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In water recompression w/ DCI

Discussion in 'Ask Dr. Decompression' started by large_diver, May 21, 2001.

  1. detroit diver

    detroit diver Great White

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    I was following along until I got to:

    "Give copious fluids as needed to maintain good urinary output. Fluids should be administered at a rate greater than 0.5ml/kg/hr--usually 1 L qhr or 1 L q4hr, titrated against the hematocrit, which should be maintained at less than 50%. The hemoconcentration associated with decompression sickness is the result of increased vascular permeability mediated by endothelial damage and kinin release. The fluids can be given orally if the diver is conscious--if not, give fluids by intravenous, if available. Avoid using hypotonic fluids, such as D5W, using 0.9% saline instead. Glucose solutions should be avoided as they have been shown to worsen neurological damage. "

    Can you elaborate in English?

    Thanks!!

    Jack
     
  2. scubadoc

    scubadoc Medical Moderator

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    Hi 'detroit diver'!!

    Basically the paragraph is saying that the injured diver needs to be given fluids in some fashion - preferably by mouth, or if possible or by intravenous route (needle in a vein). Fluids given should be about the same strength or concentration as normal blood and should not contain glucose (sugar) - as this has been shown to increase the damage that has been done to the brain by the decompression injury. (Decompression injury is damage from the presence of bubbles). A good indication that a person has been rehydrated or brought back to normal blood volume is the rate of flow of the urine, indicating that the kidneys are being supplied with the appropriate volume of blood.

    The reason for this is that the bubbles cause reactions in the blood that tend to cause concentration due to fluid seepage from the blood into the tissues, leaving a higher percentage of blood cells and less serum.

    Darn!! I trained for 14 years to learn to talk like that! Thanks for reminding me to communicate better!
     
  3. detroit diver

    detroit diver Great White

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    -
     
  4. Dr Deco

    Dr Deco Medical Moderator Staff Member

    # of Dives: I just don't log dives
    Location: Issaquah [20 miles east of Seattle], Washington.
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    Dear Detroit Diver:

    As ScubaDoc has indicated, much of this treatment is beyond the reach of the ordinary diver. That is why prompt transport to chamber is necessary if there is the suspicion that a DCS problem may be imminent.
    ___________________
    Dr Deco

    PS. Dr Deco was originally from Detroit (From 1940 to 1960, I lived near the University of Detroit High School on Seven Mile Road. Unlike Eddie Murphy (Beverly Hills Cop), I actually attended Mumford High School. :royal:
     
  5. detroit diver

    detroit diver Great White

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    Dr. Deco,

    I don't ever see myself using these methods, but they're always good to have in the memory bank "just in case". You never know when a diving opportunity might present itself!
     
  6. Lost Yooper

    Lost Yooper Loggerhead Turtle

    # of Dives: I'm a Fish!
    Location: Panama City Beach, FL
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    Here's a discussion I added to my notes on the subject between someone and George Irvine.

    Hope it helps.


    "George, looking at the emergency procedures of WKPP operations in the web site I found no mention about the possibility of IWR. Please can you elaborate on this? We often dive in remote locations (5 to 10 hours to chamber) and your experience would be usefull to let us make the best informed choice when (if) needed.
    A second question: in your experience/knowledge is it possible to identify a relation between dive/deco profile and type 1 vs. 2 DCS insurgence (ie fast ascent causes type2, shortening last stops may cause type1, or something like that) or is it completely random?

    Mario, this is too complex for this list . What we do is call make the decison based on alternatives and time to the chamber and condition of the diver. Simple bends are easy to get back in and fix, type 2 is not so easy, and it generally occurs post dive and the diver is incapacitated, and the helicopter is called. Seizure is often a concurent problem with type 2 dcs.
    WKPP divers usually do not get to the point of type 2 on one of our dives since they would have not gotten that far into the program without being discovered. Oor type 2 hits usually occur to support divers who did a dive and then did shallow support bounces, which we do not allow outright and which we have a time lag for and procedures for to prevent paradoxical gas embolism.
    How we recompress or fix the bends 99% of the time is 20 foot oxygen. The other decisions are all based on too much experience and info to put on here.

    IWR- is the protocol for the little dives we're doing over here, and everybody understands exactly what and how we are going to do this. FFM 02 at 9 meters w/tender for a period and then assent at 12 minutes per meter.
    We've looked at many different scenarios but will use this as a "blanket" prescription (though it's not my favorite). The key to doing this affectively is activation time, organization and 02. For the IWR option to exist you have to be prepared by having a game plan, in my humble opinion. Of course if there is a chamber available then you don't need to consider IWR......."




     
  7. large_diver

    large_diver Loggerhead Turtle

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    Scubakat,

    This particular course included SLAM, Dan Marine Life Injury First Aid, CPR (infant, child and adult), Basic First Aid, and Dan O^2 provider. Basically, it seemed like a good value for the money (US$200). IMHO, they tried to stuff too much into 2 8AM-5PM days. I think other agencies (e.g. PADI) separate their courses into a Medic/First Aid course and the PADI Rescue course (Mediac/First Aid is the prereq. for rescue). I think this might have been a better way to do it rather than trying to do all of this at once. Still, I found everything I learned very useful -- I just need to do some review, since we went over much of it quickly. Also not sure how ,much of the med stuff I learned would be covered in the PADI course.

    Hope this helps.
     

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