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Thread: Immersion Pulmonary Edema (IPE) at 291'

  1. #41
    New Member Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell has a reputation beyond repute Simon Mitchell's Avatar
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Quote Originally Posted by scubagrunt  View Original Post
    Well it's official. Per-dive Viagra for all
    Ha! You may joke.... this is a line of research that Richard is currently pursuing at Duke.

    Quote Originally Posted by Michael Thornton
    Thanks for that post. Based on the below information what would you suggest one do in response to symptoms? Bail out or not? Change your position in the water (To become more level)? Remove hood, unzip wetsuit? Or just ascend as quickly and safely as possible? Go on O2 at shallow depth? Change set point during shallow stop?
    Thanks
    Michael
    One problem with formulating and teaching a tailored plan to deal with IPE underwater is that it presupposes that the diagnosis will be obvious to the diver - which it may not be. For example, the commonest cause of shortness of breath underwater is probably CO2 toxicity and the "ideal" response to that may differ slightly. But lets set that aside for the moment and assume that a rebreather diver with 50 minutes of decompression correctly identifies they have an IPE problem (maybe because of clues like coughing and wheeziness which are not usually a feature of hypercapnia). What should they do?

    1. Notify the buddy that there is a problem. In an ideal world the buddy would be educated about IPE so the victim could just write "?IPE" on their slate!

    3. Terminate the dive. Decisions around completion of decompression are tricky because there is little doubt that the best initial treatment for IPE is not to be immersed any more. I think this will inevitably be a matter of the diver "playing what is in front of them". Thus, if the respiratory distress is static or only slowly progressive, then a case can be made for completing the decompression. The diver was able to achieve that in the case discussed on this thread. However, if the respiratory symptoms evolve to a point where it seems clear that they cannot be tolerated for the duration of the decompression, then the decompression should be omitted. I would certainly not be "padding" the decompression, or adding optional deep stops, or any other such strategies.

    3. Mitigate any risk factors that may be contributory. This would include things like:
    a. cease all exertion as much as possible.
    b. possibly bailing out if the work of breathing on the rebreather seems high, and if an adequate supply of appropriate O/C gases is available via high performance regulators. Under the latter circumstances there would seem little harm in trying it.
    c. if the rebreather has a back mounted counterlung orient vertically in the water (you could even try lying on your back - but that is likely not to be practical), if it has a front mounted counterlung, stay face down and horizontal, if it has an OTS counterlung then position might not make much much difference - do whatever feels best.
    d. stay on a high set point.
    e. open circuit oxygen (if available from a good regulator) may be a good idea above 6m.
    f. the benefit of removing hoods etc may be more imagined than real, but anything that makes the diver feel better is likely to be reasonable.
    g. be prepared to change plans and omit decompression if symptoms progress

    4. Spend as little time fluffing around on the surface as possible. Get assistance out of the water asap and minimize the time when not breathing from an oxygen source. Breathing air may be associated with a rapid deterioration in condition if the oedema is severe.

    5. Evacuate to the nearest hospital. It is not necessary to go to a hospital with a hyperbaric unit when dealing with IPE. Having an oxygen supply all the way to the hospital may be crucially important in these cases.

    Hope this makes sense.

    Simon M
    Last edited by Simon Mitchell; 25th September 2012 at 22:51.

  2. #42
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    thx simon .....i think you may have saved a life with this info .............steve

  3. #43
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Simon,

    Great hands on advice! Thank you for taking the time to share these important points.

    Warm regards,
    Randy

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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Quote Originally Posted by Simon Mitchell  View Original Post
    Hope this makes sense.

    Simon M
    Thank you Simon,
    I really appreciate you taking the time to write that up.

    Thanks jaboothx for posting the incident report. Its refreshing to find such an educational thread.

    I hope I never have to use this info but am glad that I took the time to read it.
    Last edited by Michael Thornton; 26th September 2012 at 01:02. Reason: spelling

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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Quote Originally Posted by Michael Thornton  View Original Post
    Thank you Simon,
    I really appreciate you taking the time to write that up.

    Thanks jaboothx for posting the incident report. Its refreshing to find such an educational thread.

    I hope I never have to use this info but am glad that I took the time to read it.
    +1
    Gabe

  6. #46
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    A final update from me on this thread, but first:

    Quote Originally Posted by Simon Mitchell  View Original Post
    One problem with formulating and teaching a tailored plan to deal with IPE underwater is that it presupposes that the diagnosis will be obvious to the diver - which it may not be. [... excellent advice follows...]

    Simon M
    Thank you, Simon, for your highly educational post.

    As was suggested by some posters and by Dr. Moon to me privately, I did follow up last week with a stress echocardiogram. I'm happy to report that I passed with flying colors - they ended the test for time because I was at the highest level and still trotting away uphill (remember that I am an endurance triathlete so this is reasonable, even if I am getting a little long in the tooth .

    Whatever it is that caused my IPE, and there have been some excellent posts on this thread summarizing the currently known prejudicial factors, we do know that it was not caused by some previously unknown physical limitation. I'll end my contributions here by repeating a few of our other posters: IPE could happen to any diver (or triathlete, or swimmer), at any time.

    My sincere thanks to everyone for treating this incident report in this spirit of community learning with which I posted it.

    Safe diving to all -
    Jean Anne

  7. #47
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Quote Originally Posted by jaboothtx  View Original Post
    As was suggested by some posters and by Dr. Moon to me privately, I did follow up last week with a stress echocardiogram. I'm happy to report that I passed with flying colors - they ended the test for time because I was at the highest level and still trotting away uphill (remember that I am an endurance triathlete so this is reasonable, even if I am getting a little long in the tooth .

    Whatever it is that caused my IPE, and there have been some excellent posts on this thread summarizing the currently known prejudicial factors, we do know that it was not caused by some previously unknown physical limitation. I'll end my contributions here by repeating a few of our other posters: IPE could happen to any diver (or triathlete, or swimmer), at any time.

    My sincere thanks to everyone for treating this incident report in this spirit of community learning with which I posted it.

    Safe diving to all -
    Jean Anne
    Jean Anne,

    I suggested this stress echocardio in a previous post and I run marathon and other long distance trails races.
    you mention that "I am an endurance triathlete"
    I believe that lung alveoli of person trained on aerobic sport might be more fragile or thinner so more prone to IPE?
    Just an idea, my advice manage the min loop volume to avoid depression always have enough gas in to avoid depression. Meaning anticipate and manually add gas as needed.

    Safe dive
    Emmanuel

  8. #48
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Quote Originally Posted by jaboothtx  View Original Post
    A final update from me on this thread, but first:



    Thank you, Simon, for your highly educational post.

    As was suggested by some posters and by Dr. Moon to me privately, I did follow up last week with a stress echocardiogram. I'm happy to report that I passed with flying colors - they ended the test for time because I was at the highest level and still trotting away uphill (remember that I am an endurance triathlete so this is reasonable, even if I am getting a little long in the tooth .

    Whatever it is that caused my IPE, and there have been some excellent posts on this thread summarizing the currently known prejudicial factors, we do know that it was not caused by some previously unknown physical limitation. I'll end my contributions here by repeating a few of our other posters: IPE could happen to any diver (or triathlete, or swimmer), at any time.

    My sincere thanks to everyone for treating this incident report in this spirit of community learning with which I posted it.

    Safe diving to all -
    Jean Anne
    Well done Jean Anne for making it through.

    Thanks Simon too for your always excellent advice.

    I had a near fatal IPE incident in July '11 and awareness of it has to help. BTW, I brief any boat I'm on these days with what to do if it recurs. I'm pretty anal about it as I need to feel sure that crew know how to respond - I suggest you do the same. I've done about 50 dives since my incident and the first couple of each trip is pretty nerve wracking. After that I settle down.

    Best of luck getting back in the water and congrats again for keeping a cool head.

    One question: how did you know about IPE? How had you heard of it?

    Final point: I now have also made a signal for 'catastrophic issue' so that any buddy knows the event is very serious rather than me just wanting to finish up the dive cos my eyebrow is itchy.

    Best,
    John

  9. #49
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    Re: Immersion Pulmonary Edema (IPE) at 291'

    Hey John, glad you made it out OK, too and most of all:

    Glad that you had no more incidences!!!

    I think IPE is an underreported event AND
    I think that EVERY diver is potentially susceptible.

    So the more we hear and learn about it the better for us all.

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