My Wifes IPE in Cozumel

[Lorenzoid]

A diver's rising blood pressure from the anxiety caused by the divemaster/group leaving him behind, and the exertion from trying to keep up could be a dangerous combination.

 

[Griffo]

I've never heard of this before so I enjoyed the read.

To the OP: you spent a considerable amount of time on sinus issues. Was this relevant to the issue or were you venting a bit of frustration? I understand if the latter.

I was trying to explain two things:
a) why the DM and other divers in the group would not be surprised to lose easy sight of us. If we'd been on the same level i'm sure we wouldn't have been left behind
b) why we skipped the previous days diving (people ask about repetitive diving before incidents)

It's also why I mentioned things like reg servicing, BP / Heart history, drugs etc as they are all commonly listed as possible "causes" of IPE events.

Do you believe getting semi-separated from the DM contributed to this?

Only in-so far as we might have all slowed down a little or thumbed the dive earlier. If I had been in communication distance and able to ask him how much further, we probably would have told them to go on without us. As I said, we don't enjoy 20 min blue water swims, we may have decided to skip the dive and enjoy the next one.

Were the 33% nitrox tanks tested before the dive?

Yes the tanks were marked and we re-tested on the boat ride out.

Were they tested afterwards for CO?

Not to my knowledge, we were at the hospital and it didn't occur to me until the next day.

Lastly, you have not named the dive op. This is an unflattering report on the DM. Do you believe this contributed? If so I believe you have a duty to name the op.

Thank you for the write up.

No, we don't blame the DM for anything apart from taking us on a crap dive. He knew we were a competent team who was having issues clearing, so I don't expect that he would baby us. I'm just frustrated around the "what if". If we'd just re-surfaced when he realised we were miles away from the reef, maybe it would not have happened. But who knows.

To be fair, it's a very well regarded dive opp and the owner seemed as surprised by some of the incident management as I was. I also have to respect the high standard that the boat captain was obviously trained to. I'm not sure I should slander the business for a medical event that nobody really understands and a DM that was a little lax. I am a bit salty though that the shop did not own a cable to take dives off their own rental computers.

 

[clownfishsydney]

Apparently it has even happened to surface swimmers. From what I have been reading, I get the impression that ascent rate is not believed to be a factor.

You can be standing in water and have it happen! So long as it is high enough up your body.

 

[clownfishsydney]

IPO/IPE is only now becoming better understood. But for sure the trigger or "strenuous exercise" could be fighting current or lots of finning.

According to the articles cited in this thread that: There is also evidence that IPO may be the commonest cause of death in amateur scuba divers

Also the same source (UKDMC) states that:

A survey showed that 1.4% of triathletes had one or more episodes of IPO/IPE Most triathletes that die during an event die during the swim, rather than during the cycle ride or run.

Do not even need "strenuous exercise" to set it off, I know three cases where there was none at all, one even happened within a few minutes of entering the water and less than a minute underwater.

Agree about the claim it may cause most scuba diving deaths, I can think of a lot of people I know who died (friends, friends of friends or who I heard about) just in Sydney or NSW area who I now think were probably IPE. It has same symptoms as a drowning.

 

[Vitesse2l]

I was at a talk by the UK's DDRC this week, subjects were DCS and IPO. As mentioned above factors were exercise and (obviously) immersion. Also discussed were blood pressure and cold.

The doctors stated that IPO looks the same as drowning at autopsy. They talked about triathletes as well with a 2/3 to 1/3 ratio of cases to scuba.

 

[Oitzu]

I was trying to explain two things:
a) why the DM and other divers in the group would not be surprised to lose easy sight of us. If we'd been on the same level i'm sure we wouldn't have been left behind
b) why we skipped the previous days diving (people ask about repetitive diving before incidents)

It's also why I mentioned things like reg servicing, BP / Heart history, drugs etc as they are all commonly listed as possible "causes" of IPE events.

First of, great writing and very informativ.
You gone into great detail about factors that could have lead to the IPE.
But i wonder over 2 variables that are still open: (sorry if this was asked inb4 and i missed it)
- Hydration: Was she well hydrated or maybe even "overhydrated"?
- Weighting: Would you/she say she was perfect weighted or over/underweighted for the dive?

 

[ChuckP]

Thanks for taking the time to write this up. I think my OW training briefly mentioned IPE as a possible effect of a rapid ascent but no details on what it's actually like nor that it could happen on a normal dive profile.

Ow training probably covered AGE, arterial gas embolism, those result from lung trauma possibly holding your breath during ascent. The ipo/ipe is liquid in the lungs - drowning from inside....

 

[dmaziuk]

The bad news is pink froth can be indicative of either, it takes a doctor with a stethoscope to tell the difference. The good news is in either case the immediate remedy is oxygen: you can't go wrong by putting the victim on O2.

 

[Griffo]

First of, great writing and very informativ.
You gone into great detail about factors that could have lead to the IPE.
But i wonder over 2 variables that are still open: (sorry if this was asked inb4 and i missed it)
- Hydration: Was she well hydrated or maybe even "overhydrated"?
- Weighting: Would you/she say she was perfect weighted or over/underweighted for the dive?

- I don't believe over-hydration would be possible. We'd had a couple of drinks the night before, got up, and gone diving. If anything under-hydration would be more likely
- We'd done a basic weight check two days before. With the heavy HP 100 she only need a couple of kilo's. It might not have been perfect but she wasn't "student dive" over-weighted.

 

[Stoo]

I've never heard of this before so I enjoyed the read.

To the OP: you spent a considerable amount of time on sinus issues. Was this relevant to the issue or were you venting a bit of frustration? I understand if the latter.

Do you believe getting semi-separated from the DM contributed to this?

Were the 33% nitrox tanks tested before the dive?

Were they tested afterwards for CO?

Lastly, you have not named the dive op. This is an unflattering report on the DM. Do you believe this contributed? If so I believe you have a duty to name the op.

Thank you for the write up.

Onset of an IPE has nothing to do with any of these things. They can effect almost anyone at any time. I have read that SEALS are frequently struck with them due to they high level of exertion in the water. They are brought about when cardiac output isn't up to the task of moving fluid out of the lungs. The pressure gradients divers are subjected to is the only thing that creates the situation where an IPE occurs. Following recovery, a full cardiac evaluation should be undertaken.

It will be interesting to hear what the OPs wife's Doctor says. My long-time buddy had an IPE a couple of years ago and our local diving doc told him he was done with diving. They "negotiated" and settled on strictly recreational diving. Basically his condition was that my buddy not get himself into a deco obligation. He needs to dive conservatively so that he can end a dive as soon as he feels anything amiss. The dive where he was hit with the IPE had earned him 18 minutes of deco ON OXYGEN. Interestingly, the Doc her told him he should have blown off the stops, as he could have died as long as he was in the water. There was a chamber near by.

Interestingly, my buddy was diving with a guy whose girlfriend was one of DAN's leading IPE researchers at the time. She was on the phone giving advice as things progressed!