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Thread: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

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    Martin Gregory Clerkin MGC has a spectacular aura about MGC has a spectacular aura about MGC has a spectacular aura about MGC has a spectacular aura about MGC has a spectacular aura about MGC's Avatar
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    rEvoIII

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    Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Immersion Pulmonary Edema 06/May/13

    Okay, Iím writing this as a cathartic exercise and also to give details of my little incident on my recent trip to Egypt, itís meant to be a frank account of what happened and it may be a bit graphic for some but itís ďthe whole pictureĒ or not at all.
    If you have any opinions, positive or negative, please feel free to vent them, if youíre being a Jerk, Iíll leave it to others to tell you!

    So some basics:
    Iím 51, reasonably fit but not active in the exercise sense, blood pressure is 100/75, so spot on where it should be, Iíve had a fitness check last year and a ďfitness to dive checkĒ this year (more later) and both came out top notch.
    5í 11íí and 16st 6lbs or 105kg ish if you prefer, so still technically obese on a BMI scale but Iíve slimmed down from 19st in June last year, so Iím heading in the right direction.
    I was properly hydrated and had been taking rehydration salts each day.
    Back end was a bit loose due to the change in food but I didnít have the squirts.

    The Boat:
    King 2, through ďDive connectionĒ in El Gouna, chartered for two weeks diving by my good friend Simon TW.

    Dive on the trip prior to this, was a day at Abu Nuhas on the Chrisoula K and Giannis D, both good entertaining wrecks and a day on the Rosalie Moller with around 2 to 2.5hrs in water each day and max depth day 1 at 24m (ish) and day 2 at 40m (ish).

    The dive:
    40 max planned on Umm Gamar reef, we were looking for a wreck, three teams, one at 20m mark, me and my buddies at 40m and a further team between 40 and 60m.
    Diving a rEvo RMS hCCR, mini titanium with no additional lead, 5mm Lomo full wet suit, no hood or gloves.
    Dil was 20/30 Trimix, standard 3lt tins and one bailout Ali 80 with air, all gas analysed and verified before the dive by me.
    Scrubber had 4hrs of usage on it in 24 degrees C water, RMS showing 2 hrs plus of scrubbed time before cycling required.
    Shearwater was on 30/85 GF

    So previous days diving had gone well no issues, but I must admit that I did feel a little wheezy (in hind sight), but nothing that would cause me to be concerned.

    We dropped in off the boat, I was diving with Brian and Allan, both of whom Iíve dived with before, theyíre both solid guys and Iíd be more than happy to dive with them at any given opportunity.
    We did our bubble and bail check at 6m, everything fine and we headed on down, I was feeling good, no issues.
    Brian led off at his normal rate, which in hind sight was a bit too quick for my liking but with many things like this, it didnít seem to bad at the time, we had the odd stop when Brian spotted something squidgy to photograph, at these points I rested.
    Around 20 minutes into the dive I started to feel tired and a little overstretched, my chest was making some odd noises but nothing at that stage that started any alarm bells ringing, just the odd rasp and an involuntary cough here and there, after another 5 mins or so, it started to feel worse and I started to feel uneasy, I was rasping a bit more at that stage and my chest felt as though it was gurgling on every breath.
    I signaled to Allan that I wasnít well and that we should go up, Allan got Brianís attention and he motioned that we should swim up the reef, rather than go straight up, I agreed (a mistake - possibly) and we headed up from 38m to around 23m, my breathing was labored but not that drastic (or so I thought), I checked my Shearwater and noticed that the RMS warm up cycle was running, so instead of green numbers I was getting amber read outs, this freaked me out a bit as I wondered WTF was going on, was it telling me that the scrubber was fcuked?

    Elevate the level of stress due to the uncertainty, I was breathing heavily and it was getting more difficult to breathe, I thought at that stage that I was going to break through the scrubber and give myself a CO2 hit as well, as it turns out I was wrong, but at the time it all seemed quite plausible to my fevered mind, I started to lose things from that point onwards.

    I bailed out, managed to change both computers to OC, but failed to drop the set point, and ascended to 9m in reasonably controlled manner, the guyís can confirm or correct me here as I definitely wasnít on the right side of sensible, I was breathing like a train and getting no better, my chest was tight and I felt like I was breathing through fluid (which I was).
    I then started to freak that I was going to run out of gas, I checked the gauge and there was plenty but that still didnít help me, I motioned to Brain that I needed his bail out and he clipped it on to me (at my insistence), I had his reg in a death grip, ready to use.

    I check my main Shearwater at that point and all I has was battery warnings and no data, the solenoid had been firing away as I hadnít dropped the SP and eventually the batteries had given out, I couldnít function brain wise at that point and didnít have the ability to accept the warning notifications and clear the screen which would have given me depth, time etc, all this took around 2 minutes or so.

    I then looked at my Petrel, which told me I had 15 mins of deco to do, at that point I bugged out, I was 8 meters from the surface and my brain said, ďthere is no way I can keep this up for another 15 minutes, you son are going to dieĒ (or words to that effect).
    So I flipped into flight mode and ascended, better bent than dead? I donít know, I seem to remember it wasnít a ďhit the up buttonĒ ascent but I went pretty quickly.

    I hit the surface and inflated my wing, classic, spit reg out, fuck me I still canít breathe! gob full of water with the next wave, cough splutter etc, reg back in Ė thatís no fcukin good! reg outÖÖÖ. continue this cycle for a while, whilst wailing like a baby and waiting for the Helium bubbles to kick in.
    I alternated between ď Iím fuckedĒ and ďI am not going to dieĒ and so on, I couldnít see the boat, Allan had popped an SMB up but it was flattish in the water and I couldnít get to it, I tried to get to mine but nothing was making any sense to me.
    I finally could see the boat but I knew they couldnít see the SMB, so I waved knowing full well that the chances of them spotting me were nil, still, I had to try.

    In between coughing up crap, wailing and rasping like a pensioner on his last legs I also managed to shit myself, the final indignity, I was going to die, they were going to recover me and then discover Iíd filled my pant, bollox!

    The guyís surfaced after ten minutes and set about stabilizing me in the water and signaling the boat, which was just as well as I was getting really tired.
    Brian got behind me and provided a barrier between my mouth and the waves, Allan popped up my yellow smb and started waving like mad at the boat, funny moment, Allan managed to smack me on the head with the smbís, I laughed, coughed some crap up, then was sick, hmmmm perhaps I am going to make it.

    Obviously the crew spotted us as the boat started to head rapidly in our direction, I was dekitted in the water and helped up onto the boat and given O2 straight away.
    My breathing had slowed down somewhat and stabilized with the O2, miraculously I wasnít bent, no symptoms and no pain.
    I stayed on O2 as the others were picked up and we headed back to port, even though I wasnít showing any signs of DCI it was thought prudent to get back asap.
    I was kept warm and hydrated, I managed to cough up some more crap off my lungs (which wasnít pink and frothy, more yellowish) and my chest eased, after a while I managed to go and have a shower (not hot) to clean up.

    By the time we got back to port I was fine and my chest felt raw but not full of crap and I could breathe normally.
    My unit was checked and was working fine, the scrubbers were fine and working correctly.

    I chose not to go to the pot, whether, you reading this consider that an unwise decision or not, the choice was mine.

    I had the following day off diving and it was suggested that I go to the hospital to have a ďfitness to diveĒ check at the very least and I agreed.
    So off I went and the doctor gave me a good going over, listened to my chest and everything was fine and working properly.

    The following day I went diving, two shallow dives (23m and 24m respectively) for around an hours duration each, under close supervision, had a good laugh watching Jacob finishing his MOD2, but if Iím honest, although my outward appearance was calm, I was bricking it and listening meticulously to every breath.

    Final days diving for me before heading home, I bailed out of the morning 40m dive as I wasnít comfortable going to that depth so soon and opted for the 8-9m reef dive on the afternoon, which apart for some moments of interest I didnít enjoy at all.
    The following day I flew home.

    So what have I learnt? well, Iíve done some research and IPE can happen at any time to anyone, Iíll not bore you with the details, look it up if youíre interested, so Iím not unique or predisposed to this kind of episode, opinions vary on whether itís Okay to dive again after experiencing IPE, as in my case, recovery can be quick, others are not so lucky and can experience significant lung impairment for considerable lengths of time.
    I had a mild case.

    I should have dropped the pace earlier, not saying that the outcome would have been different but you donít want to work hard on CCR.

    When I signaled to go up, I should have gone straight up and not swum up along the reef, again not saying it would have made a massive difference, but up means up and I didnít indicate the level of distress I was feeling to my buddies and lets face it weíre not mind readers.

    Should I have stayed on the loop? not sure, opinions seem to be divided on other accounts Iíve read, Iím erring on the side of staying on the loop, elevating the O2 and coming shallow quickly, but that would take some control and clear headedness which I definitely didnít have at the time.

    Should I have made myself more familiar with the working of the RMS system and the potential for the readout to go into count down, which while having no real significance, changed the colour of the read out and caused me to freak?
    Yes I bloody well should have and if I was to level any criticism at others, I might suggest that the new RMS user be encouraged to attend a ďfamiliarization sessionĒ on the system with his instructor, I did both my MOD1 and 2 on a non RMS unit, I stress this is my fcuk up not anyone elseís.

    Oh and next time, Iím taking the bloody scooter!!

    I want to thank Brian and Allen, they cut their deco short to get to me as quickly as possible, they both came shallow and were watching me from 3m to ensure I was still moving, 3 people bent and incapable would have been bloody stupid.

    The boat crew were spot on, those guyís are not only great at the normal ďday jobĒ but they got me out of the water smoothly and onto the O2 with great speed.

    And my friends on the boat for their concern and support, you know who you are, Ta!
    Finally thanks to Simon, without your support Iím not sure Iíd have got back in again.

    To round this off, Iím not entirely sure I want to continue diving and on the flip side I donít know if I want to give it up!
    Iím taking some time off from diving in any case, to see if I can get my head straight and make sure Iím Okay physicallyÖÖÖÖwatch this space ☹☺

    Post report note, Iíve waited to post this until after the rest of the guyís and gals had finished their trip, I didnít want to distract them from having a good time, in my mind Iím coming round to the decision of not giving it up, I need to do some more research on IPE and the possibility of re-occurrence.
    Iím going to continue with my weight loss and start a fitness regime and see if I can get some more medical advice and a thorough check up on what my lungs are doing Ė I feel fine by the way, the odd flash back, but the urgency of the memory is fading thankfully.

    Marty

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    RBW Member jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk has a reputation beyond repute jkaterenchuk's Avatar
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Thanks for sharing glad your doing well.

    John

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    Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Thank you for the concise account of your experience. It's these sort of post many of us learn a great deal from and really glad to hear you're alright

    I hope to catch up with you on a dive someday.

    Regards,

    Lance


    Sent from my iPad using Tapatalk HD

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    rEvo

    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Thank you for your candid account and honesty. Glad you are doing better and have recognized some mistakes and the way to fix them.

  5. #5
    RBW Member dreamdive has disabled reputation dreamdive's Avatar
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Hello Marty!

    Glad you are fine! Since I had an episode just like yours, I know how scary it might have been for you as it certainly was for me.

    If you are interested in helping the scientific community, Dr. Moon at Duke University is studying the phenomena of IPE intensly. Let me know if I can give you his contact information (just PM me).

    One more thing to think about: It might be quite possible that OVERhydration may contribute to developing it.

    Then of course, it might just be one of those phenomena that happen without any precise cause.

    The key is to stay calm (while you feel like you are suffocating) and to minimize your workload, because you want to decrease your oxygen requirements.

    On another thought:

    Given that this is being heard of more and more frequently, I want to suggest that the community comes up with a new Diver Signal for "Hey, I think I might have IPE" thus, help me out of the water the quickest and safest way possible.

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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Really glad to hear you're alright and thanks for all the information.
    Best Ossi Italy

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    Martin Gregory Clerkin MGC has a spectacular aura about MGC has a spectacular aura about MGC has a spectacular aura about MGC has a spectacular aura about MGC has a spectacular aura about MGC's Avatar
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    Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Quote Originally Posted by dreamdive  View Original Post
    Hello Marty!

    Glad you are fine! Since I had an episode just like yours, I know how scary it might have been for you as it certainly was for me.

    If you are interested in helping the scientific community, Dr. Moon at Duke University is studying the phenomena of IPE intensly. Let me know if I can give you his contact information (just PM me).

    One more thing to think about: It might be quite possible that OVERhydration may contribute to developing it.

    Then of course, it might just be one of those phenomena that happen without any precise cause.

    The key is to stay calm (while you feel like you are suffocating) and to minimize your workload, because you want to decrease your oxygen requirements.

    On another thought:

    Given that this is being heard of more and more frequently, I want to suggest that the community comes up with a new Diver Signal for "Hey, I think I might have IPE" thus, help me out of the water the quickest and safest way possible.
    Be glad to help out, so send me his details
    On the signalling bit, I just think that we need to be a bit more forceful to get the message across, pointing at your chest, then giving the "I'm not really okay" sign with a forceful UP should get the message across
    As divers we need to talk more, pre dive, on what constitutes a real issue and what we'll do if the shit hits the fan!

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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Quote Originally Posted by MGC  View Original Post
    Be glad to help out, so send me his details
    On the signalling bit, I just think that we need to be a bit more forceful to get the message across, pointing at your chest, then giving the "I'm not really okay" sign with a forceful UP should get the message across
    As divers we need to talk more, pre dive, on what constitutes a real issue and what we'll do if the shit hits the fan!
    Here it is Marty:

    Richard Moon, MD
    Professor of Anesthesiology
    Professor of Medicine
    Medical Director, Center for Hyperbaric Medicine & Environmental Physiology
    Chief, Division of General, Vascular and Transplant Anesthesia
    Duke University Medical Center
    Durham, NC 27710, USA
    Tel: (919) 684-8762
    Fax: (919) 681-4698

    About the signal, something like: one thump at the chest with the "not OK" signal and "up"? Maybe some other members have suggestions, too.

    I think discussions like this one on the forums helps bring awareness to the issue. Until there is a way to prevent IPE, I hope anybody else experiencing it is willing to share his/her experience and provide suggestions on what might be helpful to all parties involved.

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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Thank you for the honest account. Glad you made it through.
    Ken

    Quote Originally Posted by Dsix36  View Original Post
    Just remember that listening to an idiot such as myself may very well get your arse dead.

  10. #10
    RBW Member Paul S is on a distinguished road Paul S is on a distinguished road Paul S's Avatar
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Hi Marty,

    I was out with the Simon and Co. last week so we didn't cross paths. I wasn't aware of what happened, but glad you got through it OK. Does explain a couple of hyper alert reactions I got when I coughed on a deep dive though.

    Yours isn't the first IPE story I've heard in conditions like that (you probably already know the other one). Part of me wonders if a contributory factor is that the warm water not allowing the moisture to condense out of the breathing gas so it's heavily moisture laden. In which case bailing out may have been a good thing as it got you breathing dry gas. That's just speculation though, so talk to the Docs.

    You'll be pleased to hear that Allan was still complaining about Brian's pace at the end of the trip, and his fascination with all things squidgy.

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