Is it DCS?

[pipedope]

As for denial. I've reread the posts. I'm far from sure denial was a factor here. There was a question. That is why the thread was started in the first place. I've had the same kind of question. Hmmm, that itch I have; is it DCS? Or, is it just dry skin? Hmmm, that joint pain; is it DCS? Or, is it just a hang over from the load I carried a couple days ago? To me asking the question is not denial. It is intelligently beginning the medical assessment process.

Now, if the assessment comes up DCS, or probably DCS and the person doesn't seek medical help, THAT is Denial, with a capital D.

Peace Brother.

I disagree.

The BAD denial is right at the beginning, right when the diver surfaces and gets a pain and is wondering, "could this just be DOMS?" (DOMS = Delayed Onset Muscle Soreness).

Right then is the time to say to the buddy, "Hey, I have some pain here can you give me a 5 minute neuro?"

It really does only take 5 minutes and often less as you may see indications of trouble right away. In this case you call DAM and EMS and declare the emergency and then complete the neuro. Then put the diver on O2.

The Catalina Island Chamber website has a good video on the 5 minute neuro exam.

In the commercial world divers are monitored after all deco dives and dives that 'might' produce DCI by other members of the team. We WANT to know as soon as possible and get treatment as soon as possible.

This is not a slam against divers who wait or anyone else.

That is the beauty of the 5 minute neuro. It gives you something solid to hang your hat on as far as calling in the problem. If my buddy could cause pain by squeezing this morning and now can only manage a fair handshake, I KNOW something is not right.

Maybe I should start a drive to get the 5 minute neuro to be a standard drill before and after all diving.

 

[DandyDon]

Maybe I should start a drive to get the 5 minute neuro to be a standard drill before and after all diving.

Might be a wonderful idea. I don't know it...

 

[H2Andy]

there are a number of variations, but this one looks close to the one we covered
in Rescue class:

http://www.google.com/search?q=cach...+five+minute+neurological+test&hl=en&ie=UTF-8

 

[dtdiver]

tim

glad you're OK regardless of the cause.

my vyper has three levels of "conservativity"

does your fusion have the same capability and if so , where was it set?

on multiday, deep dives i set mine to be more conservative , and if possible always dive max nitrox.

how quickly did your symptoms clear when they recompressed you??

a question for the professors in the audience..

is there a difference in how quickly symptoms clear (for example joint vs muscular vs skin ), and does the rate at which the symptoms clear correlate with prognosis?

dt

 

[DandyDon]

Thanks Andy. Couldn't handle the Catalina Chamber video; too puter dumb.

I'm printing that out to put in my log book, and I'll practice with my home bud!

 

[itziar]

Thanks Andy. Couldn't handle the Catalina Chamber video; too puter dumb.

I'm printing that out to put in my log book, and I'll practice with my home bud!

A similar set of instructions comes in the DAN America "Dive & Travel Medical Guide" that you probably have. Section III, page 61-63 (of the 1/99 edition) "On-Site Neurological Examination".

This is a nice booklet to bring together with the logbook, just in case...
It also has information on what to do in case of confronting other emergencies.

-- Itziar

 

[DandyDon]

Yep, got that book, too. I need to read the directions, huh...?

 

[ArcticDiver]

I disagree.

The BAD denial is right at the beginning, right when the diver surfaces and gets a pain and is wondering, "could this just be DOMS?" (DOMS = Delayed Onset Muscle Soreness).

Lets' see now...I say the first thing to do is to have a medical assessment. You say you disagree. That the diver should have a neurological exam. Apparently you don't know what a medical assessment is.

A medical assessment is what the folks do on the ambulance when they are called to help you. It is what the folks in the Emergency Department do when they first get you in the door. In short it is an examination to get a best guess on what the problem is and hopefully results in an accurate diagnosis and treatment focused on that diagnosis.

Following an assessment protocol helps prevent tunnel vision. In a suspected DCS case a proper assessment would look at more than just neurological symptoms because barotrauma can affect more, or not have CNS symptoms at all.

More important, it recognizes that there is Something Wrong, or Perceived Wrong. Otherwise the diver wouldn't be complaining of a problem. Even if the problem isn't DCS the actual complaint may be serious.

As for denial; you have a unique definition of Denial. From what you say even asking the question about DCS is a form of denial. That seems to be too harsh. It isn't asking the question that is denial; it is failing to bleieve and act on the results of the answer.

 

[ArcticDiver]

Quote: But let's look at this misunderstanding here...

Quote:
Originally Posted by ArcticDiver
Hopefully we haven't denigrated into a silty atmosphere here. On the basis that we haven't the following is offered.

While what you say may be literally true that a person "can" get bent, following an intelligently conservative dive profile reduces the odds significantly. One of the factors in biasing a dive profile in the diver's favor is interpreting tables, whether electronic or manual.

In this case two different dive models were being used, since there were two different brands computers. From the postings it appears that one indicated the dive was much more adventerous than the other. So, how to apply the different indications to the situation was diver judgement. The fact that one stayed in the "green" throughout the dives I'm sure was a significant factor in that diver judgement.

Quote by DandyDon:
This is the erroneous type of analysis that I'm defending against here, in that Tim never said that his Oceanic stayed in the "green" throughout the dives, not at all... End Quote:




I put the word "green" in quotation marks as a literary convention. If I had realized you were going to take it literally I would have used the words: "...stayed in the no deco required area throughout the dive." Using quotation marks in this way is a chancy thing that I think I'll avoid in the future.

As for calling DAN: If my memory serves I think the DAN recommendation is to go to the nearest emergency medical facility before going to the chamber. Their reasoning as I recall is that the chamber may be already busy and the emergency facility will have the ability to give supportive care while waiting and that the ED will have the ability to do a proper assessment to determine whether a chamber ride is in fact necessary.

 

[pipedope]

Lets' see now...I say the first thing to do is to have a medical assessment. You say you disagree. That the diver should have a neurological exam. Apparently you don't know what a medical assessment is.

A medical assessment is what the folks do on the ambulance when they are called to help you. It is what the folks in the Emergency Department do when they first get you in the door. In short it is an examination to get a best guess on what the problem is and hopefully results in an accurate diagnosis and treatment focused on that diagnosis.

Following an assessment protocol helps prevent tunnel vision. In a suspected DCS case a proper assessment would look at more than just neurological symptoms because barotrauma can affect more, or not have CNS symptoms at all.

More important, it recognizes that there is Something Wrong, or Perceived Wrong. Otherwise the diver wouldn't be complaining of a problem. Even if the problem isn't DCS the actual complaint may be serious.

As for denial; you have a unique definition of Denial. From what you say even asking the question about DCS is a form of denial. That seems to be too harsh. It isn't asking the question that is denial; it is failing to bleieve and act on the results of the answer.

I am talking about Before even asking for a medical assesment.
Let me see, diver surfaces and then has pain that wasn't there before, thinks, "this is not DCI, I wasn't down that long." Now how do you get to a medical assesment before anybody even knows anything is wrong?

MOST divers will be in denial (not a river in Egypt) and will try to rationalize away the pain. Until somebody does something, there is no one to do a medical eval. At this point the diver is probably not even telling his buddy of the problem.

Are you familiar with the 5 minute neuro?
It doesn't take an EMT or Paramedic or doctor or nurse to do one. Anyone who can learn to dive can learn to do the exam.
The exam does no good until you do it.

So, unless the DIVER overides his (her) denial and ASKS for an exam, OR the buddy does the exam as a matter of routine action after a dive then the diver is just getting worse.

The problem is NONE of those people you are talking about even know you exist until somebody makes the call.
DAN will steer you the right way but ONLY IF THEY ARE CALLED.

My main concern is the thought and actions that happen before the call to DAN and/or EMS.


I don't know anyone who says they are glad they waited to get treatment for DCI. I know lots of people who say they wish they had acted MUCH sooner.

In sailing we say that the moment you think of reducing sail it is probably about 5 minutes late. Similarly in diving the moment you think the 'bent' word it is probably time to activate the system and get help.

I think my understanding of denial is fine. You might look it up in the dictionary and tell me how a diver not even admitting to himself that the 'might be bent' is NOT denial.

Have you even had a case of DCI?
Have you ever seen a case of DCI?
Have you read the DAN materials on DCI and seen how long divers rationalize and deny the problem before they finally get treatment?
There are even cases of divers on dive boats that had staggers and chokes that KEPT DIVING. If that is not denial by the diver (and everyone else on the boat) I don't know what is.