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

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

    Thanks for positing this for the rest of us to learn from it.

    Not specifically related to this incident, but I have a question for those more familiar with the IPE. I have made an observation after reading similar posts about instances of the IPE on a rebreather. This might be a known fact already, but is there a link between the heavy workload mixed with significant changes in hydrostatic pressures experienced on a CCR and occurrence of the IPE? Can design and positioning of the counterlungs as well trim/position in the water which both have a significant impact on the hydrostatic lung loading increase the possibility of the IPE?
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  2. #12
    RBW Member LeCrabe is an unknown quantity at this point LeCrabe's Avatar
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Quote Originally Posted by MGC  View Original Post
    Immersion Pulmonary Edema 06/May/13

    Okay, I’m writing this as a cathartic exercise and also to give details of my little incident on my recent trip to Egypt, it’s meant to be a frank account of what happened and it may be a bit graphic for some but it’s “the whole picture” or not at all.
    If you have any opinions, positive or negative, please feel free to vent them, if you’re being a Jerk, I’ll leave it to others to tell you!

    So some basics:
    I’m 51, reasonably fit but not active in the exercise sense, blood pressure is 100/75, so spot on where it should be, I’ve had a fitness check last year and a “fitness to dive check” this year (more later) and both came out top notch.
    5’ 11’’ and 16st 6lbs or 105kg ish if you prefer, so still technically obese on a BMI scale but I’ve slimmed down from 19st in June last year, so I’m 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 didn’t have the squirts.

    The Boat:
    King 2, through “Dive connection” 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 I’ve dived with before, they’re both solid guys and I’d 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 didn’t 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 wasn’t well and that we should go up, Allan got Brian’s 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 guy’s can confirm or correct me here as I definitely wasn’t 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 didn’t 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 hadn’t dropped the SP and eventually the batteries had given out, I couldn’t function brain wise at that point and didn’t 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, “there is no way I can keep this up for another 15 minutes, you son are going to die” (or words to that effect).
    So I flipped into flight mode and ascended, better bent than dead? I don’t know, I seem to remember it wasn’t a “hit the up button” ascent but I went pretty quickly.

    I hit the surface and inflated my wing, classic, spit reg out, fuck me I still can’t breathe! gob full of water with the next wave, cough splutter etc, reg back in – that’s no fcukin good! reg out………. continue this cycle for a while, whilst wailing like a baby and waiting for the Helium bubbles to kick in.
    I alternated between “ I’m fucked” and “I am not going to die” and so on, I couldn’t see the boat, Allan had popped an SMB up but it was flattish in the water and I couldn’t 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 couldn’t 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 I’d filled my pant, bollox!

    The guy’s 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 smb’s, 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 wasn’t 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 wasn’t 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 wasn’t 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 “fitness to dive” 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 I’m 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 wasn’t 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 didn’t enjoy at all.
    The following day I flew home.

    So what have I learnt? well, I’ve done some research and IPE can happen at any time to anyone, I’ll not bore you with the details, look it up if you’re interested, so I’m not unique or predisposed to this kind of episode, opinions vary on whether it’s 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 don’t 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 didn’t indicate the level of distress I was feeling to my buddies and lets face it we’re not mind readers.

    Should I have stayed on the loop? not sure, opinions seem to be divided on other accounts I’ve read, I’m 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 didn’t 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 “familiarization session” 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 else’s.

    Oh and next time, I’m 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 guy’s are not only great at the normal “day job” 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 I’m not sure I’d have got back in again.

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

    Post report note, I’ve waited to post this until after the rest of the guy’s and gals had finished their trip, I didn’t want to distract them from having a good time, in my mind I’m 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.
    I’m 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 – I feel fine by the way, the odd flash back, but the urgency of the memory is fading thankfully.

    Marty
    Hi Marty,
    First of all, glad everything turned fine. I can easily imagine how scarry this experience was.
    Secondly I am not MD but something strike me in you story. I have been many time in the red sea and I have suffered ALMOST EVERY TIME the back end problems you described (no critics to our egyptian friends but it takes some use for our western european digestive systems...)
    I could easily imagine that the electrolitic imbalance that resulted from this episode+the warm dry weather resulted in stress for your kidneys functions.
    This could have resulted in a artificial hyperhydration (and amplified by the use of the salts) and then favored your IPE.
    Maybe I am totaly off target but I see a logic in this reasonning.
    Your thoughts everybody.
    Thank you anyway for sharing.
    Last edited by LeCrabe; 20th May 2013 at 10:39.

  3. #13
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Hi Marty, Thanks for that, really glad you walked away from that one and feel happy enough to tell that tail so others can learn from it.

    I would think the DDRC in Plymouth would be quite interested in hearing from you too ;)

    Finally best of luck on getting wet again but don't rush it its something you need to do at your own pace.

    Kevin

  4. #14
    RBW Member dreamdive has disabled reputation dreamdive's Avatar
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Quote Originally Posted by Pawel Szopinski  View Original Post
    Thanks for positing this for the rest of us to learn from it.

    Not specifically related to this incident, but I have a question for those more familiar with the IPE. I have made an observation after reading similar posts about instances of the IPE on a rebreather. This might be a known fact already, but is there a link between the heavy workload mixed with significant changes in hydrostatic pressures experienced on a CCR and occurrence of the IPE? Can design and positioning of the counterlungs as well trim/position in the water which both have a significant impact on the hydrostatic lung loading increase the possibility of the IPE?
    Pawel,

    since we don't know the etiology of IPE, anything has to be considered. In my case the workload was mild. Also as I recall, IPE issues occurred with BMCL as well as FMCL. IPE is not just limited to CCR divers. IPE has been described in Scuba divers, snorkles, triathelete swimmer, Army combat swimmers.

    Personally I wonder if hyperhydration is an issue since water immersion results in blood volume being shifted from the periphery to the core. This causes an increase in vascular hydrostatic pressure (initially). The heart "sees" increased blood volume and atrial stretch receptors get activated signaling to the kidneys to "get rid of the excessive volume" i.e. start to pee. Excessive increased pulmonary vasculature pressure results in interstitial fluid transudation from the vasculature into the alveoli thus increasing lung water aka pulmonary edema.

    I hope that Dr. Moon from Duke will be able to shed a light on this issue so that we may find a preventable measure (hopefully).

    Regards,

    Claudia

  5. #15
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Quick asside is that the same Umm Gamar with the small cave at about 28M?

  6. #16
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Hi Marty

    First of all I think you forgot a potentially important factor. The Thai food you had the day before which was so HOT it matted the ceramic bowl it came in

    I think I speak for all of us who were on the King 2 when you had your incident that we were all very happy when you showed no signs of being bent and that your breathing became easier and easier.

    Just as important we were all very happy and impressed when you returned in the water with us, even if you were "bricking it". I'm sure I still owe you a pint for "catching" my DSMB before it swam away

    I hope that you get back in the water soon again mate, and that I'll see you next year at the dive fest !!!

    ohh and for those of you wondering why Marty was laughing during my MOD2 it might have something to do with this skill:



    -Jacob

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

    I did it exactly the same last year: -75mts diving. Quite current, loaded with heavy photo equipment and three lateral tanks. First time with home made BMCL (but so good), my blood pressure is high. I felt all of that and I thought it was by the workload. I also thought that I was going to die and on the other hand i could get it. Happened again on another dive with current. Days later in dives with currents it was very calm and nothing happened. My thinking is: I have to dive slowly going with Rebreather, even if you feel fine in current, the symptoms come when you ascend, itīs not the same that OC, as everybody know.
    Nothing wrong since.
    I hope you understand my english.
    Last edited by Majete; 22nd May 2013 at 19:07.

  8. #18
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    Re: Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Thank you for sharing! Certainly task loading did not help the situation...

    - Paul's RMS doco states to jump only with at least 45 minutes showing on RMS. Normally this occurs during the 5 minute pre breathe. Did the RMS system have correct display before you jumped?
    - Do you have auto solenoid switch configured for ascent?
    - Any change or customization of the unit which would affect position on your back?

    Thanks! Dwayne
    Last edited by DwayneJ; 24th May 2013 at 00:49.

  9. #19
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    Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Dwayne,
    RMS had over 2hrs on it before I needed to cycle the scrubbers
    No
    Nope the unit was where it should be.

    Marty

  10. #20
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    Immersion Pulmonary Edema 6/5/13, Umm Gamar, Hurghada, Egypt

    Had an echocardiogram tonight, all as it should be and everything is working just fine :)

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