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Thread: Pulmonary Oedema incident

  1. #41
    RBW Member JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by Sutty  View Original Post
    If you do a search for "negative pressure pulmonary oedema" or "negative pressure pulmonary edema"(american spelling) you will pull up a load of case reports. It's a well recognised phenomenon in anaesthesia, although I suspect there are also often other factors at work in many cases.
    Doh! I meant to say this ''Negative pressure pulmonary edema has been mentioned in a couple of places although I have been told that it has never been documented in Divers in the scientific/medical literature"

    Soz,
    John

  2. #42
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by lemon  View Original Post
    from the DAN website regarding IPE:

    "Divers who have experienced IPE are concerned with the likelihood it will recur. Unfortunately, that likelihood is not known, so many physicians recommend that people with a history of IPE not return to diving. Still others recommend taking an antihypertensive medication before each dive. Before considering a return to diving after IPE, DAN recommends the diver consult with a doctor knowledgeable about the condition."

    still premature to say exactly what caused your incident but if it does turn out to be IPE it seems that there are some experts who will allow continued diving with anti-hypertensive meds. whether or not that would be appropriate for you would need to be determined by your doctors but at least it looks like there may be options.
    Yep, indeed I've read that DAN article. I think a lot may hang off what my cardio says but we'll see.

    My main objective will be not dying and if that means not diving so be it. But if I feel there's a reasonable chance that we understand what caused it and if we can mitigate these factors then I will hopefully be able to go back - albeit shallow, warm and on OC to start off with.

    Cheers,
    J

  3. #43
    Reaction to trigene?

  4. #44
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    Re: Pulmonary Oedema incident

    Did you clean the unit & if so what with?

  5. #45
    RBW Member MatV is a jewel in the rough MatV is a jewel in the rough MatV is a jewel in the rough MatV is a jewel in the rough MatV is a jewel in the rough MatV is a jewel in the rough MatV is a jewel in the rough MatV's Avatar
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    Re: Pulmonary Oedema incident

    From personal experience I can state that all your Symptoms except for the tingling lips are the same as in my accident of pulmonary edema.
    Contributing in my case were: too tight wet suit Jacket,a too tifght factory new reg, considerable effort at depth /17m, some divers had to use their knives as a pulling aid, being a little negative because we exercized "horizontal ascent" with stops at 6/3m, latter I refused because of an uncanny feeling. At the bottom again I was wondering why it took me so long to get the right bearing home. a 11m, I could sense soomething was wrong, at 3m (short slope of sandy bottom) I realized I could only ventilate, but not really get oxygen (was on OC), so I inflatedt my BC before even thinking of notifying my buddy. Who emerges some minuter later, maybe two, and took another to realize my predicament. Since I could neither shout or whistle, I waived my arm up and down. Then he began to understand I started to tow me the 250m to shore, where two army comrades quickly jumoed in to help. At the same time others had called for the ambulance, which arrived 12 minutes later. At this time they already had undressed me, put me in the foil blanket, and I was breathing oxygen from the WENOLL Rescue Rebereather. Since I was to weak to ventilate, I squished the bag myself. This gave some relief, but I was badly coughing al the time, and a bit of brownish sputum was leaving my lungs. The physician meanwhile had me diagnosed with lung edema by auscultation (listening to the sound the lungs made) and provided an IV entry and shot me a lasix infusion, which almost instantly showed effect.
    I was hauld into the EMT-Van, and the rebreathers oxygen began to expire, so I got a Draeger/Ambu OC combination. The cracking resitance of this was very high for me, and I was too weak to do pump the Ambu reservoir bag. Thsi was when my blood oxygen dropped to 68 percent. I was aware of everything full time, but feeling weaker. Then they asked me if I was wearing 3rd teeth and that ( I had handed them my insurance card before..) Next thing I knew was being in a fantastic bed, and a little man with a very fatigued face asking me about what had happened.
    This was the next mornig. The accident occurred at 2000 the night before. The Heli had brought me to the Navy's medical Institute, where the Officer on Duty immediately decided it was no decompression event, and so I awoke in the ICU unit of the Kiel University medical clinic, after a night a CPAP breathing an oxygen enriched mix. They had CT rayed my upper body and confirmed quite an amount of tissue liquids in my lungs. Which was resorbed by the same day, and the next day I could leave feeling quite well.

    Aftermath: Heart diagnosis showed an impeded outflow an an increased size of the left chamber muscle, as well as a downward bump in the ECG T-Streak. Signs of 10 years of unsuffiecient HP-treatment. The next years this was remedied, and now these signs have vanished, I can cycle 250W not exceeding 250/85 mmHG RR.
    Lesson learnt: Don't underestimate the consequences of even intermediate HP, and be not too shy to take a pill or two a day, even if this is life long.
    You do not feel it coming before it is alomost to late, because CO2 elimination ist not impeded (too high a gradient), but oxygen transfer through the thickened membranes is. And the thickening (by "blood pressure reflected into the right (lung) circuit) can happen almost instantaneously(Within several seconds). Obviously, an elevated oxygen partial pressure at depth helps to dissimulate the onset of symptons, so it is no wonder the full severity showed near the surface where ppO2 had dropped.

    Rebreather related thoughts: A CCR where you have to suck down gas, may worsen conditions towards an edema, an SCR will probably not do this, it is already the remedy actually.
    Mat

  6. #46
    RBW Member JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by MatV  View Original Post
    From personal experience I can state that all your Symptoms except for the tingling lips are the same as in my accident of pulmonary edema.
    Contributing in my case were: too tight wet suit Jacket,a too tifght factory new reg, considerable effort at depth /17m, some divers had to use their knives as a pulling aid, being a little negative because we exercized "horizontal ascent" with stops at 6/3m, latter I refused because of an uncanny feeling. At the bottom again I was wondering why it took me so long to get the right bearing home. a 11m, I could sense soomething was wrong, at 3m (short slope of sandy bottom) I realized I could only ventilate, but not really get oxygen (was on OC), so I inflatedt my BC before even thinking of notifying my buddy. Who emerges some minuter later, maybe two, and took another to realize my predicament. Since I could neither shout or whistle, I waived my arm up and down. Then he began to understand I started to tow me the 250m to shore, where two army comrades quickly jumoed in to help. At the same time others had called for the ambulance, which arrived 12 minutes later. At this time they already had undressed me, put me in the foil blanket, and I was breathing oxygen from the WENOLL Rescue Rebereather. Since I was to weak to ventilate, I squished the bag myself. This gave some relief, but I was badly coughing al the time, and a bit of brownish sputum was leaving my lungs. The physician meanwhile had me diagnosed with lung edema by auscultation (listening to the sound the lungs made) and provided an IV entry and shot me a lasix infusion, which almost instantly showed effect.
    I was hauld into the EMT-Van, and the rebreathers oxygen began to expire, so I got a Draeger/Ambu OC combination. The cracking resitance of this was very high for me, and I was too weak to do pump the Ambu reservoir bag. Thsi was when my blood oxygen dropped to 68 percent. I was aware of everything full time, but feeling weaker. Then they asked me if I was wearing 3rd teeth and that ( I had handed them my insurance card before..) Next thing I knew was being in a fantastic bed, and a little man with a very fatigued face asking me about what had happened.
    This was the next mornig. The accident occurred at 2000 the night before. The Heli had brought me to the Navy's medical Institute, where the Officer on Duty immediately decided it was no decompression event, and so I awoke in the ICU unit of the Kiel University medical clinic, after a night a CPAP breathing an oxygen enriched mix. They had CT rayed my upper body and confirmed quite an amount of tissue liquids in my lungs. Which was resorbed by the same day, and the next day I could leave feeling quite well.

    Aftermath: Heart diagnosis showed an impeded outflow an an increased size of the left chamber muscle, as well as a downward bump in the ECG T-Streak. Signs of 10 years of unsuffiecient HP-treatment. The next years this was remedied, and now these signs have vanished, I can cycle 250W not exceeding 250/85 mmHG RR.
    Lesson learnt: Don't underestimate the consequences of even intermediate HP, and be not too shy to take a pill or two a day, even if this is life long.
    You do not feel it coming before it is alomost to late, because CO2 elimination ist not impeded (too high a gradient), but oxygen transfer through the thickened membranes is. And the thickening (by "blood pressure reflected into the right (lung) circuit) can happen almost instantaneously(Within several seconds). Obviously, an elevated oxygen partial pressure at depth helps to dissimulate the onset of symptons, so it is no wonder the full severity showed near the surface where ppO2 had dropped.

    Rebreather related thoughts: A CCR where you have to suck down gas, may worsen conditions towards an edema, an SCR will probably not do this, it is already the remedy actually.
    Mat
    Hi Matt,

    Thanks a lot for your post. Sounds like you had a bit of a near miss too and like me, were lucky enough to have excellent people around you to get you through.

    A note: you don't have to suck down gas on a rEvo, I just wasn't using it as instructed (probably cos I was a bit fatigued) and relied on the ADV for a couple of breaths on descent when I should have been manually adding. Whether the sucking hard on the ADV had anything to do with what happened to me is conjecture and there are some higher value targets (like hypertension) that I will be examining first.

    Thanks for your thinking into why the situation got worse as I got shallower. I don't know why it didn't occur to me. Of course, with a lower PO2 and reduced intake/circulation because of the oedema I presumably went hypoxic, although NOT from the rebreather, simply from my oedema.

    Interesting food for thought. Thanks for sharing. People are coming out of the woodwork with similar oedema related stories.

    I wonder how 'uncommon' this condition really is????

    John

  7. #47
    Classic Kiss diver Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty is a name known to all Sutty's Avatar
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    Re: Pulmonary Oedema incident

    A quick thought - if you are even thinking about diving again then before you do I would suggest doing some swimming. As this is head-out immersion it could provoke pulmonary oedema more than a good quality reg under water, and it is something you have to be able to do! Stay in your depth and with supervision at least for a while.

  8. #48
    RBW Member JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by Sutty  View Original Post
    A quick thought - if you are even thinking about diving again then before you do I would suggest doing some swimming. As this is head-out immersion it could provoke pulmonary oedema more than a good quality reg under water, and it is something you have to be able to do! Stay in your depth and with supervision at least for a while.
    I've been doing it from 2 days from the incident .

    Diving I can give up if I'm forced. Swimming and being in the water (I've kids 5 & 7 and we swim at least once a week - mainly them surfing on my back while I swim a width or two underwater) is non negotiable.

    No issues at all so far. By and large I'm generally unbreakable. I think I just had a really bad day at the office. That said, I will be taking it very easy getting back into diving assuming they clear me. I will also be sorting any lifestyle issues prior to (target rich environment) and will be going shallow, warm and OC to start off with. My CCR is not on eBay yet

    J

  9. #49
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    Re: Pulmonary Oedema incident

    That's great. You may already have done but try a prolonged period of immersion, eg >1hr and make sure you are good.

  10. #50
    RBW Member JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes has a spectacular aura about JClynes's Avatar
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    Re: Pulmonary Oedema incident

    Quote Originally Posted by Sutty  View Original Post
    That's great. You may already have done but try a prolonged period of immersion, eg >1hr and make sure you are good.
    Longest I've done has been 90 mins. No probs. Although I wasn't exerting for a lot of the 90 mins. Exerting I've probably done 60 mins, with breaks from exertion in between. All fine.

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