Immersion Pulmonary Edema (IPE) - unknown cause, known killer

[Bubbletrubble]

Please read some of those links. Someone who tends to a triathlon every year says there are around half of a dozen swimmers that just swim to the bank and get out. He remembers them coughing. Do we know? How would we know if someone isn't alerted to be there?

I think you are discounting the many other medical and non-medical possibilities which could explain a triathlete with a cough dropping out of the swim stage of the competition. Here's just one example: salt water aspiration syndrome. There's also the possibility that the swimmer had a cough but dropped out for an unrelated issue (muscle pull/tear, exacerbation of previous muscle/joint injury, intense cramping, etc.).

 

[Jax]

My point is that there is no one there to check . . . what would it take besides a trained responder using a stethoscope to hear the lung sounds?

I'm hoping for awareness -- IS this more common that previously thought?

If you read the links on triathletes and the Navy swimmers -- This is just weird.

 

[Bubbletrubble]

My point is that there is no one there to check . . . what would it take besides a trained responder using a stethoscope to hear the lung sounds?

I'm hoping for awareness -- IS this more common that previously thought?

If you read the links on triathletes and the Navy swimmers -- This is just weird.

I don't know, Jax. I think you're getting caught up in the hype of the coincidental reporting of a handful of cases here on ScubaBoard. Yes, IPE has been reported to occur in highly fit triathletes and Navy swimmers. Sure, it's possible that IPE occurs in a larger number of divers than previously thought. That can be said about a lot of conditions.

Nevertheless, since knowledge of IPE by the general diving public won't alter the basic first aid response to a diver in respiratory distress, I fail to see the impetus in sensationalizing/publicizing the condition. All it accomplishes is getting the general diving public to fret unnecessarily about a rare disorder.

 

[Jax]

People that will fret make their own hell.

It's kind of like carbon monoxide. PD rare all around. Still - such a little thing as to test a tank . . . am I fretting because I have a carbon monoxide tester?


I'm pretty sure those that had IPE and told their stories would agree that it is important to know these little things.

 

[shoredivr]

Sorry -- using some old terminology from way back . . . in this case, I meant using a bag on the victim. I've noticed all the DAN kits seem to have bags.

The big thing in combat medic was to fix the ABCs (Airway, Bleeding, Cardiac), push the fluids (IV) and get 'im out of there.

Aha, your perspective and interest becomes clear! Thanks Jax!

 

[TSandM]

Jax, I think this is probably an underrecognized problem. I know of several cases myself, and I'm only one person; my guess is that there are enough per year across the US to merit physicians knowing a bit more about this entity. (Although it seems to respond fairly well to standard treatment for pulmonary edema of whatever source.)

Considering positive pressure ventilation in the field is not absolutely wrong. In particular, if I had a conscious patient who had a history of past IPE, and said her symptoms were the same, AND I had the equipment to do some bagging, I'd see if the patient was willing to cooperate with that. It's not easy to hold positive pressure with a simple bag-valve-mask system, operated by hand, and it's quite uncomfortable for the patient. Even the BIPAP systems we use in the hospital, which are very effective, are not tolerated very well by a lot of patients. The shorter of breath someone is, the less happy they are with a thick mask strapped to their face.

It's a good thing to know about, so that if someone comes out of the water short of breath, it doesn't get discounted. But I do think the first aid treatment is likely to be the same, because the equipment and training to a) diagnose accurately and b) provide advanced pulmonary support, are not going to be at the typical dive site. However, mentioning the possibility to the medics who arrive is NOT a bad idea, since it would be my guess that most emergency medical personnel have never heard of this problem.

 

[blue sky]

With thanks to TDS' gbgdiver:

This is a test with an individual who deliberately undergoes Hypoxia - having less oxygen in your system than you need.




Link for faster: hypoxia - YouTube

Been there done that. Didn't have a clue!

 

[freewillie]

Just a few quick thoughts.

Supplemental oxygen is indicated for any cause shortness of breath in a diver who just surfaces. Could be IPE but would also be indicated for DCI/AGE or lung injury from aspiration (inhaling water/vomit). Either way regardless of diagnosis the therapy would be the same.

CPR is only indicated if the patient has either stopped breathing or has lost a pulse (heartbeat). And in addition to chest compressions rescue breaths would be given as well although some revisions have the rescuer giving only chest compressions without breaths. In any event you should still keep the victim on supplemental oxygen.

The bags you see attached to oxygen face mask are not the same as an ambubag - the one Jax has picture were the rescuer squeezes the bag to force oxygen into the victim's lungs. These are generally only in hospital or ER settings not on dive boats.

The actual diagnosis is not determined until later, the goal of the first responder is to keep the victim alive until they can get to a hospital and medical attention.

In reviewing the article on the Chesepeake police officer it is impossible to determine the cause of the accident. Any specualtion on cause including IPE is just a guess. Makes for an interesting discussion though.

 

[Low]

This is a rather interesting discussion for sure. I'm rather curious to know more of the causes that would bring such an episode about. From some of the references in the OP I'm not seeing any mention of things bring out of the ordinary. What are some possibilities that could put someone at risk? The more I read about this the more I realize that IPE could be difficult to identify in someone else. If nothing else the more information brought to light the more it will help people to be in tuned with themselves.

 

[TSandM]

The causes and predisposing factors for IPE are not well understood, and in fact, Duke is currently running a research project to study people who have had this condition, to see if there are identifiable abnormalities that would predict the problem. Some cases are associated with some high blood pressure, but not all. Some are related to cold, but again, not all. It will be interesting to see what Duke comes up with.

At this point I would say that this is a diagnosis that should be considered for acute, severe shortness of breath in someone who has been diving. It is one, however, of several.