Taboo Decompression

[johndiver999]

So you conducted a neuro exam on yourself? How long you gonna stay under there solo on high ppO2s? You're assessing, deciding on a 'treatment plan' self treating, and self monitoring - all while injured AND on top of that you're alone in the ocean. Lay on the deck and get yourself on surface O2 after calling the coast guard to get you outa there to proper care.

For me, in situations where a person who is bent and we know that they did not do something crazy, like an explosive ascent or missed a bunch of deco and the problem is pain, then the option for immediate re-descent is something that seems less crazy to me - as I see examples of resolutions.

In the last year, I've seen re-descents with normal 34-36% nitrox and resolution of pain and symptoms. I assume that if a diver descends with no pain it is an omitted decompression and if thy have symptoms then it should be called IWR. If they redescend with a little pain and it resolves in 10 minutes, what do we call that?

After ANY dive, every diver does a self assessment of their neurological condition and how they feel. so the concept of self assessment after a dive does not seem so outlandish to me.

If a diver feels bad, goes back down until they feel better, comes up slow and then gets up and feels fine, I'm not so sure that EMS needs to be activated. Especially if, afterwards, they can sip oxygen on the boat while they contemplate the error of their ways.

The problem I have seen with activation of EMS is that it can take hours before recompression takes place and that does not always generate desirable outcomes. If the accident is in a remote location, a chamber might be a long, long way away.

BTW, a solo diver, in a remote location, could activate EMS and then re-descend and do some of his waiting underwater.

 

[berndo]

There was a long thread about the two instructors who died at Lake Werbellin in 2021. Recommend reading through that thread first before revisiting it in this thread. Based on dive computer profiles it seems that the dead divers might have attempted to conduct some sort of omitted decompression or IWR protocol after making a rapid ascent to the surface, but no one knows for certain exactly what they did or why.

I skimmed through. Just wild speculation based upon nothing, really.

 

[rjack321]

For me, in situations where a person who is bent and we know that they did not do something crazy, like an explosive ascent or missed a bunch of deco and the problem is pain, then the option for immediate re-descent is something that seems less crazy to me - as I see examples of resolutions.

In the last year, I've seen re-descents with normal 34-36% nitrox and resolution of pain and symptoms. I assume that if a diver descends with no pain it is an omitted decompression and if thy have symptoms then it should be called IWR. If they redescend with a little pain and it resolves in 10 minutes, what do we call that?

After ANY dive, every diver does a self assessment of their neurological condition and how they feel. so the concept of self assessment after a dive does not seem so outlandish to me.

If a diver feels bad, goes back down until they feel better, comes up slow and then gets up and feels fine, I'm not so sure that EMS needs to be activated. Especially if, afterwards, they can sip oxygen on the boat while they contemplate the error of their ways.

The problem I have seen with activation of EMS is that it can take hours before recompression takes place and that does not always generate desirable outcomes. If the accident is in a remote location, a chamber might be a long, long way away.

BTW, a solo diver, in a remote location, could activate EMS and then re-descend and do some of his waiting underwater.

Maybe you should learn what the on-site neuro exam even is before saying "just do it yourself"

https://dan.org/health-medicine/health-resources/diseases-conditions/on-site-neurological-examination-2/

 

[crofrog]

If people are serious about IWR, you must be setup for it. Realistically you need to go to 60 feet on 50% O2. And get on 100% as soon as possible, depending on the depth that symptoms subside.

Did you read the paper

In-water recompression

Divers suspected of suffering decompression illness (DCI) in locations remote from a recompression chamber are sometimes treated with in-water recompression (IWR). There are no data that establish the benefits of IWR compared to conventional first aid ...

www.ncbi.nlm.nih.gov

 

[Celt]

Did you read the paper

In-water recompression

Divers suspected of suffering decompression illness (DCI) in locations remote from a recompression chamber are sometimes treated with in-water recompression (IWR). There are no data that establish the benefits of IWR compared to conventional first aid ...

www.ncbi.nlm.nih.gov

Obviously if a chamber is available, you’re not going to need IWR. It’s about the needs of a diver. How bad are they, where is the nearest chamber and in our case, can you get there close to sea level in time. You can do all the reading you like but still have to make decisions on the day, that’s what real diving is about instead of internet diving.

 

[crofrog]

Obviously if a chamber is available, you’re not going to need IWR. It’s about the needs of a diver. How bad are they, where is the nearest chamber and in our case, can you get there close to sea level in time. You can do all the reading you like but still have to make decisions on the day, that’s what real diving is about instead of internet diving.

Did you read the paper?

I'll put a picture in here for you from it.

 

[Tom_Ivan]

Two additional data points on the topic
1-my brother, on a recreational dive, thinks he got inner ear DCS. He got really bad vertigo and was disoriented on his ascent. He descended a little bit and the symptoms all disappeared. After a few minutes at that depth he was able to ascend without incident.
2. Richard Pyle has a story about an out of gas incident as a teenager and skipped all his stops on the way to the surface. He recognized the symptoms of DCS once on the boat so hooked up a fresh cylinder and resubmerged until the symptoms disappeared. He was able to return to the boat without further incident (until his next dive when he had another OOG but that's another story).

Hopefully everyone here as seen the video on the topic with Simon Mitchell. He makes it very clear that early recompression is key to successful recovery.

I'm pretty sure if I was diving remotely (in a cave or whatever) and got symptoms I'd be wanting to do some IWR.

 

[iointerrupt]

I'm pretty sure if I was diving remotely (in a cave or whatever) and got symptoms I'd be wanting to do some IWR.

It's easy to be sure when it's just theoretical.

In reality, there is bent and then there is bent.

There's "my arm hurts, but maybe it was from climbing up the ladder", and there's "all my joints have stabbing pains and I'm so exhausted I can't stand up".

The linked paper above even mentions this, there is only a narrow window of symptoms that make sense for IWR, bad enough to be worth getting in, but not so bad that you'll kill yourself attempting it.

In the end I agree with Celt on this, there isn't much to actually say, if it happens, hard decisions get to be made then and there.

 

[boulderjohn]

2. Richard Pyle has a story about an out of gas incident as a teenager and skipped all his stops on the way to the surface. He recognized the symptoms of DCS once on the boat so hooked up a fresh cylinder and resubmerged until the symptoms disappeared. He was able to return to the boat without further incident (until his next dive when he had another OOG but that's another story).

The other story includes failed IWR, extensive hyperbaric treatment, and months of rehab before he could walk again. Decompression Sickness Treatment & Recovery | True Story

Pyle is indeed a proponent of IWR in certain cases, and he is the author of one of the IWR protocols.

 

[Gone for diving]

The other story includes failed IWR, extensive hyperbaric treatment, and months of rehab before he could walk again

That was a pretty crazy day of diving,,
I think he even admits he I'd a ton of young and stupid stuff,

Do you think he would be alive if he hadn't stayed underwater before they could evacuate him?

There seems to be a lot of old diving stories of IWR, probably because if you didn't fix it yourself you were screwed, remember no cellphones and other tech we take for granted.