Diver CO Poisoning With a Twist...

[DeepSeaDan]

Greetings,

Saw this today & thought I'd share it in light of recent activity regarding CO poisoning & divers:


Carbon monoxide poisoning mimicking arterial gas embolism in a commercial diver.

Holt J, Weaver LK.
Source

Hyperbaric Medicine, LDS Hospital, Salt Lake City, Utah, USA. Julie.Holt@imail.org

Abstract

A 32-year-old male commercial diver was working at 7,000 feet of altitude in a municipal water tank, at a depth of 27 feet for two hours. While surfacing from a compressed-air surface-supplied dive, he exhibited loss of consciousness and neurological symptoms. He was presumptively diagnosed with arterial gas embolism, flown by pressurized aircraft to a regional medical center and treated with hyperbaric oxygen. During the U.S. Navy Treatment Table 6, new information suggested the patient's air supply had been contaminated by a continuously running engine and compressor. His admission blood was then assayed for carboxyhemoglobin (COHb), which measured 8.8% six hours after surfacing, including four hours of normobaric oxygen inhalation. His estimated COHb based on rough reported half-life calculations at the conclusion of the dive was approximately 45%. The patient's diagnosis was changed to carbon monoxide poisoning from contaminated breathing gas. Upon hospital discharge, he exhibited problems with balance and gait, nystagmus, word-finding limitations and slurred speech. Also, he had cardiac injury treated with carvedilol. When evaluating diving-related casualties, including in commercial divers, clinicians should consider carbon monoxide poisoning as a differential diagnosis.

45%!! I'd like to know how symptomatic this fellow was prior to surfacing, as he would have been on 2-way comms. with the surface Tender &/or Dive Supervisor, he would have undoubtedly been complaining of classic CO poisoning symptoms...


Best,
DSD

 

[RogerAGrimes]

45%!! Holy crap!

 

[Ayisha]

Wow, so not only did it look like an AGE, it might have even looked like a heart attack since there was cardiac injury. Maybe CO poisoning should be routinely tested for in diving accidents...

Thanks for the info.

 

[DandyDon]

I am a little confused by the term "compressed-air surface-supplied" but I guess he was diving on a Hookah system. That's a significant risk to those systems, and I can't think of a way to monitor the air for CO as it flows? Perhaps a transparent, inline chamber in which a Pocket CO could be inserted - with someone to watch it closely? I don't know if it could take the pressure tho. Maybe another unit...?

 

[Wookie]

I am a little confused by the term "compressed-air surface-supplied" but I guess he was diving on a Hookah system. That's a significant risk to those systems, and I can't think of a way to monitor the air for CO as it flows? Perhaps a transparent, inline chamber in which a Pocket CO could be inserted - with someone to watch it closely? I don't know if it could take the pressure tho. Maybe another unit...?

I'd think you would monitor it with a CO clear.

 

[swamp diver]

I am a little confused by the term "compressed-air surface-supplied" but I guess he was diving on a Hookah system. That's a significant risk to those systems, and I can't think of a way to monitor the air for CO as it flows? Perhaps a transparent, inline chamber in which a Pocket CO could be inserted - with someone to watch it closely? I don't know if it could take the pressure tho. Maybe another unit...?

No definitely not a Hookah system but rather a low pressure compressor with diesel engine as in the Amron link. The commercial diver in the water tank would have on a hard hat with full comms as seen in this video at 3.07 minutes.
Liquivision Technology Diving Services - YouTube

325 Low Pressure Diesel Air Compressor 18.7cfm at 175psi

As of 2011 in Canada an accident like this would not be possible since all commercial dive compressor systems whether low or high pressure must have an inline CO monitor installed and monitored by the dive tender. The Analox CO Clear has been very popular as has the unit from Nyad.com which Bauer USA installs on its compressors but is much more expensive.

Likely the exhaust from the diesel engine driving the compressor was entrained into the intake. The real problem arises on windless days when these exhaust plumes extend out laterally and vertically often contaminating the intake even if installed away from the engine.

---------- Post added May 1st, 2012 at 02:39 AM ----------



---------- Post added May 1st, 2012 at 02:40 AM ----------

45%!! Holy crap!

Symptoms of carbon monoxide pois... [Undersea Hyperb Med. 2012 Mar-Apr] - PubMed - NCBI

 

[DeepSeaDan]

I am a little confused by the term "compressed-air surface-supplied" but I guess he was diving on a Hookah system. That's a significant risk to those systems, and I can't think of a way to monitor the air for CO as it flows? Perhaps a transparent, inline chamber in which a Pocket CO could be inserted - with someone to watch it closely? I don't know if it could take the pressure tho. Maybe another unit...?

Oddly enough, I did this same job for a town high up in the Canadian Arctic many moons ( 1981 ) ago. The commercial diving contractor I worked for at the time played by the rules ( as they existed then ). I used a "Rat Hat" ( a commercial diving helmet designed by Bob Ratclife, he of Oceaneering International fame - it was/is their official "hat" for all Oceaneering ops. ), supplied by a 3-part umbilical ( air hose, comm. wire & a strength member ). My gas supply was several "K" bottles ( 260ft3 each ) manifolded together, as we were working inside a closed building. I had an inverted 80ft3 scuba bottle on my back for bailout purposes ( standard equipment to this day ). My tender acted as dive control ( via 2-way radio ) & standby diver - there was another hat on a separate umbilical for emergency use. This "air-diving spread" was considered sufficient / practical for this job, and met company standards. For most other "surface air" ( as commercial diving work is all surface-supplied, it is described as either surface air, surface gas, bell bounce or saturation diving ) jobs, we also included an l.p. compressor, in-line filter pack, volume tank and h.p. K-bottles for back-up.

So I never had the opportunity to get CO poisoning from an active compressor that day. I did many, many surface air jobs over the years without incident, and this was in many ways due to the excellent practices of the company I worked for; sadly, not all commercial diving contractors are created equal ( this is not intended to be a criticism of the injured diver's company - I have no knowledge of their practices / protocols, nor am I familiar with the logistical circumstances of the dive in which he was injured ). I am pleased to hear from Swamp Diver that in-line CO monitoring is now mandatory for commercial dive ops. in Canada. It should be mandatory worldwide.

Regards,
DSD