Refusing chamber treatment for an injured diver (Decompression illness)

[BoltSnap]

A diver suffering from signs and symptoms of severe Decompression sickness after making several dives to 50 meters (2 or 3 dives but not sure) was refused treatment in the local chamber in Libya because they said that 3 days have passed since he suffered the injury. They are also worried about a internal bleeding in his head after he was complaining of pain in the left side of his head.

Does this sound right in terms of refusing chamber treatment for this person due to 3 day in reaching the treatment facility and fear of potential internal bleeding? Is there a time limit for accepting injured divers in chambers after injury?

 

[diver 85]

If so, Mosquito Coast lobster divers(headed toward Roatan) would be in bad shape-----ugh, make that worse shape...I would think not--but---who knows over there...

 

[DeepSeaExplorer]

I think there is a reasonable time limit. After three days, the damage has already been done and there can't be any bubbles left.

 

[DocVikingo]

A diver suffering from signs and symptoms of severe Decompression sickness after making several dives to 50 meters (2 or 3 dives but not sure) was refused treatment in the local chamber in Libya because they said that 3 days have passed since he suffered the injury. They are also worried about a internal bleeding in his head after he was complaining of pain in the left side of his head. Does this sound right?....

Hey Burhan,

No, it is not right. While recompression therapy tends to be more effective the earlier it is stared, a 2-3 day delay per se does not preclude treatment. The signs/symptoms of DCI can show improvement even when a hit was many days prior to commencing hyperbaric therapy.

As for worry about intracranial bleeding since he was complaining of pain in the left side of his head, this also appears very unsound. Headache, sometimes severe, is a common symptom of DCI. Head pain can also signal cerebral arterial gas embolism (CAGE), for which hyperbaric therapy is the treatment of choice.

Cheers,

DocVikingo

---------- Post added September 15th, 2014 at 04:08 PM ----------

After three days, the damage has already been done and there can't be any bubbles left.

Hi DeepSeaExplorer,

Oh, indeed, typically the offending bubbles in DCI are entirely gone after a very brief period of time. However, the situation is not as simple as you seem to be suggesting.

Most immmediately, when bubbles form in blood vessels they may cause a mechanical restriction in blood supply with reduced oxygenation of tissue. However, they also may initiate an inflammatory response/cascade that results in further compromise of circulation and associated edema that may continue long, long after all bubbles have disappeared. The provision of hyperbaric oxygen can do much to help ameliorate both of these conditions.

Regards,

DocVikingo

 

[doctormike]

Hey Burhan,

No, it is not right. While recompression therapy tends to be more effective the earlier it is stared, a 2-3 day delay per se does not preclude treatment. The signs/symptoms of DCI can show improvement even when a hit was many days prior to commencing hyperbaric therapy.

As for worry about intracranial bleeding since he was complaining of pain in the left side of his head, this also appears very unsound. Headache, sometimes severe, is a common symptom of DCI. Head pain can also signal cerebral arterial gas embolism (CAGE), for which hyperbaric therapy is the treatment of choice.

Cheers,

DocVikingo

I generally agree with you, Doc, and there certainly are benefits of late HBO treatment. Just one point - since we don't have much information about what actually happened at that facility, or what the doctor's actually said, it's hard to make definitive statements about the care given. I have learned that over many years from seeing second opinions for patients who initially seem to have been given poor care, but then when you figure out what actually happened by going beyond a second (or third) hand report, and get some details, things look different.

Also, it's pretty standard practice to rule out other causes of neurological symptoms before instituting hyperbaric therapy. When I took my chamber ride, I got a head CT first for precisely that reason - if you have a patient with a hemorrhagic stroke, non-gas cerebral embolism, ischemic stroke, etc.. and you throw them into the chamber immediately, you may end up with a worse outcome because of the delay in correct treatment. While headache can certainly be caused by DCI, there are a lot of other things that cause headache.

So, as with most things, the devil is in the details!

 

[BoltSnap]

No CT done, they just dismissed him because they believed treatment won't be effective after this length of time (around 3 days) and the fact that he complained of "pain" in one side of his head. No CT or anything done. The victim was a commercial spearfisherman and the treatment facility was commercial diving treatment facility at an oil company that isn't always trilled about treating divers from outside the company. After talking to a couple of the people who were "there" at the time of the incident, I get the strong feeling that they just didn't want to hassle with him or take the responsibility since the victim wasn't "one of them" in the oil company. They gave a lot of BS talk to the locals about why he can't be treated taking advantage of the unsophistication and lack of education of the local population unfortunately.

 

[DocVikingo]

I- since we don't have much information about what actually happened at that facility, or what the doctor's actually said, it's hard to make definitive statements about the care given.

Hey Mike,

Fair enough.

Cheers,

Doc

 

[doctormike]

Hey Mike,

Fair enough.

Cheers,

Doc

Yup, but the follow up post from the OP seems to support your initial impression..!

I know that people with significant neurological injuries will get benefits from prolonged courses of treatment stretching out over weeks, even if the initial treatment was early. Sad situation, reminds me of this.

 

[Dr Deco]

Late treatment of DCS addresses physiological pathways not involving mechanical shrinkage of gas bubbles. This usually involves repeated treatments over many days. It is a very involved process with respect to time. I can certainly imagine that the chamber operators were not interested in starting down this path for a non employee [if I understand this correctly].

 

[BoltSnap]

Late treatment of DCS addresses physiological pathways not involving mechanical shrinkage of gas bubbles. This usually involves repeated treatments over many days. It is a very involved process with respect to time. I can certainly imagine that the chamber operators were not interested in starting down this path for a non employee [if I understand this correctly].

Would this refusal be acceptable decision from a "medical" point of view (when not worrying about the employee issue)?