Recompression And Medical Ethics

[Duke Dive Medicine]

That's just what I was wondering, whether it's primarily for legal reasons, or whether it's actually technically infeasible for some reason. Sounds like it's mostly the former? With respect to forced ventilation, chest compressions etc., I would expect that all the technology to enable this already exists, and that it is cheaper than human labor over the long-term, is that the case? I'm just trying to understand things better, please correct me where needed. Thanks!

It's not just for legal reasons. Complications from hyperbaric oxygen therapy are low-probability, high-consequence events. It might happen in the future, but at present there are no automated mechanisms that can recognize CNS oxygen toxicity or pneumothorax and intervene appropriately.

Best regards,
DDM

 

[Lorenzoid]

Isn't that what kr2y5 meant by "legal reasons"? I would think "low-probability, high-consequence events" are what the medical community is most concerned about guarding against liability for. The potential for dire consequences is why the standard of care is high.

 

[Duke Dive Medicine]

Liability, and harm to the patient. We don't just worry about lawyers you know.

Best regards,
DDM

 

[kr2y5]

It's not just for legal reasons. Complications from hyperbaric oxygen therapy are low-probability, high-consequence events. It might happen in the future, but at present there are no automated mechanisms that can recognize CNS oxygen toxicity or pneumothorax and intervene appropriately.

Best regards,
DDM

Thank you. What does one do with a patient that has a CNS hit in the chamber? I always thought (and it sounds like maybe I'm mistaken) that a CNS hit was a condition that passes on its own, and that it is only life-threatening under water because of the near certainty of inhaling water when one convulses. Could such patient choke on his vomit and need help clearing his airway? Does a doctor administer an injection to a patient in the chamber? If I happen to be in a chamber and someone next to me has the CNS hit, and (hypothetically) there isn't a doctor around, is there something to watch for, or something I can do to make them less miserable?

 

[Duke Dive Medicine]

The proper treatment for CNS O2 toxicity in the chamber is to remove the patient from oxygen, let the symptoms subside, then reapply the oxygen, with pharmacologic intervention if necessary. You would never be expected to help with that if you were a patient in a multiplace chamber; the inside attendant would take care of that. In a monoplace chamber, the outside attendant would have the patient apply an air mask if the symptoms were mild; if the patient was having a seizure, they would wait until the seizure subsided then surface the chamber.

Best regards,
DDM

 

[KevinNM]

It is an interesting concept though and standards of care change as medical knowledge and capabilities "advance." Like it or not we now have robotic surgery and virtual medical visits. Why not one day an automated chamber with remote supervision.

Our Davinci surgical robots are operated by a very highly trained surgeon in the same room. It isn't exactly what people think it is.

 

[KevinNM]

The other element to getting something like this is to get a champion at an institution. For example, we rebuilt our cardiac caterization procedure rooms to modern standards and then 2 years later the organization recruited a highly desired cardiologist who wanted an entirely new lab based on a different vendors system as part of the deal. So they built him a new lab with his preferred equipment and the old rooms became the new interventional radiology procedure rooms.

However cath labs get used a lot, as many people have heart attacks. It's probably harder to get a chamber built like this. But not impossible, particularly if there was outside funding.

 

[uncfnp]

Our Davinci surgical robots are operated by a very highly trained surgeon in the same room. It isn't exactly what people think it is.

I know its not exactly what the poster had in mind. Just an example of how things change. I doubt either medicine or technology is quite there yet for a truely independent automated system but it is an intriguing idea. And not just for recompression chambers but for providing healthcare to remote and underserved areas in general.

The idea of an automated recompression chamber just happens to be an extreme example of this concept. But beyond the legal, medical and technical challenge, I think the cost of such a system in an area otherwise well covered by traditional healthcare would be prohibitive.

See section titled Robotic Hands Across the Water...

The Robo-Doctor Will See You Now

 

[BeijaFlor]

Going into a chamber is a traumatic event. Going in on cruise control would be even more so.

I can only reply from my own experience, but I didn't feel that my Table 6 chamber-ride in West Palm Beach was traumatic at all. Admittedly, I had only a Type 1 hit in a knee joint ... it felt like a gout attack, but the pain had vanished during my last dive (long story there) and worsened when I surfaced; that's when I called DAN -- and they set things up behind the scenes with St. Mary's Hospital. The treatment was uneventful ... I suppose, though, if I'd had a worse hit (like a CNS hit or "the chokes"), I would have found the whole episode "traumatic."