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

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    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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    JJ Hybrid

    Inspo, Hammer Head, KISS rEvo

    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

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    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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    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.:D

    Rob
    DMT
    Assoc. Member UHMS

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

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    Quote Originally Posted by ReikiMaster
    Cannibals have the right idea, get em in the the pot!

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    rEVO

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    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.


  8. #8
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    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.


  9. #9
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    rEVO

    KISS, Flex, Satori, Mk15.5, ++

    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).

  10. #10
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    "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

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