Wreck

[Kiwiology]

Some sort of crazy edema going on here, I just don't know enough about thoracic and respiratory pressure to even begin so ..... take patient to hospital

[chbare]

Some sort of crazy edema going on here, I just don't know enough about thoracic and respiratory pressure to even begin so ..... take patient to hospital

What other questions should we ask? Are there things we can look at? Who should we contact during transport for the most reliable information? Any other sources we can call for dive emergencies? Where will we take this patient and how will he go?

Take care,

chbare.

[CBEMT]

1-919-684-4DAN

[tniuqs]

My first question would be how was this Temp measured @ 91F (~32.7 C) point being is it core ? So I am assuming that it is, 10 cm up the (fill in blank)

Hypothermia may the most serious consideration here and I would be skeptical of pulse ox readings due to decreased perfusion, that said > 35 C the patients LOC may be also decreased, shivering may likely not be observed, active extermal rewarming teqniques and gentle handling advised. If one can't pop a line in perferal then consider IO.

(PMHX Allergies and History of event may be difficult to obtain)any Medic Alert Bracelet? And we a certain no red inflamed "whip like papules/ blisters" ?

The CC of "pain all over my body" could be indicative of the bends / chokes (pick your term) or in fact hypothermia ....

Chest sounding "WET" BI basilar lung sounds could be from numerous causes, from aspiration pneumonia or a near drowning event, if SPO2 is 100 and patient not bradycardic or tachycardic.

What other questions should we ask?

So G/F is present whats the PMHX from her or is she a typical "I dunno he picked me up in a bar last week type?" thinking was patient drinking last evening ?

Who should we contact during transport for the most reliable information?

Information on what the patient or the situation ... personally if I asked Medical Director for advice in this patient he would have a chat in the back room later .

Any other sources we can call for dive emergencies?

Where will we take this patient and how will he go?

Thing is with a 7 minute transport, flight altitude considerations "tree tops" if possible and get to a facility ASAP, why contact medical control when patient is stable, well, except for information patch.

And where I live there is no open water (it solid state) this time of year and no "dive emergency phone numbers"

cheers

<late edit> is the Dive record on his computer and take that with you to hospital.

Edited December 18, 2009 by tniuqs

[chbare]

1-919-684-4DAN

Got it, you call DAN and they ask the following questions:

How deep did the patient actually go? Remember, he planned to go a specific depth, but did something happen during the dive?

Bottom time?

What type of equipment?

What type of gas mix? Remember, he planned to use something.

They recommend rapid transport to the multiplace chamber.

Take care,

chbare.

My first question would be how was this Temp measured @ 91F (~32.7 C) point being is it core ? So I am assuming that it is, 10 cm up the (fill in blank) Yep.

Hypothermia may the most serious consideration here and I would be skeptical of pulse ox readings due to decreased perfusion, that said > 35 C the patients LOC may be also decreased, shivering may likely not be observed, active extermal rewarming teqniques and gentle handling advised. If one can't pop a line in perferal then consider IO.

(PMHX Allergies and History of event may be difficult to obtain)any Medic Alert Bracelet? And we a certain no red inflamed "whip like papules/ blisters" ? NKA

The CC of "pain all over my body" could be indicative of the bends / chokes (pick your term) or in fact hypothermia ....

Chest sounding "WET" BI basilar lung sounds could be from numerous causes, from aspiration pneumonia or a near drowning event, if SPO2 is 100 and patient not bradycardic or tachycardic. I believe the patient is tachycardic.

What other questions should we ask?

So G/F is present whats the PMHX from her or is she a typical "I dunno he picked me up in a bar last week type?" thinking was patient drinking last evening ? She knows him well, was one of the shallow water support divers. What about having somebody track the dive buddy down?

Who should we contact during transport for the most reliable information?

Information on what the patient or the situation ... personally if I asked Medical Director for advice in this patient he would have a chat in the back room later .

Any other sources we can call for dive emergencies?

Where will we take this patient and how will he go?

Thing is with a 7 minute transport, flight altitude considerations "tree tops" if possible and get to a facility ASAP, why contact medical control when patient is stable, well, except for information patch. That is the course I would take.

And where I live there is no open water (it solid state) this time of year and no "dive emergency phone numbers"

cheers

<late edit> is the Dive record on his computer and take that with you to hospital.

So, upon looking at the equipment you notice that he was in fact not using SCUBA equipment. He was actually using a mk 15.5 closed circuit rebreather. You look at his dive computer and at 435 FSW ( ~132.6 meters) it looks like his mix was heliox 90/10/ (90% helium/10% oxygen). Does this jive with this history that was given earlier in this scenario? You also note that 435 FSW was the maximum depth with a "bottom time" of about a minute. Does this jive with what was said earlier? ((You may or may not actually access this info in real life, but your going to get it to ensure advancement of the scenario.))

Does something seem fishy?

Take care,

chbare.

[Kiwiology]

Damn it, where is MacGuyver when you need him.

I have absolutely no idea so I'm going to find a nice spot of beach and get my tan on, I am sick of being stopped by the police who think I'm an escaped corpse coz I'm so white

[chbare]

Damn it, where is MacGuyver when you need him.

I have absolutely no idea so I'm going to find a nice spot of beach and get my tan on, I am sick of being stopped by the police who think I'm an escaped corpse coz I'm so white

No worries, this is a tough one that will most likely take some mad google skillz.

So, you fly him to the multiplace chamber and he is taken back down to depth for a several hour decompression. His signs and symptoms resolve upon "diving" to depth.

While the hyperbaric gurus work their magic you track down the dive buddy for the story:

The dive began without incident with both divers planning on utilising trimix at deeper depths. However, upon reaching 435 FSW, the patient began acting strange and suddenly developed a brief period of what is described a "seizure like activity." The buddy immediately recognised there was something wrong and terminated the dive. The patient transitioned to a bail out tank of trimix by open circuit and he immediately improved with no further "seizure activity." Then, the patient and his buddy began ascending per dive computer instructions while the support team ensured additional tanks of gas were available.

** Side note: you can google a rebreather; however, it works much differently from a SCUBA apparatus. A SCUBA apparatus is also called an open circuit because you inhale gas from a tank and exhale out into the surrounding ocean. A rebreather works by recycling exhaled gas and utilising chemical reactions to "scrub" carbon dioxide from the breathing circuit and recycle the remaining gas. Clearly, it is critical to monitor the levels of the various gasses in the breathing circuit or disaster can ensue. However, the advantage to a rebreather being very little wasted gas and extended dive times while utilising less gas. In addition, the prudent rebreather diver brings along a SCUBA setup as a backup in the event of rebreather failure. The terminology for transitioning to an open circuit device in the event of rebreather failure is called "bail out" or going to the open circuit bailout.

What do you think occurred at depth? You may need to google; however, what occurred is not unique to rebreather diving? In addition, could this problem have been a factor in the development of the bends in spite of ascending per dive computer and dive table recommendations?

Take care,

chbare.

[Richard B the EMT]

1) As a precaution, I would also transport the dive buddy. If it is the "Bends" (spell it as a plural, by the way), there is a chance the dive buddy may not yet be exhibiting symptoms.

2) As I have now one definite and one possible, once we actually transport, destination would be the center with the multi-place recompression chamber, even though it is, per information supplied in this string, about 8 minutes further out from the rescue LZ than the one place recompression chamber center. Air transport would be as near to a rooftop/treetop altitude as the pilot can maintain safely.

Please translate "FSW". I am presuming the "F" is feet.

That number of "1-919-684-4DAN" is, I think, the US contact number of the "Diver's Alerting Network"?

Did anyone mention "Narcosis of the Deep"? I have read that, below certain depths, when the gas mixture is off, either tanked air, combination gasses, or re breathers, it is kind of a narcotic or euphoric effect on the diver, causing him "to feel like taking off his mask and giving it to a passing fish" (Quote remembered from a Jacques Cousteau TV show from back in the late 1960s or early 1970s).

[chbare]

1) As a precaution, I would also transport the dive buddy. If it is the "Bends" (spell it as a plural, by the way), there is a chance the dive buddy may not yet be exhibiting symptoms.

Good call, and that is how you obtained the information above.

2) As I have now one definite and one possible, once we actually transport, destination would be the center with the multi-place recompression chamber, even though it is, per information supplied in this string, about 8 minutes further out from the rescue LZ than the one place recompression chamber center. Air transport would be as near to a rooftop/treetop altitude as the pilot can maintain safely.

Pretty much, brief the PIC of the situation, but his/her call ultimately.

Please translate "FSW". I am presuming the "F" is feet. FSW = Feet of sea water.

That number of "1-919-684-4DAN" is, I think, the US contact number of the "Diver's Alerting Network"? Yes.

Did anyone mention "Narcosis of the Deep"? I have read that, below certain depths, when the gas mixture is off, either tanked air, combination gasses, or re breathers, it is kind of a narcotic or euphoric effect on the diver, causing him "to feel like taking off his mask and giving it to a passing fish" (Quote remembered from a Jacques Cousteau TV show from back in the late 1960s or early 1970s).

You may be on to something. I believe what you are talking about is nitrogen narcosis or "rapture of the deep." This occurs when divers go too deep breathing compressed air or a nitrox mix (nitrogen/oxygen). It can also occur at shallower depths as well. In theory, I think some degree of narcosis could occur when you breath a high nitrogen mix under pressure. Nitrogen narcosis can be rather unpredictable. However, the patient was breathing heliox 90/10, 90% helium and 10% oxygen, therefore nitrogen narcosis would not have occurred. Something somewhat similar however?

Take care,

chbare.

[tniuqs]

Did we forget about treatment for Hypothermia ?

Or are we working on the "hypothermia is protective" research is valid in this senario ?

BTW although "standard" definition of tachycardia, I seldom get excited with a heart rate of 110, heck my heart rate is that high when I get to go flying in a A109 E, just to compound the scenario (if it was longer flight time and weather a complication and a CG Eurocopter AS365 Dauphin 2 was available would one pick that as an option ?) well in a perfect world Working out out of that bird well my heart rate would go up and become sexually aroused ...

Pretty much, brief the PIC of the situation, but his/her call ultimately.

Agreed the PIC is ultimately responsible for entire air crew, patient and a rather expensive fling wing ALWAYS.

If s/he has to go higher well I don't have a death wish personally.

FSW = Feet of sea water. http://www.scuba-doc.com/physics.htm

However, upon reaching 435 FSW, the patient began acting strange and suddenly developed a brief period of what is described a "seizure like activity.

This could explain the Lung Sounds a possible aspiration pneumonia ? the FiO2 of 10 % (so something YES does sound fishy) a tad on the low side. I am not familiar with in trimix but CO2 scrubbers in operating room can fail or absorb so much CO2 to become useless (good QA/QC is the ticket).. but testing I suspect that this would fall under the "dive investigation team".

My experience in Hyperbarics is for CO poisoning, identified anaerobic sepsis or a sudden decompression for fighter pilots and big ass land based submarines (as coined by CAF Captain IC) so I am out of my "depth" with the Dive stuff, the anti static long johns were the only reason I volunteered because I looked so svelte in them ....

cheers