Annual Diving Report - Divers Alert Network

APPENDIX A. DIVE INJURY CASE REPORTS
He was taken by air ambulance pressurized to one atmosphere to a larger hospital, but further
diagnostic tests were inconclusive, and it was decided to continue hyperbaric therapy. The day
after arrival, the diver received two treatments at 33 fsw (10 msw) for two hours with no
improvement and later that day, a Table 6. Over the next seven days, he received 1-2 woundcare
hyperbaric treatments (33 ft/10 msw) for 2 hours during which he reached a clinical plateau
with no further improvement. His symptoms decreased over the next few months but intermittent
symptoms continued, perhaps because of the existing disc problem.
Case 9 – An instructor had pain, numbness, and motor weakness after
14 dives at altitude over two days. The signs and symptoms improved
with recompression and resolved completely with time.
A 52-year-old male recreational scuba instructor completed a series of 14 open-water training
dives in two days. The first day involved six dives to a maximum depth of 60 ffw (18 mfw), and
there were eight dives on the second day, three to a maximum depth of 103 ffw (31 mfw). All
dives were completed using compressed air with corrections for an elevation of 5,000 ft
(1,524 m). He made frequent ascents for training maneuvers and admitted to exceeding the limits
specified by his computer.
Between his dives on the second day, he noted persistent right knee and ankle pain and later
numbness and tingling of his right arm and leg that he hoped would go away and did not report.
His drive home 24-hours later involved an additional ascent to 10,500 ft (3,200 m) which
worsened his symptoms. He also noted mild right arm and leg weakness. At home, he again
hoped his symptoms would resolve. When his symptoms persisted after 36 hours and he also
developed right sided chest pain, he contacted the DAN Diving Emergency Hotline and was
referred to a local hospital with a hyperbaric center.
On exam, the physician found weakness in the right arm, areas of decreased sensation to
pinprick on the right arm and leg, and an unsteady tandem gait (heel to toe walking). A chest xray
and cardiac workup were negative. He was recompressed on an extended Table 6 after
which only mild right neck and right wrist pain remained. In total, the diver received four
hyperbaric oxygen treatments over three days and was discharged with transient paresthesia of
the right hand and wrist. Follow-up exams ruled out a patent foramen ovale (PFO), and he was
cleared for return to diving after six-weeks if he remained asymptomatic and avoided severe
exposures. After persisting for 12 months, the paresthesia was relieved by a surgical procedure
to remove a ganglion cyst.
Case 10 – Subjective neurological symptoms on Day 9 during 18 dives
over 12 days were relieved nine days after onset by three
recompressions.
An experienced 41-year-old female diver was vacationing in Cozumel where she completed 18
multi-level dives over 12 consecutive days. Her maximum depth was 120 fsw (37 msw), and her
dives were executed according to a dive computer. She admitted to several dives during which
her computer displayed obligated decompression stops that she omitted because the computer
had “locked-out.” She followed her dive buddy’s profile.
On day nine, she noted paresthesia in her left calf which persisted through the balance of her
dive trip and during her flight home at 33 hours after her last dive although she denied an
68 Annual Diving Report: 2006 Edition