Completely normal nitrox dive to 25m gave me DCS

[Duke Dive Medicine]

Wouldn't it be important to know about an existing FPO in the event of an accident requiring a decompression chamber? It might affect what treatment plan the doctors go with.

No, it wouldn't. Treatment choice is based on diagnosis and symptom presentation.

Best regards,
DDM

 

[Duke Dive Medicine]

DDM-
Thank you. Since the cardiologist just ordered the procedure without an IV, and he and the tech both knew that I wanted to check for a PFO, does that suggest I should find a sharper cardiologist? (Putting that diplomatically, I hope.) Who will order the procedure with contrast, at the least?
I'm not sure how finding one would affect my diving, since I'm already conservative. But confirming that I don't have to worry about one, would give me one less thing to be concerned with. There's enough FUD propagated by the diving industry, so when it comes to more objective medical issues that have more finite answers (i.e. there is or isn't a PFO) I like to make properly informed decisions.

With DCS these days...onceuponatime we had the USN tables, period. Now there's Bühlmann, RGBM, revised secret proprietary untested tables in every computer...as the joke goes, I'm sure there's a pony in that pile.(G)

Hi Red,

Any test for PFO will involve IV bubble contrast. The contrast is actually sterile saline solution that's been agitated between a couple of syringes to the point where it has a lot of bubbles in it.

A note on the transcranial Doppler that Kevrumbo described above: a negative TCD test may be reassuring but it does not rule out PFO 100%. Also, a positive TCD is not diagnostic for PFO; further testing would be necessary to rule out other sources of arteriovenous shunting.

Re the tables, that's a bit of an oversimplification. The decompression algorithms currently in use are considered relatively safe; however, no decompression table carries a 0% risk of decompression sickness.

Best regards,
DDM

 

[Kevrumbo]

Wouldn't it be important to know about an existing FPO in the event of an accident requiring a decompression chamber? It might affect what treatment plan the doctors go with.

No, it wouldn't. Treatment choice is based on diagnosis and symptom presentation.

Best regards,
DDM

Here in Southern California, if a diver presents to the Catalina Hyperbaric Chamber even with latent or vague signs of DCS but with history of PFO, then the patient will likely be recommended to undergo immediate Recompression HBOT.

 

[Duke Dive Medicine]

Here in Southern California, if a diver presents to the Catalina Hyperbaric Chamber even with latent or vague signs of DCS but with history of PFO, then the patient will likely be recommended to undergo immediate Recompression HBOT.

I'd be interested to hear more details about this from one of the practitioners there. I'm not sure it's quite that simple. @TC: Any insights?

Best regards,
DDM

 

[tc]

No, that's not accurate. We treat the symptoms as they are presented.

Knowledge of an existing PFO would be only one consideration in the history.

Their immediate dive history and any prior DCS and how it presented would be more significant.

 

[Kevrumbo]

I'd be interested to hear more details about this from one of the practitioners there. I'm not sure it's quite that simple. @TC: Any insights?

Best regards,
DDM

No, that's not accurate. We treat the symptoms as they are presented.

Knowledge of an existing PFO would be only one consideration in the history.

Their immediate dive history and any prior DCS and how it presented would be more significant.

Think about it DDM (and you too @TC)

We have a dedicated 24/7 Recompression Chamber here in Southern California solely for diving accident casualties. A diver presents with vague symptoms but clearly articulates a history of a diagnosed PFO. Of course the Lifeguard/Paramedics will observe, monitor & consult with an on-call Los Angeles County General Hospital/USC Medical Center Emergency Medicine & Hyperbaric Physician (and probably the patient's own Doctor as well), with the Recompression Chamber prepared, energized and crew standing by. . .

@Duke Dive Medicine ,given our unique and fortunate emergency support for divers here in Southern California, how is the above not a simple scenario of potential treatment options as described?

(@TC if I were that patient, I would electively insist to undergo Immediate HBOT anyway. . .)

 

[tc]

Kevin, my statement stands. I don't know where you're coming up with that info but it is NOT in any protocol at Catalina.

 

[Kevrumbo]

Kevin, my statement stands. I don't know where you're coming up with that info but it is NOT in any protocol at Catalina.

Tom, @Duke Dive Medicine asked for details regarding a hypothetical scenario as described above of diver presenting to the chamber with vague symptoms and a history of PFO.

Initial protocol within that context would be observation and monitor for developing signs & symptoms of DCI, isn't that correct?

 

[tc]

Here in Southern California, if a diver presents to the Catalina Hyperbaric Chamber even with latent or vague signs of DCS but with history of PFO, then the patient will likely be recommended to undergo immediate Recompression HBOT.

Tom, @Duke Dive Medicine asked for details regarding a hypothetical scenario as described above of diver presenting to the chamber with vague symptoms and a history of PFO.

Initial protocol within that context would be observation and monitor for developing signs & symptoms of DCI, isn't that correct?

"Immediate Recompression" is not the same as "observation and monitor". Observe & Monitor would be correct.

 

[Kevrumbo]

"Immediate Recompression" is not the same as "observation and monitor". Observe & Monitor would be correct.

Alright agreed, "observe & monitor" in this instance is the initial Catalina protocol with the Chamber on stand-by ready for "immediate" use as needed.