you go and keep away spectators
-you hold this please
- you do that

and then a protocol is followed
like check for breathing, pulse etc.

all this are "standards" or "action plans" and all of them are better than chaos.
And still one could argue: Why not FIRST do this and why in THAT order. But lifesaving is the ACTION.

My 2 cents only :-)

Mark Chase · 31st August 2006, 09:22

Quote: (Originally Posted by db8us)

So this means: Forget about it ?
As an anaesthesist you also know about emergency procedures.
The most important thing on an accident scene is that someone STARTS with acting:
-you there secure this place with lights etc
-You there go and call the number XXX and tell then 2 people unconcious
- you go and keep away spectators
-you hold this please
- you do that

and then a protocol is followed
like check for breathing, pulse etc.

all this are "standards" or "action plans" and all of them are better than chaos.
And still one could argue: Why not FIRST do this and why in THAT order. But lifesaving is the ACTION.

My 2 cents only :-)

I completely agree.

In situations of panic a clear cut standard will instigate a rapid response. Some response is better than no response especially if that response is based on proven methods.

One thing i would say is that if a tox happens in 6m of water then get the diver to the surface is the first point of action when convulsions have stopped. The divers 02 saturation will be such its likely he wont be bent.

The next question is why purge the reg into the divers mouth if he is on land? Just use normal oral resuscitation methods.

The text is confusing as it seems to be dealing with the diver on land and not in the water but some of the points covered are relevant in water only.

ATB

Mark Chase

Drmike · 31st August 2006, 09:57

Quote: (Originally Posted by Mark Chase)

I completely agree.

In situations of panic a clear cut standard will instigate a rapid response. Some response is better than no response especially if that response is based on proven methods.

One thing i would say is that if a tox happens in 6m of water then get the diver to the surface is the first point of action when convulsions have stopped. The divers 02 saturation will be such its likely he wont be bent.

The next question is why purge the reg into the divers mouth if he is on land? Just use normal oral resuscitation methods.

The text is confusing as it seems to be dealing with the diver on land and not in the water but some of the points covered are relevant in water only.

ATB

Mark Chase

Land?

The trough they are refering to is a habitat and the 'out of water' reffers to being in it. (at least the head being above the water)

If anyone ever sees me with my head in a tigers mouth - please remove it

jhaaja · 31st August 2006, 10:05

Quote: (Originally Posted by Drmike)

Land?

The trough they are refering to is a habitat and the 'out of water' reffers to being in it. (at least the head being above the water)

If anyone ever sees me with my head in a tigers mouth - please remove it

Do you mean the head or the tiger?

JH

abowie · 31st August 2006, 10:06

Fair comments. I'm not being unreasonably negative though, just realistic.

The idea of having a protocol is so that people act in a predetermined fashion. One of the ideas behind that is to minimise panic. People who think that they are doing the right thing and are following a predetermined path that they have faith in are likely to perform those tasks better than people who panic.

It's all very well to put up a protocol to deal with a particular situation but personally I doubt very much that this one is going to make a good outcome very much more likely. As much as anything because I believe that nothing is going to. So I don't have any sort of alternative to suggest.

Some of the things, like trying to ventilate the diver using their second stage, simply won't work. Other things like "waiting till the diver recommences respiration ....etc etc " are just wishful thinking.

Keeping an unconscious diver underwater is almost guaranteed to result in their death by drowning. NOT bolting to the surface with them if you have deco obligation yourself will prevent you getting a nasty bend though so from that point of view has some merit.

About the only thing that may save the diver is already being on a FFM. Even that is no guarantee; fill the FFM with water or vomit and it's not much help to you.

Sorry if I sound negative but just because someone wrote a protocol for an emergency situation doesn't necessarily mean it is either a good protocol, or that it is going to work.

Drmike · 31st August 2006, 10:06

Quote: (Originally Posted by jhaaja)

Do you mean the head or the tiger?

JH

you see!..thats why we need a protocol

Drmike · 31st August 2006, 10:13

Quote: (Originally Posted by abowie)

Fair comments. I'm not being unreasonably negative though, just realistic.

The idea of having a protocol is so that people act in a predetermined fashion. One of the ideas behind that is to minimise panic. People who think that they are doing the right thing and are following a predetermined path that they have faith in are likely to perform those tasks better than people who panic.

It's all very well to put up a protocol to deal with a particular situation but personally I doubt very much that this one is going to make a good outcome very much more likely. As much as anything because I believe that nothing is going to. So I don't have any sort of alternative to suggest.

Some of the things, like trying to ventilate the diver using their second stage, simply won't work. Other things like "waiting till the diver recommences respiration ....etc etc " are just wishful thinking.

Keeping an unconscious diver underwater is almost guaranteed to result in their death by drowning. NOT bolting to the surface with them if you have deco obligation yourself will prevent you getting a nasty bend though so from that point of view has some merit.

About the only thing that may save the diver is already being on a FFM. Even that is no guarantee; fill the FFM with water or vomit and it's not much help to you.

Sorry if I sound negative but just because someone wrote a protocol for an emergency situation doesn't necessarily mean it is either a good protocol, or that it is going to work.

Andrew this protocol is from the WKPP and the dives they are doing using habitats. With that in mind and the diver toxing during elevated ppo2 deco (100% O2 only when dry in habitats) I suspect the protocols (of getting the diver into a habitat etc) are a lot more useful than you are assuming.

This is the main reason we put the two little habitats in Sra Keow cave - so that we would have 2 places (12m and 4.5m) to take a convulsing (or otherwise ill) diver and hopefuly get their heads out the water.

[of course this all depends on the ability to actually find the habitat

)

cedricverdier · 31st August 2006, 10:48

Hi all,

As you may remember, we had some interesting discussions about this topic a few months ago.
We ended up with a kind of protocol that is summarized in an article and a flowchart in the Rebreather World library.

The WKPP protocol (cited in the reference of this article) may only apply in very specific circumstances and some Rebreather World members and hyperbaric doctors didn't agree with this protocol. So maybe based on new opinions, it could be a good idea to update the article I wrote then.

Cheers

31st August 2006, 07:56	#11 (permalink)
Janos "Two Sheds" Current Rebreather/s: Classic Kiss Other Rebreather/s: Classic Kiss Join Date: Feb 2005 Location: East Surrey Posts: 594	Re: WKPP - Dealing with O2 tox protocols Also I think that there was some clarification issued earlier this year, and that GUE now recommend that if they have a reg in their mouth, then you shouldn't remove it, even to switch to a lower F.O2 gas. However I'm not DIR trained but I'm sure someone who is will be along shortly to correct me if I'm wrong. Janos [Now all we need is for someone to come along and suggest that Rebreather World is not the correct place to discuss DIR procedures and the symmetry will be complete ] __________________ You can lead a horse to water but you can't climb a ladder with a large bell in both hands - Vic Reeves www.hellfins.com/shed
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31st August 2006, 08:36	#12 (permalink)
abowie Fighting Girl Current Rebreather/s: Sport Kiss Other Rebreather/s: Join Date: May 2005 Location: Land of Oz Posts: 573	Re: WKPP - Dealing with O2 tox protocols Sorry guys, this is all pie in the sky. I've seen various "protocols" for underwater seizures. I doubt that they're based on anything more than opinion and wishful thinking. My job involves managing people's airways; I'm an anaesthetist (anaesthesiologist to the Americanos). It's akin to having a protocol for saving someone from a tiger and starting it with: 1. Remove victim from tiger's mouth. It's simply not that easy. __________________ Andrew Bowie Rebreather-friendly Buddy
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31st August 2006, 08:49	#13 (permalink)
db8us Custom Title Allowed! Current Rebreather/s: Other SCR Other Rebreather/s: Other SCR Join Date: Sep 2005 Location: Germany Posts: 225	Re: WKPP - Dealing with O2 tox protocols Quote: (Originally Posted by abowie) It's simply not that easy. So this means: Forget about it ? As an anaesthesist you also know about emergency procedures. The most important thing on an accident scene is that someone STARTS with acting: -you there secure this place with lights etc -You there go and call the number XXX and tell then 2 people unconcious - you go and keep away spectators -you hold this please - you do that and then a protocol is followed like check for breathing, pulse etc. all this are "standards" or "action plans" and all of them are better than chaos. And still one could argue: Why not FIRST do this and why in THAT order. But lifesaving is the ACTION. My 2 cents only :-)
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31st August 2006, 09:22	#14 (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: 2,558	Re: WKPP - Dealing with O2 tox protocols Quote: (Originally Posted by db8us) So this means: Forget about it ? As an anaesthesist you also know about emergency procedures. The most important thing on an accident scene is that someone STARTS with acting: -you there secure this place with lights etc -You there go and call the number XXX and tell then 2 people unconcious - you go and keep away spectators -you hold this please - you do that and then a protocol is followed like check for breathing, pulse etc. all this are "standards" or "action plans" and all of them are better than chaos. And still one could argue: Why not FIRST do this and why in THAT order. But lifesaving is the ACTION. My 2 cents only :-) I completely agree. In situations of panic a clear cut standard will instigate a rapid response. Some response is better than no response especially if that response is based on proven methods. One thing i would say is that if a tox happens in 6m of water then get the diver to the surface is the first point of action when convulsions have stopped. The divers 02 saturation will be such its likely he wont be bent. The next question is why purge the reg into the divers mouth if he is on land? Just use normal oral resuscitation methods. The text is confusing as it seems to be dealing with the diver on land and not in the water but some of the points covered are relevant in water only. 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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31st August 2006, 09:57	#15 (permalink)
Drmike Custom Title Allowed! Current Rebreather/s: MK 15.X Ouroboros Other CCR Home Build Other Rebreather/s: Inspiration Classic Other CCR Home Build Join Date: Feb 2005 Posts: 3,157	Re: WKPP - Dealing with O2 tox protocols Quote: (Originally Posted by Mark Chase) I completely agree. In situations of panic a clear cut standard will instigate a rapid response. Some response is better than no response especially if that response is based on proven methods. One thing i would say is that if a tox happens in 6m of water then get the diver to the surface is the first point of action when convulsions have stopped. The divers 02 saturation will be such its likely he wont be bent. The next question is why purge the reg into the divers mouth if he is on land? Just use normal oral resuscitation methods. The text is confusing as it seems to be dealing with the diver on land and not in the water but some of the points covered are relevant in water only. ATB Mark Chase Land? The trough they are refering to is a habitat and the 'out of water' reffers to being in it. (at least the head being above the water) If anyone ever sees me with my head in a tigers mouth - please remove it __________________ Cave diving is a sport Wreck diving is a sport Diving in general is a sport 'Rebreather diving' is not a sport its the delusional obsession with a highly dangerous and often inappropriate piece of equipment Last edited by Drmike : 31st August 2006 at 10:01.
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31st August 2006, 10:05	#16 (permalink)
jhaaja Custom Title Allowed! Current Rebreather/s: Inspiration Classic Other Rebreather/s: Join Date: Mar 2005 Location: Finland Posts: 884	Re: WKPP - Dealing with O2 tox protocols Quote: (Originally Posted by Drmike) Land? The trough they are refering to is a habitat and the 'out of water' reffers to being in it. (at least the head being above the water) If anyone ever sees me with my head in a tigers mouth - please remove it Do you mean the head or the tiger? JH
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31st August 2006, 10:06	#17 (permalink)
abowie Fighting Girl Current Rebreather/s: Sport Kiss Other Rebreather/s: Join Date: May 2005 Location: Land of Oz Posts: 573	Re: WKPP - Dealing with O2 tox protocols Fair comments. I'm not being unreasonably negative though, just realistic. The idea of having a protocol is so that people act in a predetermined fashion. One of the ideas behind that is to minimise panic. People who think that they are doing the right thing and are following a predetermined path that they have faith in are likely to perform those tasks better than people who panic. It's all very well to put up a protocol to deal with a particular situation but personally I doubt very much that this one is going to make a good outcome very much more likely. As much as anything because I believe that nothing is going to. So I don't have any sort of alternative to suggest. Some of the things, like trying to ventilate the diver using their second stage, simply won't work. Other things like "waiting till the diver recommences respiration ....etc etc " are just wishful thinking. Keeping an unconscious diver underwater is almost guaranteed to result in their death by drowning. NOT bolting to the surface with them if you have deco obligation yourself will prevent you getting a nasty bend though so from that point of view has some merit. About the only thing that may save the diver is already being on a FFM. Even that is no guarantee; fill the FFM with water or vomit and it's not much help to you. Sorry if I sound negative but just because someone wrote a protocol for an emergency situation doesn't necessarily mean it is either a good protocol, or that it is going to work. __________________ Andrew Bowie Rebreather-friendly Buddy
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31st August 2006, 10:06	#18 (permalink)
Drmike Custom Title Allowed! Current Rebreather/s: MK 15.X Ouroboros Other CCR Home Build Other Rebreather/s: Inspiration Classic Other CCR Home Build Join Date: Feb 2005 Posts: 3,157	Re: WKPP - Dealing with O2 tox protocols Quote: (Originally Posted by jhaaja) Do you mean the head or the tiger? JH you see!..thats why we need a protocol __________________ Cave diving is a sport Wreck diving is a sport Diving in general is a sport 'Rebreather diving' is not a sport its the delusional obsession with a highly dangerous and often inappropriate piece of equipment
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31st August 2006, 10:13	#19 (permalink)
Drmike Custom Title Allowed! Current Rebreather/s: MK 15.X Ouroboros Other CCR Home Build Other Rebreather/s: Inspiration Classic Other CCR Home Build Join Date: Feb 2005 Posts: 3,157	Re: WKPP - Dealing with O2 tox protocols Quote: (Originally Posted by abowie) Fair comments. I'm not being unreasonably negative though, just realistic. The idea of having a protocol is so that people act in a predetermined fashion. One of the ideas behind that is to minimise panic. People who think that they are doing the right thing and are following a predetermined path that they have faith in are likely to perform those tasks better than people who panic. It's all very well to put up a protocol to deal with a particular situation but personally I doubt very much that this one is going to make a good outcome very much more likely. As much as anything because I believe that nothing is going to. So I don't have any sort of alternative to suggest. Some of the things, like trying to ventilate the diver using their second stage, simply won't work. Other things like "waiting till the diver recommences respiration ....etc etc " are just wishful thinking. Keeping an unconscious diver underwater is almost guaranteed to result in their death by drowning. NOT bolting to the surface with them if you have deco obligation yourself will prevent you getting a nasty bend though so from that point of view has some merit. About the only thing that may save the diver is already being on a FFM. Even that is no guarantee; fill the FFM with water or vomit and it's not much help to you. Sorry if I sound negative but just because someone wrote a protocol for an emergency situation doesn't necessarily mean it is either a good protocol, or that it is going to work. Andrew this protocol is from the WKPP and the dives they are doing using habitats. With that in mind and the diver toxing during elevated ppo2 deco (100% O2 only when dry in habitats) I suspect the protocols (of getting the diver into a habitat etc) are a lot more useful than you are assuming. This is the main reason we put the two little habitats in Sra Keow cave - so that we would have 2 places (12m and 4.5m) to take a convulsing (or otherwise ill) diver and hopefuly get their heads out the water. [of course this all depends on the ability to actually find the habitat ) __________________ Cave diving is a sport Wreck diving is a sport Diving in general is a sport 'Rebreather diving' is not a sport its the delusional obsession with a highly dangerous and often inappropriate piece of equipment Last edited by Drmike : 31st August 2006 at 10:33.
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31st August 2006, 10:48	#20 (permalink)
cedricverdier S21 M.I.B. Current Rebreather/s: Evolution Megalodon Other Rebreather/s: Not Bought Yet Inspiration Classic Inspiration Vision Sport Kiss Classic Kiss Join Date: Apr 2005 Location: Worldwide! Posts: 494	Re: WKPP - Dealing with O2 tox protocols Hi all, As you may remember, we had some interesting discussions about this topic a few months ago. We ended up with a kind of protocol that is summarized in an article and a flowchart in the Rebreather World library. The WKPP protocol (cited in the reference of this article) may only apply in very specific circumstances and some Rebreather World members and hyperbaric doctors didn't agree with this protocol. So maybe based on new opinions, it could be a good idea to update the article I wrote then. Cheers __________________ Cedric Verdier PADI Course Director, ANDI-IANTD-PSAI-TDI-DSAT-DAN-NAUI-CMAS Instructor Trainer Trimix (CCR and OC) and Cave Diving Instructor Trainer www.CedricVerdier.com DIRrebreather member
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