American tourist dies while diving Cozumel caves.....

[DandyDon]

I read on another board that...

...the autopsy report revealed elevated carboxyhemoglobin levels. An attempt was made to analyze the contaminated tank, but a CO analyzer was unable to be located on the island.

It's really sad that a CO analyzer could not be found on the island. Dave at Aldora Divers said they were getting one last year when they helped install the CO monitors on Meridiano's compressors, but who knows? Any dive Op there could afford to keep one on hand and test all the tanks delivered but I guess they just don't want to bother. Under those circumstance, they'd want to calibrate twice a year - or own two and send one back to the USA with a trusted customer to mail in for calibrating, but they could have the cal-gas brought in on the ship that delivers the Oxygen they use for Nitrox.

For any dive plan, the diver has to protect his/herself, or tack the risks involved with trust-me diving huh?

 

[KellyBracket]

.... The technology for testing COHb levels has changed dramatically in the last couple of years with the recent availability of CO-oximetry units which do not require a blood sample to be drawn, and in fact can be used right out in the field by non-medical staff ....
Our academic emergency departments here have only had these Masimo Rad-57 CO oximetry units for just over a year now and I wonder if this is what might be available on Cozumel? If the local chamber does not have one of these I'd certainly donate towards the $3500 in order to purhase one in order to screen for suspected CO exposure. ...

I want to temper any enthusiasm people may have for purchasing one of the Massimo RAD-57 devices. The units can be notoriously inaccurate, both displaying falsely high and low readings. Most of the studies that seem to show the utility of the device were not controlled, and did not employ any methods to verify the readings of the unit. This study below, however, had a rigorous methodology, and confirmed all device readings with simultaneous laboratory analysis of blood CO levels.
Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.

Anecdotally, I presented an M&M for our ED where a falsely high CO level found by the Massimo device steered the clinicians away from what turned out to be the true cause of the patient's headache, a ruptured aneurysm. The bottom line for me is that, without laboratory verification, I don't believe the device can be used safely; e.g. in the field or on a dive boat.

First post - long time lurker!

 

[beachnik]

Just stumbled upon a good deal on an Analox CO EII. Interested (?) - follow the links:

http://www.scubaboard.com/forums/an...at-limited-time-offer-co-eii.html#post6094962

 

[swamp diver]

I want to temper any enthusiasm people may have for purchasing one of the Massimo RAD-57 devices. The units can be notoriously inaccurate, both displaying falsely high and low readings. Most of the studies that seem to show the utility of the device were not controlled, and did not employ any methods to verify the readings of the unit. This study below, however, had a rigorous methodology, and confirmed all device readings with simultaneous laboratory analysis of blood CO levels.
Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement.

Anecdotally, I presented an M&M for our ED where a falsely high CO level found by the Massimo device steered the clinicians away from what turned out to be the true cause of the patient's headache, a ruptured aneurysm. The bottom line for me is that, without laboratory verification, I don't believe the device can be used safely; e.g. in the field or on a dive boat.

First post - long time lurker!

Hello KB,

Thanks for thoughts on the Rad-57 and it is true the final verdict is not in, however having spoken with a Duke hyperbaric doc these units are still in use in the emergency and have had their accuracy and precision evaluated informally by comparying the unit's reading against formal blood COHb.

Locally in the academic EDs where these units have been introducded a similar evaluation comparing the Rad-57 to blood COHb is underway and so far I am told the results are favourable. I'm not sure if these willl be published but other groups have added to the performance data some quite recently.

There are researchers looking at using these units in the field for the woodlands firefighters who often have no respiratory protection and are exposed to smoke for the duration of their shift. The Rad-57 was the unit chosen for the study and a certain number of firefighters will have their blood drawn for COHb.

Accuracy of noninvasive multiwave pulse oximet... [Ann Emerg Med. 2011] - PubMed - NCBI (July 2011)

http://www.ncbi.nlm.nih.gov/pubmed/18500075

A new tool for the early diagnosis of carbon m... [Inhal Toxicol. 2009] - PubMed - NCBI

The fact Duke University continues to use the Rad-57 and the fact they receive a large number of CO poisonings suggests the balance of evidence tilts in favor towards using the Rad-57 to screen potential CO exposure patients particulary in the field (fire fighters, divers, etc.) where access to blood COHb is not available.

 

[Maya'sMim]

Should divers be checking their compressed air in addition to EAN? This post has me thinking/concerned........

 

[Texas Torpedo]

Absolutely..

 

[DandyDon]

Should divers be checking their compressed air in addition to EAN? This post has me thinking/concerned........

Only if you want to know what's in it.

Agencies teach checking O2 levels. Sadly they avoid the reality of CO risks. You can expect your dive operator to provide an O2 analyzer, but not so with CO - so buy the CO analyzer before you buy an O2 unit.

 

[Dive-aholic]

should divers be checking their compressed air in addition to ean? This post has me thinking/concerned........

yes!!

 

[Chris12day]

I am a little late to this discussion.

I have some questions/comments....

1. I have still not seen any evidence to demonstrate that a single tank has extremely high levels versus all other tanks filled! I have seen data clearly showing once the temperature of the mineral oil exceeds its auto-ignition temperature, CO is produced. NOT JUST IN A SINGLE TANK! It is very atypical that no one else recieving fills from this company became ill. Who's tank was it? What was originally in the tank? If the tank had a high level of CO prior to filling, it would not have been found in filling the single tank.....This is why equipment is impounded and tested when a death typically occurs in the U.S. It is called liability, not speculation!

2. Did the company who filled the tanks have an online CO monitoring system? When was it last calibrated? Was it in calibration? Was it installed correctly? Was it installed in the correct place?

3. It has been claimed that CO (carbon monoxide) from a bad fill killed this person. Where is the evidence? Unless the tanks in question were actually measured using a certified laboratory for testing gas samples for oxygen, nitrogen (N2), carbon monoxide, carbon dioxide (CO2), moisture, and organic compounds. I personally have a hard time believing the cause of death due to carbon monoxide from a bad fill without additional physiological testing results from the body.

I know people get a good feeling knowing they checked their tank for CO. Do you know that the monitor was calibrated correctly? Do you know if the monitor is still in calibration (it was a long plane fight, with reduced pressures and dramatic temperature changes)? Was the analyzer used correctly? Did you actually read the whole manual? Did you test your ability to analyze a blind sample? Does the "pocket" analyzer actually measures carbon monoxide or something else and is related back to a CO concentration? There is a lot more to testing than actually testing the sample. Just ask someone who was sitting on death row for 30 years that was latter cleared with scientific evidence......


I do not want to suggest that anyone not buy a pocket analyzer or stop using the one they have. I only want full disclosure and an accountabillity.

Safe Diving

 

[WSOPFAN]

3. It has been claimed that CO (carbon monoxide) from a bad fill killed this person. Where is the evidence?

Read posts 62&63.......