Lung expansion injury?

[Michael_Lambert]

Hey guys,


So yesterday we are sitting in 70 feet of water just doing some skills and drills. When I turned my head to the left to check out my buddy I did so just as I was taking a deep breath and ended up pulling my regulator out of my mouth taking in a fair bit of water.

Long story short... I was able to overcome that horrible feeling and finally got breathing correctly and we ended our dive, I felt fine however still had the feeling I was going to vomit again and some minor chest discomfort... Figured it was from the violet cough/vomiting and swallowing of water.

We completed our dive at an extra slow accent and extra on the safety had a coughing fit at 25 feet got out of the water and brought up some more fluid but all seemed fine.

Got up this morning not feeling the best, coughing and felt gurgling in my chest so off I went to get it checked out.

-Blood test shows my o2 stats good
-Chest X-rays showed clear lungs, gurgling the doc said I probably brought up on the way to the hospital when I had a coughing fit.
-Completed a pulmonary lung test and passed that with out issue.

Mentioned to the ER doc what was required of me for any sort of recovery, he suggested that I still had some fluid in my lung and on the accent the coughing fit at 25 feet cleared it however the fluid caused some minor expansion on the lungs which is why I had the discomfort however the test show everything is fine.

I have emailed this to DAN and waiting a reply, I asked about diving and he said “I would not go dive the titanic, however there is no reason to stay out of the water"

Just wondering if anyone else has had this sort of issue? If so what where you told?

Thanks in advance,

Michael.

 

[jridg]

It sounds like you are OK - I would be very interested to hear what DAN has to say.

 

[Michael_Lambert]

I do feel fine and i did speak with my GP today, just wanted to let him know that the hospital was going to forward the results to him and his wife in the same office is a respiratory specialist so i was hoping he could get a consult with her on the results.

When speaking with him he said that it does not sound like anything i would have to worry about, he figured that if anything the little bit of blood i seen was actually more from the trauma in my esophagus from trying to force air down but force the water out at the same time, and i have had issue with Acid reflux the last little while so he said it would have been raw to start with.

 

[DiveDocMD]

It sounds as if you aspirated sea water during the episode. Ocean water is a more concentrated salt water than the serum that makes up our blood. As a consequence it is more irritative than normal saline (the same concentration as in our bloodstream). The body's natural response to aspiration is to cough in order to clear the foreign material whether it is seawater, coca cola, or whatever you just ate. This can go on for some time particularly if the material is particulate. What you aspirated was not just seawater. Think about all the little floating things suspended in the water column (that ruins by pictures by reflecting my flash!)

In addition, the lung may have small areas of volume loss called atelectasis. Together, the atelectasis and coughing can produce the symptom of chest pain/discomfort.

It's great that your oxygen saturation, chest xray and pulmonary function tests were normal. You should be fine and the symptoms should clear. If you find that the coughing persists or if you begin to run a fever, be sure to check back with your doctor.

 

[Michael_Lambert]

DivedocMD,

Thanks for your reply, It was freshwater... Sorry i should have said that however the water was still far from saline quality

The coughing has finished, The doctor did give me the prescription which i have filled and its called Symbicort turbuhaler 200UG and instructed to use it twice a day.

 

[walke121]

I have seen a lung over expansion injury where the diver did die and it was a very sudden event, actually happened in only 15' of water. Your circumstances don't seem to fit the classic scenario that causes an embolism. Glad you are OK. I hope you just got some water in you lungs and maybe the drugs will take care of any other issues you might have. Safe diving.

 

[shinny]

Glad to hear you're ok. Can you let us know what DAN tells you? Just interested.
Thanks,
Shinny

 

[Michael_Lambert]

Dan called got back to me, nice thing the DR actually called me back instead of replying to my email.

The DR was not sure the ER Doctors diagnoses was completely right, he was pleased to hear my o2 count was higher than average and passed the lung test. He did suggest that i did aspirate water into the lungs which seems to have cleared up.

He Referred me to a local dive doctor to follow up, They did say that if it turns out to have been an expansion injury i can expect to be given the suggestion to stay off compressed air for 3-6 months.

Speaking with the DAN DR, my own DR and a local paramedic who has been on site for several scuba related injures and he agree I did not show the signs of a lung injury but more the signs of sever chocking trauma.

 

[DiveDocMD]

Fresh water aspiration has a different mechanism of injury than salt water. With fresh water, surfactant (a natural chemical in the lungs that reduces surface tension and helps the lungs stay expanded) is "washed away" resulting in atelectasis and leakage of a protein serum into the lung space. Fluid then leaks in which is pulmonary edema.

Salt water is hypertonic (very simply, higher salt content than blood serum). In response the lungs leak fluid into the air space to try to dilute the saltwater. Again, the result is pulmonary edema.

So, no matter what kind of fluid, the result is pulmonary edema. You probably had a very mild degree of this in just a small part of the lungs.

Even in the cleanest lake or quarry there's lots of floating sediment so, again, if you start to have recurrence of cough with a fever, get back to your doctor to make sure its not a pneumonia.

 

[Michael_Lambert]

yea they suggested that as well, I have had no issues at all... Was laying on the couch tonight to see if it would be recreated and nothing everything seems good to go.