View Full Version : DCI or Sea Sickness
Copied from YD
What would you di in these circumstances?
I got back on the dive boat today to find Mrs Calamity lying down, looking pale, and feeling tired and sick. I am told by the skipper that she made a rapid ascent from 20 metres after spending about 20 minutes between twenty and thirty metres on the wreck we were diving. Alarmed, I ask why she isn't on oxygen, and am told that she has "no symptoms", and that using oxygen would be "bad practice as it may mask a bend". I point out that Mrs Calamity is tired and feels sick, and that in my opinion (as a dive doctor) she should be on oxygen as these are both potential symptoms of DCS. I am told by the skipper that she may have oxygen, but if it is given the coastguard will be called and he will ask to have her airlifted to the local chamber. In his opinion the nausea and tiredness are due to sea sickness. Another diver offered some of his deco mix, and was told by the skipper to stop, or he would ask for her to be airlifted from the boat. The issue wasn't pushed any further as Mrs C had perked up a bit by then and decided she wasn't going on O2 in any case.
Needless to say she will be receiving the close attention of a dive doctor for the next few days, and if she develops any hint of DCI will be off for some treatment. I don't want to discuss the reasons for the rapid ascent in this thread, but I am pretty angry with what happened afterwards.
My main worry is that feeling tired and sick after a rapid ascent does not equal no symptoms, and I am unaware of any training agency anywhere that recommends not giving oxygen for possible DCI. OK, it probably was seasickness, but we didn't know that for some fifteen minutes between Mrs C surfacing and the boat getting underway - that's a hell of a long time to leave a possible CNS hit without O2, given how many people have got it wrong the other way round. I really didn't like the "use oxygen and i'll have her airlifted from the boat" bit, certainly this may encourage anyone with potential DCI to ignore symptoms - surely a "start oxygen/re-evaluate/seek advice" approach would be more helpful - certainly this is the approach I have seen taken elsewhere under similar circumstances.
It would appear that fear of litigation now means an all or nothing approach rather than starting a safe and useful treatment as a precaution and using common sense to decide what needs to happen next.
CC
Before you ask, I am not going to discuss names and locations.
Mad Major
Dive Tramp
24-06-08, 20:57
Oh my! I am in agreement with you wholeheartedly here. The skipper's position here is simple, a diver after a rapid ascent under these circumstances (time and depth) showing indications of feeling unwell when not presenting with "seasickness" before the dive, should be given O2 as a matter of course and monitored closely. It is not necessarily appropriate to "have her airlifted off the boat", that decision will be made by the Coastguard, not the skipper! In any event here, advice should have been sought from the CG who would give professional guidance on the subject. Hmm, so much could be said on this, lets hear it...;)
Tell me, if O2 "masks" a bend, why would we continue to use it in the treatment of said "bend". Surely the earliest intervention with O2 therapy will greatly reduce the likely onset of that "bend"? :confused:
Any thought of DCI use oxygen - and if the skipper wants to call coastguard, so what? As DT says they will decide whether to airlift. Anyway treatment is meant to include lying down, breathing oxygen and then you call emergency services - job done!
If they thought it was DCI following an uncontrolled ascent then take the skipper up on his offer. If they didn't really think it then, why are they complaining afterwards - although clearly that boats rules (if the story is true) seem counterintuitive and designed to scare people off using the o2.
I would also have though that tiredness is a possible sympton (weakness in my manual). Anyway what sort of diving doctor would have thought, okay I'll go along with this. Is this another possible troll?
Anyway "bad practice as it may mask a bend" - mask a bend FFS - it doesn't mask it, it helps treat it! That's about as stupid as saying putting a cast on your leg might mask the break!
dive granny
24-06-08, 22:42
Some of these stories are unbelievable:eek: Having had a rapid ascent myself I say when in doubt give O2. It wont do any harm and treatment is better sooner rather than later.
FFS
Oh my! Yes, that's what I meant too! ;)
In those circumstances I would tell the skipper to call the F***ing coastguard, she is getting O2, regardless of what he thinks. The coastguard comes out to a false call are the p!ssed off, no they are happy that there is no incident....a doctor/hyperbaric chamber gets a late patient, are they p!ssed...yes if it could have been treated earlier. The boat and skipper in question should be named and shamed for all to know and avoid, cowboys!
Need a new signature now my trip is over. Have to think
I might just go for the second line of your current one myself - but why change now! :p
In those circumstances I would tell the skipper to call the F***ing coastguard, she is getting O2, regardless of what he thinks. The coastguard comes out to a false call are the p!ssed off, no they are happy that there is no incident....a doctor/hyperbaric chamber gets a late patient, are they p!ssed...yes if it could have been treated earlier. The boat and skipper in question should be named and shamed for all to know and avoid, cowboys!
:D - I love these wishy washy responses
you know me and my opinions :D
Hmmm, time to stick my head above the parapet.
There was an interesting article in the DAN magazine, probably a couple of years ago now, but I can't find it on line at the moment. They actually supported the skippers argument IN PART, what it was saying was that if you have had a rapid ascent or anything that may lead you to believe that you may have DCS AND ARE NOT displaying signs and symptoms of DCS then don't give oxygen.
The reasoning behind this?
What makes you go to A&E or a chamber? Its the pain that you feel - if you have taken oxygen then it will mask the symptoms and may delay the trip to A&E or the chamber, you aren't going to go to A&E if you feel ok are you?
In this particular case I wouldn't like to comment as I wasn't there in the actual position and I'm sure there are two sides to this story, otherwise why would a diving doctor sit back and leave it? Is tiredness on its own a symptom? Who doesn't feel tired after a dive? Do we all go to A&E because we are tired? If you are tired and are prone to sea sickness (and I am the worlds worst sailor so an expert in the subject :() then it doesn't take long to feel sick.
If there are signs and symptoms of DCS then absolutley put the diver on Oxygen but once that has started then next stop should really be A&E, but not necessarily by helicopter.
So, all i'm saying really is next time you have an incident like this, or even now, just sit and think it all through first don't just give oxygen.
Please don't shoot to much ;)
Yogi Diver
25-06-08, 08:02
I'm with Chris. Name and Shame!!!:mad:
The question of whether or not to give the O2 may or may not be relevant but the call should have been made to the coastguard and the hyperbaric centre consulted. They would have made the decision either way.
Sounds like the skipper is worried that his reputation might be tarnished if he calls for help.:confused:
I have to disagree with DaveT here ( sorry ! ).
Oxygen administration does not 'mask' the symptoms of a DCI , it helps to treat the root cause.
By reducing the PPN2 in the blood/tissues , it acts to slow down bubble growth , even to facilitate a reduction in bubble size due to reabsorbtion of nitrogen from the bubbles back into the tissues and hence out through the lungs..
By giving oxygen straight away where there is a reasonable cause to do so will help to prevent a DCI from developing at all or to at least lessen the seriousness.
Waiting until symptoms develop would not be my preferred course of action.
As for calling the coastguard , well in an ideal world yes.
However , based on my experiences of the other emergency services - once you involve them they are duty bound to act. I would be surprised if they took a 'wait and see' attitude , more likely to set some kind of rescue into action even if it turns out to be a false alarm.
If you like , a bit like phoning the fire brigade and telling then you THINK your house might be on fire.
They are not going to say - well phone us back when you can actually see the flames then !
Or am I wrong again ( someone go wake Stewart up ).
JB :O)
I have to disagree with DaveT here ( sorry ! ).
Oxygen administration does not 'mask' the symptoms of a DCI , it helps to treat the root cause.
By reducing the PPN2 in the blood/tissues , it acts to slow down bubble growth , even to facilitate a reduction in bubble size due to reabsorbtion of nitrogen from the bubbles back into the tissues and hence out through the lungs..
By giving oxygen straight away where there is a reasonable cause to do so will help to prevent a DCI from developing at all or to at least lessen the seriousness.
Waiting until symptoms develop would not be my preferred course of action.
As for calling the coastguard , well in an ideal world yes.
However , based on my experiences of the other emergency services - once you involve them they are duty bound to act. I would be surprised if they took a 'wait and see' attitude , more likely to set some kind of rescue into action even if it turns out to be a false alarm.
If you like , a bit like phoning the fire brigade and telling then you THINK your house might be on fire.
They are not going to say - well phone us back when you can actually see the flames then !
Or am I wrong again ( someone go wake Stewart up ).
JB :O)
Thats ok JB
OK, so it helps treat the root cause, and it can take away the symptoms so that you feel fine and do not go to seek further help, that is the problem. As you say, it can prevent it developing at all or lessen the seriousness. So as i said before if it has lessened the effects, has it prevented it or just lessened the effects? Who makes that call, are you saying that if you thought you had an experience that may possibly cause DCS, and you took O2 and felt fine, that you would then go to A&E? I think most people wouldn't and that is the problem
I'm not saying sit there until you are in in agony but don't take a bit of oxygen "just in case" and then assume that you are fine.
What is "reasonable cause to do so", I have seen instances where people have been in the water for 4 or 5 mins and got to 10-12 meters and ascended rapidly and were then put straight on O2 even though they displayed no signs, I have also seen someone bent after a dive to 12 meters (although a lot of other complications contributed).
I think you have to apply common sense to each and every situation and act on the circumstances, there is no single answer to every situation. We just need to be informed of the pros and cons and make our own decisions based on the facts before us.
Oh, by the way, I always carry O2 with me, just in case.
Dive Tramp
25-06-08, 18:50
In any event here, advice should have been sought from the CG who would give professional guidance on the subject.
I will always advise that the "casualty" attends the hospital as soon as possible in these cases, whether they present with any symptoms or not after having had O2 administered.
Yes, it has happened for real just recently (well, April to be exact). No names, but a similar scenario. Diver down at 15m+ for about 20mins, had a feet first ascent from 15m+ to surface. Swam to shore (it was a shore dive), and recounted her story. De-kitted and put on O2, away from others, Aberdeen HC contacted and advised us to stay on O2 and to take her to Fort William hospital for checkup asap. On arrival at FW Hosp the medics were awaiting us, Aberdeen HC had called ahead to advise them of our situation.
Two hours later (all the while on Hospital O2), she was back with the group with an "All Clear" from the medics.
Got to say, throughout all this our casualty felt no pain or any strange sensations etc, just a little self conscious about putting us to "all this trouble for me, I feel fine!" We were happy, as were the medics, that there was a good outcome. The Medics did say that the early admin of O2 was the best possible action at the time.
I a bit like phoning the fire brigade and telling then you THINK your house might be on fire.
They are not going to say - well phone us back when you can actually see the flames then !
Or am I wrong again ( someone go wake Stewart up ).
ok im awake now....:rolleyes:
firebrigade...brilliant...:D;)
im not going to pass comment on the actual happenings, if i did i would say the skipper is obviously a complete f*@£%&* who was only looking out for himself & the wanting for lack of publicity.
i do hear what daveT is saying, but there are other tests that can be carried out on a casualty prior to placing them on o2 or coming to the conclusion they have or are suspected to be a victim of a DCI.
O2 has wonderfull medicinal purposes for all sorts of injuries not just DCI.
if you have a burn, breath some O2 and it will start repairing the skin quicker, same said for bad cuts etc. etc.
dive granny
25-06-08, 21:01
I disagree with Dave T also. I was going to use the analogy of being mugged and not going to A&E to make sure nothing was broken or damaged.
Most emergency services do not mind being called out to 'false alarms with good intent'. Better safe than sorry.
As I said I have had 2 rapid ascents and had O2. I was sent to the pot in Egypt for a check and was ok, thankfully.
I have had family in the fire service, ambulance service and I'm an ex nurse. (also in another life been out with lifeboat man)so am reasonably well versed in attitudes of the emergency services.;)
ps Dave T, no 'd' in pigeon;)
Thats ok JB
and it can take away the symptoms so that you feel fine and do not go to seek further help, that is the problem.
Hmm , no.
Thats my argument against what you say.
Giving o2 doesn't take away the symptoms , its not morphine !
You wont develop a 'silent' DCI which has been dulled by the oxygen , it helps alleviate the cause , NOT the symptoms.
OAIWA?
Not getting at you , this is a good topic , glad you brought it up :)
dive granny
25-06-08, 21:25
What does OAIWA mean:confused:
Hmm , no.
Thats my argument against what you say.
Giving o2 doesn't take away the symptoms , its not morphine !
You wont develop a 'silent' DCI which has been dulled by the oxygen , it helps alleviate the cause , NOT the symptoms.
OAIWA?
Not getting at you , this is a good topic , glad you brought it up :)
Johnny has hit the nail on the head. :D
O2 does not mask symptoms or clinical signs. It has a direct physiological effect.
I'm not sure where this idea that O2 "masks" signs of DCS comes from. This is completely incorrect & a downright dangerous statement. I can only assume that someone has got mixed up & is thinking of the action of analgesics, e.g. opiates or NSAIDs which can reduce pain while having no effect on pathogenesis.
Take come message: TAKE 100% O2 AFTER DIVE FOR ANY POTENTIAL MEDICAL CONDITION & CONTACT THE EMERGENCY SERVICES... DO NOT DELAY!!
Johnny has hit the nail on the head. :D
after 500+ posts he had to get lucky sometime...:D:D:D
stew... door.. slam... gone... :p
dive granny
25-06-08, 22:20
Aw. That's a shame. Poor Johnny B;)
What does OAIWA mean:confused:
Or Am I Wrong Again :D
TWIN TANKS
25-06-08, 22:46
Name And Shame
Mad Major:d
Or Am I Wrong Again :D
I can see why Johnny needs and abreviation for that one! :D
dive granny
25-06-08, 23:25
I used to know an auxilliary who said " I'm not often right but I'm wrong again"! (signature for someone? LOL) But we musn't hijack this serious thread. :(
Not getting my point across very well am I. What I am trying to say is......
maybe DAN would do it better, if you have any back issues of Alert Diver , the DAN magazine the issue/article you are after is 1st quarter 2004 /Post-Dive Dilemma Oxygen Is Key to Recovery from DCI But Not Necessarily for Near-Misses. By Dan Nord, Director, DAN America Medical Services.
The point here is that if you start taking O2, you must then follow up with visit to the appropriate Doctor/hospital/chamber etc - even if you feel fine, which may be the case because you have taken O2. I am not saying don't use O2.
Does that say it better?
Still must go, my plane awaits, off to sunny Mexico's Pacific coast, hoping for Mantas, whale sharks etc. :D:D:D
after 500+ posts he had to get lucky sometime...:D:D:D
stew... door.. slam... gone... :p
It's called the scattergun approach :D:D
OAIWA?
;)
btw, see on threads like this where the content originated elsewhere, like on YD, can we just post links to their content and then have the discussion rather than copying their content over. A few quotes or ok, but great big blocks is debatable