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

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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...

I know one person who was diagnosed with IPE and one who was unconfirmed 20 years ago but suspected it in retrospect. There was also a death confirmed to be due to IPE by a coroner here in 2003. All 3 were diving. I have asked the two survivors to contact Duke University to give their info if they'll revisit their experiences.

This is an article regarding the death that we had here in 2003:

article:
From the Owen Sound, Ontario, Canada newspaper
Printed from www.owensoundsuntimes.com web site Tuesday, June 24, 2003 -
© 2003 Owen Sound Sun Times

Man dies exploring shipwreck
Bill Henry
Monday, June 23, 2003 - 08:00

Local news - A relatively inexperienced scuba diver has died exploring the wreck of the Arabia off Tobermory.
A post-mortem Sunday found that David Clarke, 57, of Thames Centre east of London died Friday when his lungs filled with fluid internally.
The unusual condition, known as pulmonary oedema of submersion, has been increasingly attracting attention within the diving community, coroner Dr. George Harpur said Sunday afternoon.
"It's a phenomenon in which you can acutely develop a problem with too much fluid in your lungs, not from drowning but from inside the body, kind of an internal form of drowning," he said.
Clarke, a certified diver for just two years, his son and several others
were diving from the charter boat The Lark in Fathom Five National Marine Park on Friday.
He was a fit and active man who had made fewer than 30 dives since
certification. He was in 110 feet of water at about 6 p.m. when he ran
into trouble breathing, Harpur said.
"He wasn't a terribly experienced diver, but he had been on dives of at
least 90 feet in these waters. This was deeper than he'd been before, but he had been in this kind of water."
Clarke abandoned his breathing equipment as if it were not working, then discarded a second device given to him by his diving buddy. There were no obvious signs of life when he was brought to the surface.
Paramedics were called and arrived at the dive ship on a marine park
vessel.
Clarke was taken ashore, where he was later pronounced dead by the
coroner.
"While he may have been panicked for a short while, (Clarke) died very
quickly," said Harpur, a former military diver and an expert in diving
medicine. "He died of lack of oxygen as a consequence of fluid on the
lungs."
Both discarded breathing units still had an adequate air supply, although an
investigation will look at if they malfunctioned, possibly because of the
extremely cold water, Harpur said.
Harpur said until the investigation is complete, it's too soon to
circulate information within the diving community which might help avoid similar deaths.
He said it's unlikely an inquest will be necessary.
"Most of the factors are already recognized and fairly well known," Harpur said. "There were factors involved that we have already circulated . . . like not making your first dive of the season to 33 metres and making sure that when you do dive to that kind of depth, that you've acquired adequate experience before you get there."
The depth of the water probably played at least a psychological role,
although the condition which caused the man's lungs to fill with fluid is
not related to deep water.
"It's not related to depth at all, it's related just to being submersed in
water. It's related to the fact that it's cold and it's related to the
fact that you're a male over the age of 45," said Harpur, a master diving instructor and medical advisor to several diving associations.
Clarke's was the third diving death in Ontario this year, the first in
Tobermory. It was also the second recreational diving death. The other was on a commercial diving site.
Divers make about 25,000 to 30,000 dives each year at Fathom Five National Park, about half the annual total of several years ago, Harpur said. He did not know what percentage make deep dives, but said the Arabia is "a very popular site."
Two divers died last year near Tobermory. Novice diver Scott Jamieson, 33, of Kitchener died almost exactly a year ago. His body was found on the deck of the wreck of the Forest City.
Michel Guerin, 42, of Pickering died in mid-May while diving off
Lighthouse
Point in Fathom Five Park.
© 2003 , OSPREY MEDIA GROUP Inc. All Rights Reserved.
 
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Reactions: Jax
maybe in the field we need to remember the basics..as Jax stated ABC's. I will put any diver who has issues on O2 as we wait for evac. Continuous monitoring of vitals and implement proper steps if pulse is not detected. I understand the new wave of no breathing cpr to allow the masses to feel comfy helping...but as divers, should we maybe have a level of training to deal with the oh S%#T moments that is maybe a little higher. DAN has some awesome courses for dealing with these kind of problems..and as JAX stated,(paraphrased) keep them alive and get them to a higher level of care. interesting discussion.
 
maybe in the field we need to remember the basics..as Jax stated ABC's. I will put any diver who has issues on O2 as we wait for evac. Continuous monitoring of vitals and implement proper steps if pulse is not detected. I understand the new wave of no breathing cpr to allow the masses to feel comfy helping...but as divers, should we maybe have a level of training to deal with the oh S%#T moments that is maybe a little higher. DAN has some awesome courses for dealing with these kind of problems..and as JAX stated,(paraphrased) keep them alive and get them to a higher level of care. interesting discussion.
@davetowz: The American Heart Association is very clear about the circumstances under which conventional CPR with rescue breaths should be administered instead of Hands-only CPR. Conventional CPR with rescue breaths is recommended in the following cases:

  • All infants (up to age 1)
  • Children (up to age 8)
  • Adult victims who are found already unconscious and not breathing normally
  • Any victims of drowning, drug overdose or collapse due to breathing problems.

I bold-faced the situations relevant to the general diving public.
Since those situations commonly occur in dive-related incidents, conventional CPR with rescue breaths is strongly preferred in dive rescues.
 
To piggyback on Bubbletrubble, there's quite a bit of confusion about hands-only CPR. The American Heart Association introduced it to encourage people who have not been formally trained in CPR to at least intervene to the best of their ability. People who have been through a CPR course will still perform compressions AND breaths. This becomes especially important in water emergencies since many of them, including pulmonary edema of any etiology, are respiratory in nature.
 
Cross-posting "by permission" (tongue-in-cheek)

. . . the "latest" training says just get on the 100-compressions per minute CPR. Then slap on O2. The problem is that people are backing away from mouth to mouth because of fear of disease. What if they don't have O2?

It's really-really-really important, in my first-aid-only-trained mind, to get air in the victims' lungs.


Here's the conundrum: If you are on a boat speeding towards shore, you will probably not feel a pulse and will jump into CPR!! (Source - During ERD, we got ON a Baywatch boat, with a CPR-dummy. We were told to take the vitals from a perfectly healthy person as the boat "tore off" towards "the shore". Not ONE of us could get a pulse, even with a stethoscope. So, we are told, get to the CPR. Yet . . . the victim needs air / O2 in his/her lungs.
 
BTW -- My comment above about "getting on the compressions, then slap on O2:

US Army Trains that way, & the American Heart As. trains that way. Rescue Breathing only happened after the first [-]minute[/-] cycle of compressions, unless you yelled for help for someone else that could 'get in there'.

It seems like [-]a minute[/-] that delay is a really, really long time when the victim's body is producing fluids that keep air from getting in.
 
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To join the fray. As some of you already know I had some kind of pulmonary edema hit in the summer. Long boring version can be found here: http://www.scubaboard.com/forums/accidents-incidents/395096-pulmonary-oedema-incident.html

The main thing that I think made the difference from my being here typing this up today was when the main guy tending to me forcibly blew into the O2 mark (they were administering continuous flow O2). My recovery from that point forward was rapid and dramatic.

Bubble and TSandM have alluded to several risks in doing this procedure (PPV) for an undiagnosed condition. However, I still think people should be aware that this pretty simple trick can save the day in certain circumstances.

Thanks,
John
 
To join the fray. As some of you already know I had some kind of pulmonary edema hit in the summer. Long boring version can be found here: http://www.scubaboard.com/forums/accidents-incidents/395096-pulmonary-oedema-incident.html

The main thing that I think made the difference from my being here typing this up today was when the main guy tending to me forcibly blew into the O2 mark (they were administering continuous flow O2). My recovery from that point forward was rapid and dramatic.

Bubble and TSandM have alluded to several risks in doing this procedure (PPV) for an undiagnosed condition. However, I still think people should be aware that this pretty simple trick can save the day in certain circumstances.

Thanks,
John

Thanks, John!

I would like to highlight his story:
http://www.scubaboard.com/forums/accidents-incidents/395096-pulmonary-oedema-incident.html
 
BTW -- My comment above about "getting on the compressions, then slap on O2:

US Army Trains that way, & the American Heart As. trains that way. Rescue Breathing only happened after the first minute, unless you yelled for help for someone else that could 'get in there'.

It seems like a minute is a really, really long time when the victim's body is producing fluids that keep air from getting in.

Jax,

When you say "slap on O2", do you mean "provide ventilations"? I don't mean to mince words, but if you're posting this in a basic discussion forum, you need to be clear as to what you're talking about.

Re your concern: a CPR-trained individual will not give one minute of compressions prior to initiating ventilations. The correct procedure is to provide 30 compressions at a rate of at least 100 per minute, then provide two breaths. It doesn't take an entire minute to give 30 compressions.

Best,
DDM
 
To join the fray. As some of you already know I had some kind of pulmonary edema hit in the summer. Long boring version can be found here: http://www.scubaboard.com/forums/accidents-incidents/395096-pulmonary-oedema-incident.html

The main thing that I think made the difference from my being here typing this up today was when the main guy tending to me forcibly blew into the O2 mark (they were administering continuous flow O2). My recovery from that point forward was rapid and dramatic.

Bubble and TSandM have alluded to several risks in doing this procedure (PPV) for an undiagnosed condition. However, I still think people should be aware that this pretty simple trick can save the day in certain circumstances.

Thanks,
John

John,
Thanks for posting. Your story continues to amaze me. I think that your rescuer definitely jumped in with the pocket mask at the right time. This is what TSandM was talking about when she mentioned assisting ventilations in a conscious individual. It's not easy to do, and it takes a cooperative patient, but it can definitely make a difference.
Best,
DDM
 
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