Annual Diving Report - Divers Alert Network

APPENDIX A. DIVE INJURY CASE REPORTS
Case 7 – Divemaster candidate experienced joint pain within three
hours following six dives which were relieved by three
recompressions.
A 26-year-old male divemaster candidate participated in six training dives over three days in
which the deepest was to 70 fsw (21 msw), and the maximum depth of the last dive was 53 fsw
(16 msw) with 34% nitrox. Dives were conducted in accordance with his dive computer. The last
dive ended at approximately 1 PM. At about 4 PM, he noted right knee pain at a 7 on a 0-10
scale. Within an hour, he developed pain in his right wrist, left knee, and ankle pain which he
rated 7 on a scale of 0 to 10. The symptoms did not improve during the day, and he became
anxious with chest discomfort and difficulty on deep inspiration. He presented to the local
Emergency Room at 1:30 AM and was referred for evaluation to the hospital hyperbaric unit. An
initial treatment on Table 6 reduced the pain to 3 out of 10 in all affected joints, and he became
pain free during a second treatment the same day with on Table 9 (45 feet for 102 minutes). He
noted slight discomfort by next morning which resolved completely with another Table 9.
Case 8 – A diver with back trouble developed pain and motor
weakness in his back and legs after 11 dives over three days
complicated by altitude exposure. He had partial resolution during a
long series of recompressions.
A 63-year-old male divemaster had made 50 dives during the past year and more than 200
lifetime dives. He had a history of degenerative lumbar disc disease and hypothyroidism for which
he took synthetic thyroid hormone. He was on a liveaboard vacation and had made 11 dives over
a 3 day period with a maximum depth of 128 fsw (39 msw) and a last dive depth of 100 fsw (30
msw). All dives were uneventful and used 32% nitrox with dive times according to an air
computer.
He performed five dives the first day, four the second, and two morning dives on the third day. He
stated he was well hydrated, well rested and had not consumed any alcohol. While returning to
the boat after the second morning dive, he developed pain in his lower back consistent with his
pre-existing disc condition, but he was able to climb onto the boat without assistance. He did not
make another dive but opted to rest, have a back massage, and eat lunch. Feeling better, he
participated in a walking tour of a local island which took him to an altitude of about 2,000 ft
(610 m). During the tour, the back pain returned, and he had difficulty walking due to numbness in
his legs but was able to return to the vessel where a physician also on vacation was concerned
that might have neurological DCS. They informed the boat captain who placed the diver on first
aid oxygen while they traveled to a nearby island with a hyperbaric chamber.
Upon evaluation, the hyperbaric physician found the diver had abnormal skin sensations
bilaterally from his navel down to his toes, exhibited profound difficulty walking, and unsteadiness
while standing. The diver was recompressed on Table 6 with extensions but had minimal
improvement of his symptoms. Another Table 6 administered the following morning provided only
slightly greater relief. Given the history of disc problems, the hyperbaric physician arranged for
transfer to a hospital with greater diagnostic capability than on the island. As weather delayed air
evacuation until the third day, the diver was treated again on a Table 5.
Annual Diving Report: 2006 Edition 67