Should PFO Screening be made necessary for Tech diving

[nikkifsu]

Hi, I don't dive (yet) and I came across this site after seeing an episode on
Investigation Discovery's Disappeared about a person without any cave diving training getting supposedly lost in a cave...but I started reading some stuff on here and I think that it is crazy how smart the people on here are!!! I went to medical school so I know all about the stuff being posted such as partial pressures (undergrad chemistry), PFO, all the medical stuff, etc, and it's crazy that people on here are all educated about those things. It's crazy to hear people talk about DIC like it's something that everybody knows about. Smart bunch haha.

I was just really impressed. I want to get ino diving sometime after I finish having surgeries (I was in a near-fatal car crash last October) and have the money to travel and get certified, so probably when I'm back in grad school. You know in medical school we learned like nothing about DCS. I remember maybe one small group where they talked about flying after diving. So I totally understand why one can go to the ER suspecting DCS and get the run around...sucks. But I was just curious:

1) is hyperbaric medicine a residency or a fellowship? It's not something we really heard about in med school and I left mid 3rd year after the accident. Everybody was going into surgery, OBGYB, family medicine, etc
2) I have read that there are still some bubbles even if no DCS symptoms are experienced - if proper decompression protocol are followed, is there still some small amount of long term damage suffered to joints, etc (like small emboli blocking small vessels and accumulating tissue damage over time and not noticing it for years)... I guess I mean is diving rough on your body after years and years of doing it?
Thanks

 

[bygolly]

I understand that part of the screening test for PFO involves the use of a Valsalva maneuver to increase intra-thoracic pressure which may open an unsealed PFO and allow right to left shunt of the injected micro-bubbles. Exertions following a dive such as climbing a boat ladder fully kitted or moving heavy gear about on the deck could produce the same increase in intra-thoracic pressure and shunting. I have seen some discussion on the boards regarding exertions immediately following a dive and the advice to avoid such things but I have not heard anything lately.

Are these precautions still valid?

If so should boat operators be re-considering how they board divers after a dive...especially provocative dives?

Do you know of any studies that have included this factor or any studies that plan to?

Cheers and thanks in advance.

 

[Duke Dive Medicine]

1) is hyperbaric medicine a residency or a fellowship? It's not something we really heard about in med school and I left mid 3rd year after the accident. Everybody was going into surgery, OBGYB, family medicine, etc
2) I have read that there are still some bubbles even if no DCS symptoms are experienced - if proper decompression protocol are followed, is there still some small amount of long term damage suffered to joints, etc (like small emboli blocking small vessels and accumulating tissue damage over time and not noticing it for years)... I guess I mean is diving rough on your body after years and years of doing it?
Thanks

Hi Nikki,

1. There are different degrees of hyperbaric medicine training. To be eligible for board certification you have to have completed a one-year fellowship. Most of our anesthesia residents rotate through the clinic during their intern year as well.
2. Aysymptomatic venous bubbles are pretty common after dives deeper than about 60 FSW. Typically they are trapped in the pulmonary circulation where they're gradually reduced in size and eliminated. Long-term damage to the joints of the long bones is usually seen only in saturation divers. It's possible to get asetpic osteonecrosis after one bad incident of DCS if it goes untreated, but that's pretty rare.

Good luck with your recovery! Hopefully they'll let you pick up where you left off.

Best regards,
DDM