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Thread: Pulmonary Oedema incident

  1. #21
    RBW Member lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon has a spectacular aura about lemon's Avatar
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    Re: Pulmonary Oedema incident

    wheezing and pulmonary edema is often seen in acutely decompensated congestive heart failure (chf). the pulmonary edema can certainly lead to hypoxemia and cyanosis. one of our treatments for this in the ER (i'm a board certified ER physician) is positive pressure ventilation which often can dramatically improve oxygenation in acutely decompensated patients. kudos to whoever had the presence of mind to try this on you - perhaps it helped in your case too.

    i don't know much about IPE but I second the above comments regarding getting a cardiac echo done. while your event may have been caused by something more "exotic" like IPE, its important to check out the "usual suspects" as well. you'll definitely want to check that your heart is functioning normally and that it is pumping effectively at baseline; a cardiac echo would be quite helpful in this respect. assuming thats normal, i think you'd also want to get some form of cardiac stress testing done to ensure that you don't have a problem with your heart functioning properly when under stress. an acute ischemic event can certainly put you into acute chf with pulmonary edema.

    i'm sure your cardiologist will have these checked. i would also second the above comments re: this not being a panic attack. while it would be absolutely normal to have symptoms of panic and anxiety going through something this severe underwater, its extremely unlikely to be the cause of your symptoms.

    anyway, my .02 worth. best of luck with your medical evals and i'll be keeping my fingers crossed for you.

  2. #22
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by JClynes  View Original Post
    Simon, quick question for you as I don't remember much of the ascent - what were your impressions of my condition at that time? Did I seem O'K or not?

    Thx,
    John

    Thanks,
    John
    No, you were just very trusting, I don't think that you were finning much I was lifting you. You we just doing your best to stay alive. When we got to 6 metres I wanted to stop and I tried to indicate that we should at least have a pause but you shook you head and gave me the thumb.

    On the surface you had a bit of life in you but as I was pulling you towards the boat you were going limp.

  3. #23
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by Simon TW  View Original Post
    No, you were just very trusting, I don't think that you were finning much I was lifting you. You we just doing your best to stay alive. When we got to 6 metres I wanted to stop and I tried to indicate that we should at least have a pause but you shook you head and gave me the thumb.

    On the surface you had a bit of life in you but as I was pulling you towards the boat you were going limp.
    Damn, I knew someone would make me tearful. I remember shaking my head at 6m. I remember also trying to vent my wing at some point but you were doing it for me already so I thought I'd not confuse things. It was around the same time. These are pretty much the only thoughts I remember for the entire of our ascent.

    Cheers mate for sticking with me. Sorry for putting you through what I did but my infinite thanks for getting me through it. You'll have many vestal virgins waiting for you on the other side. I'll also try and arrange some for this side too

    J
    Last edited by JClynes; 4th September 2011 at 21:26.

  4. #24
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by lemon  View Original Post
    wheezing and pulmonary edema is often seen in acutely decompensated congestive heart failure (chf). the pulmonary edema can certainly lead to hypoxemia and cyanosis. one of our treatments for this in the ER (i'm a board certified ER physician) is positive pressure ventilation which often can dramatically improve oxygenation in acutely decompensated patients. kudos to whoever had the presence of mind to try this on you - perhaps it helped in your case too.

    i don't know much about IPE but I second the above comments regarding getting a cardiac echo done. while your event may have been caused by something more "exotic" like IPE, its important to check out the "usual suspects" as well. you'll definitely want to check that your heart is functioning normally and that it is pumping effectively at baseline; a cardiac echo would be quite helpful in this respect. assuming thats normal, i think you'd also want to get some form of cardiac stress testing done to ensure that you don't have a problem with your heart functioning properly when under stress. an acute ischemic event can certainly put you into acute chf with pulmonary edema.

    i'm sure your cardiologist will have these checked. i would also second the above comments re: this not being a panic attack. while it would be absolutely normal to have symptoms of panic and anxiety going through something this severe underwater, its extremely unlikely to be the cause of your symptoms.

    anyway, my .02 worth. best of luck with your medical evals and i'll be keeping my fingers crossed for you.
    thanks for your post Lemon. My heart and its function will be under the spotlight. My guess is I have some issue, hypertension + something else. We'll see. I hate the guesswork and have been latching from one theory to another as so many sound plausible. But ultimately I suspect underlying medical issues to be at the heart of this. I've not exactly lived an exemplary healthy lifestyle these last couple of decades.


    John

  5. #25
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    Re: Pulmonary Oedema incident

    Immersion pulmonary oedema is in my opinion a bit more likely simply due to the fact that you survived. A heart attack with acute onset heart failure with hypoxia and cyanosis tends to be fatal, it's definitely not the norm to see it spontaneously reverse with just oxygen treatment. You should of course have a full check-up either way though.

    I wonder if IPE is actually a lot more common than the incident reports suggest. I've seen one case myself and there's been at least two cases at "my" hospital in the last ten years and this is not a high volume dive destination, the area we serve sees maybe 200-300 dives per year. Of course, the first two cases were never reported as the cardiologists that took care of them never heard of IPE. It was sorted under the odd stuff happens label until it came up during a discussion about diving.

  6. #26
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by izze  View Original Post
    Immersion pulmonary oedema is in my opinion a bit more likely simply due to the fact that you survived. A heart attack with acute onset heart failure with hypoxia and cyanosis tends to be fatal, it's definitely not the norm to see it spontaneously reverse with just oxygen treatment. You should of course have a full check-up either way though.

    I wonder if IPE is actually a lot more common than the incident reports suggest. I've seen one case myself and there's been at least two cases at "my" hospital in the last ten years and this is not a high volume dive destination, the area we serve sees maybe 200-300 dives per year. Of course, the first two cases were never reported as the cardiologists that took care of them never heard of IPE. It was sorted under the odd stuff happens label until it came up during a discussion about diving.
    Hi Izze,

    Does cardiogenic pulmonary oedema have to be accompanied by a heart attack? Certainly my heart x-rays and ecgs all appeared normal.

    From the little I know about pulmonary oedema it sounds like hypertension in conjunction with immersion alone can cause it without it including a heart attack. But I am not a doctor and the (subtle?) differences between cardiogenic pulmonary oedema caused or aggravated by immersion and 'pure' immersion pulmonary oedema seem a little opaque/confusing to me.

    I think I will be able to furnish everyone with more answers once I've seen my cardiologist and I will be sure to post back here then.

    Thanks,
    John

  7. #27
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    Re: Pulmonary Oedema incident

    Dr M of these waters considers this to be one of his interests and has a paper up on Rubicon that's of value for a light read.

    Rubicon Research Repository: Item 123456789/7642

    Wifie has had a mild episode of this on OC gear that was poorly serviced and the symptoms match what you stated but you went cyanotic. She just had an onset that stopped her from further diving with a severe chest rattle, breath shortness and a sensation of water inhalation when none were present from her kit. You definitely are more likely to have causative agents at play that need to be sorted before diving again.

    Good luck with the investigations.

  8. #28
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    JJ

    Re: Pulmonary Oedema incident

    Quote Originally Posted by JClynes  View Original Post
    Hi Izze,

    Does cardiogenic pulmonary oedema have to be accompanied by a heart attack? Certainly my heart x-rays and ecgs all appeared normal.

    From the little I know about pulmonary oedema it sounds like hypertension in conjunction with immersion alone can cause it without it including a heart attack. But I am not a doctor and the (subtle?) differences between cardiogenic pulmonary oedema caused or aggravated by immersion and 'pure' immersion pulmonary oedema seem a little opaque/confusing to me.

    I think I will be able to furnish everyone with more answers once I've seen my cardiologist and I will be sure to post back here then.

    Thanks,
    John
    I suppose I should clarify that I mean that without pre-existing heart disease acute pulmonary oedema is unlikely unless a ischemic event (heart attack) took place. If you have congestive heart failure, immersion could cause the oedema.

    My opinion is that a normal electrocardiogram makes this less likely. CHF caused by hypertension tends to have some visible abnormalities on a ECG and if this was a cardiogenic oedema I would expect a pathological ECG for hours after the incident, even if you were feeling better.

  9. #29
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    Re: Pulmonary Oedema incident

    Have been involved in the rescue of a PO casualty myself and it scared the crap out of me - i'm at work at the minute but will drop you a PM this evening... J.

  10. #30
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    Re: Pulmonary Oedema incident

    To the original poster - very brave / useful / thought provoking thread, thanks

    QUOTE
    And no, didn't have the symptoms you described. In a nutshell mine were:
    1. Wheezing (at depth)
    2. Tingling lips (at depth)
    3. Not sure, something very bad, thinking was going to pass out (at depth)
    4. Not able to breathe, no other sensation (on surface)
    END QUOTE

    Im not medically qualified in ANY way, BUT have to say these symptoms sound a LOT like ox tox to me from a dive training viewpoint

    1) Wheezing (high PO2 causing issue with the alveolae of the lungs, definitely felt this decoing out on 100% @ 6m for 20 mins, granted minor, but increasing
    Pulmonary effects etc, etc, but unlikely after such a SHORT time granted

    2) Tingling lips. Textbook/primary symptom of ox tox, as taught be several agencies if I remember correctly. Maybe even arguably most common cause ...
    T in CONVEDNTID

    Tingling IS a symptom I'd normally assoc with the hypoxia, but NOT lips as they got good blood flow...

    3) Been reported by very experienced divers as a common sign of serious stress/panic ( and who wouldn't be if you really though something was seriously wrong...) ALSO could be interpreted as the C in CONVENTID i.e. Confusion...

    4) O2 is a well know vasoconstrictor/may aggravate the lungs (loss of vital capacity etc etc, again unlikely in short exposure) but sounds like it could cause difficulty breathing...

    I am in NO way saying it was this, and in NO way contradicting the doctors,
    I just want to learn

    Concerning that in the heat of the moment, due to similarities, easy for a diver/divers/boat crew to misdiagnose perhaps.

    Same to me perhaps as diff between DCS/DCI may be academic on the boat, just give O2/ first aid, transport to help etc.
    Perhaps this isnt one to distinguish till hospital, as first aid of O2, legs elevated etc seems pretty similar

    Anyway given this, perhaps with hindsight having the cells properly tested /testing the calibration (if possible) would have been a good idea/maybe a cause for concern/suspision before subsequent dives.
    If not tested, then 100% sure unit was working ok, may be a little high...

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