Completely normal nitrox dive to 25m gave me DCS

[Duke Dive Medicine]

Cody, I just got off the phone with the on-call medic at DAN, they have your email, they're going to try to get hold of you.

 

[Duke Dive Medicine]

Can you tell us the medical justification from the attending hyperbaric physician at the different facility to now undergo a Treatment Table 6A???

We're hound dogs barking up the same tree. It will be interesting to hear the rationale.

 

[SFJCody]

No further treatment is planned. Thank you so much everyone. I will treat my remaining symptoms as inflammation and hope that they recede with time. DAN has contacted me.

 

[Kevrumbo]

Please help me understand their rationale for this. Given the information you have provided, table 6A is completely inappropriate. 6A was the primary initial treatment for arterial gas embolism, but the deep spike is 165 feet (50 meters), not 197 feet (60 meters). The rationale was that the offending bubbles would be decreased in size to the point where they no longer caused symptoms. 6A fell out of favor even for AGE because of the risk of additional on-gassing during the deep spike.

Taking a recovering DCS patient to almost 200 feet in a chamber is medically unsound and possibly harmful. It is extremely unlikely that there were bubbles left in you after your other treatments. The symptoms you were experiencing were caused by the inflammatory effects of the bubbles that had been there. This treatment may have aggravated that inflammation and caused your symptoms to reoccur.

<edit> I just read the part about discontinuing the treatment because of bradycardia. Sinus bradycardia is a well-known and generally harmless side effect of hyperbaric oxygen therapy. The blood vessels constrict, so it doesn't take as much cardiac output to maintain blood pressure. As long as your blood pressure was within normal limits and the bradycardia was sinus in origin (i.e. not related to some sort of conduction block), I can't think of a reason to discontinue the treatment.

I strongly recommend that you insist that your treating physician consult either DAN or us before proceeding with any additional treatments. DAN U.S. is +1 919 684 9111, our 24-hour consult line is +1 919 684 8111. Please do not do allow them to do another one of these "treatment table 6 alpha" treatments without getting a second opinion.

Best regards,
DDM

I don't think AGE is indicated in @SFJCody case and don't understand the physician's order for a Table 6A either.

By the way DDM, Treatment Table 6A for AGE at a 6ATA pressure spike, breathing ppO2 3.0 bar of Eanx50 or Heliox 50/50 squeezes spherical embolism bubble size to 55% of the original occluding diameter -nearly half of their initial pathogenic stroke causing bubble size. IMO, the risk of additional on-gassing because of this deep spike is secondary to quickly restoring oxygenated blood flow to counteract the hypoxia of affected tissues.

 

[Duke Dive Medicine]

That was fast. Thanks for the update. If you are still experiencing DCS symptoms then hyperbaric oxygen treatment may be appropriate, but I would exercise caution with the facilities you have been treated at. If you are not treated, your symptoms will probably resolve over time, but the neurological symptoms are concerning. Did DAN offer you any alternative facilities? That may be worth considering.

Best regards,
DDM

 

[SFJCody]

There are no other facilities available in this country. I am scheduled to return to the UK next week, I'll check in at the London dive chamber to see if they what they recommend.

 

[Duke Dive Medicine]

I don't think AGE is indicated in @SFJCody case and don't understand the physician's order for a Table 6A either.

By the way DDM, Treatment Table 6A for AGE at a 6ATA pressure spike, breathing ppO2 3.0 bar of Eanx50 or Heliox 50/50 squeezes spherical embolism bubble size to 55% of the original occluding diameter -nearly half of their initial pathogenic stroke causing bubble size, IMO, the risk of additional on-gassing because of this deep spike is secondary to quickly restoring oxygenated blood flow to counteract the hypoxia of affected tissues.

Yes, I know this In gas embolism cases where the bubble is still thought to be present, that's a viable option. They tend to work themselves through pretty rapidly (you've probably seen the video of the gas bubbles going through the dog's brain circulation) so the further out from the injury the less effective this would be. We've considered it in the rare iatrogenic gas embolisms that happen in our own hospital and have 50/50 mix on hand for cases that we can get in the chamber rapidly. In practice this often isn't the case, though.

Best regards,
DDM

 

[Duke Dive Medicine]

There are no other facilities available in this country. I am scheduled to return to the UK next week, I'll check in at the London dive chamber to see if they what they recommend.

That sounds like the best option. Wishing you well.

Best regards,
DDM

 

[Kevrumbo]

Yes, I know this In gas embolism cases where the bubble is still thought to be present, that's a viable option. They tend to work themselves through pretty rapidly (you've probably seen the video of the gas bubbles going through the dog's brain circulation) so the further out from the injury the less effective this would be. We've considered it in the rare iatrogenic gas embolisms that happen in our own hospital and have 50/50 mix on hand for cases that we can get in the chamber rapidly. In practice this often isn't the case, though.

Best regards,
DDM

(Off topic now) ; But looking at this as a First Responder Dive Master, Boat Crew & Captain here in SoCal, who just witnessed a dive accident victim suddenly appear at the surface and unresponsive going into full cardio-respiratory arrest, the protocol & prep upon emergency delivery to the Catalina Hyperbaric Chamber will always be R/O AGE, R/O near Drowning. The Chamber Crew and Baywatch Paramedics will be prepared to perform CPR and Advanced Life Support (with no defibrillator allowed though inside the Chamber), in the 85-90F heat of compression down to 6ATA. . .

 

[Duke Dive Medicine]

Off topic for this thread but maybe an interesting conversation in a thread dedicated to heroic treatment measures for badly injured divers.

Best regards,
DDM