Diving Issues

[cfaulknor]

In class tonight, we were told that patients suffering from decompression sickness or nitrogen necrosis should be placed in the left lateral recumbent position. Is there any logical reason as to why? I thought it was proven that it does no good... Can someone give me some insight?

[Ridryder 911]

The theory is that the "air bubble" will be possibly be entrapped in the chamber and not be perfused increasing the embolus. The same is true for P.E., DVT etc.. It is still widely used, have not seen recent citations of studies of it.

Ace ?

R/R 911

[Punisher]

I would highly recommend getting in touch with the Divers Alert Network (DAN), which is run as an affiliate of the Duke University School of Medicine's Anesthesiology Department. They are the go-to guys (and gals) on anything dive medicine related. http://www.diversalertnetwork.org/

But Rid is essentially correct, the theory behind the left lateral recumbent positioning is to place the right atrium uppermost in relation to the other chambers to allow the air bubbles to pool there. I believe there have been ultrasound studies done to test this theory, but I do not have copies nor citations for them, but I would imagine that the researchers associated with DAN would either be able to direct you to them, or provide them for you.

[Punisher]

And by the way, it's nitrogen narcosis, not necrosis. :wink:

[Nate]

:shock:

[tinman694]

And by the way, it's nitrogen narcosis, not necrosis. :wink:

Uh, Narcosis (read Narc'ed) only happens at depth. It is from the high partial pressure of nitrogen you have due to the pressure differential (each 33 foot depth is 1 atmosphere--so around 100 feet you are getting about 3x the nitrogen you get on the surface) it is a narcotic effect, similar to getting Nitrous oxide at the dentist.

You don't get it on the surface (Unless you have a nitrous bottle lying about)

The main reason for left lateral would also be for general airway control---as people who embolize or are badly bent usually PUKE!

And I mean by the bucket full. Most laypersons who take the general emegency dive med courses (Like the PADI and SSI rescue courses) don't know anything, so you give them some simple steps to perform. The Left Lateral would also help on the bubble formation, but I defer to my esteemed college in the previous posts.

Best thing for someone suspected of emboli or the bends is High Flow O2, and a Texaco Drip to the nearest Decompression chamber for a ride. As a regular diver who also does rescue (read recovery) That is something I really do fear!

[kevkei]

Not only left lateral recumbent but also a slight Trendelenberg position.

[BlackSheep]

According to *Divers Alert Network's Medical Director, Dr. Richard Moon, there may be benefit in a transient head-down posture for divers with arterial bubbles, but the balance of opinion and data favors a horizontal position. If the diver is unconscious or vomiting, or if the diver's upper airway is compromised, place them laterally recumbent, either left or right, so that the airway can be effectively managed. Divers who are experiencing neurological symptoms of decompression illness must not be allowed to sit up until inside a recompression chamber.

*Divers Alert Network (DAN) is a 501©(3) non-profit medical and research organization dedicated to the safety and health of recreational scuba divers and associated with Duke University Medical Center (DUMC). DAN is supported by the largest association of recreational divers in the world. Founded in 1980, DAN has served as a lifeline for the scuba industry by operating diving's only 24-hour emergency hotline, a lifesaving service for injured divers. Additionally, DAN operates a diving medical information line, conducts vital diving medical research, and develops and provides a number of educational programs for everyone from beginning divers to medical professionals. [/font:4dee08021d]

[aussiephil]

Interesting topic, & worthy of discussion, i was taught the same reason as Rid.

However, what does yr protocol say, isnt that the determining factor in posutring yr pt. You can us information to try & change yr protocols, but unless thry change, do what they say. It aint rocket science.

Much like the thread on leg elevation for a cardiac arrest or hypotension. Interesting discussion, but yr protocol will over ride any discussion in here.