Report on Decompression Illness, Diving Fatalities and Project Dive

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Appendix A: Dive Injury Case <strong>Report</strong>sAppendix A: Injury Case <strong>Report</strong>sCase 1 — Aggressive dives in teenage diverwith pain only symptoms and full resolutionThe diver was a 14-year-old male who hadbeen certified for approximately two years,making 30 dives per year. He was in goodhealth and had no history of illness.He performed two dives on one day; bothincluded safety stops. The first dive was to 90fsw (27 msw), with a one-hour surface interval,and the second dive was to 80 fsw (24msw). He used open circuit scuba, air and adive computer to calculate his dive profiles.His dives were uncomplicated and within thelimits of his dive computer.After surfacing from his last dive, he experiencedmild pain in his left knee. He also experienceddizziness, which he felt was quitesevere. Within 10 minutes he began feelingmoderate pain in his right elbow and a fairlysevere headache. At that time, he was placedon surface oxygen.After 20 minutes on oxygen, his symptomshad stabilized and had begun to subside. Afterone hour of oxygen, all symptoms were minimal.During transport to a local hospital, hewas without oxygen, and he felt some recurrenceof elbow pain. His symptoms weregreatly reduced by the time he reached thehyperbaric facility and completely resolvedduring a standard U.S. Navy Treatment Table6 (TT6).The diver had no problems with joints andhad never had these types of symptomsbefore. The immediate onset of pain anddizziness concerned other divers and frightenedthe injured diver. First aid oxygen at 15liters per minute via a non-rebreather maskseemed be effective in reducing and almosteliminating symptoms before treatment. Toprevent a worsening or a return of symptoms,oxygen should be maintained until divers arereleased to professional medical care .Symptoms occurring immediately after thedive indicate a potentially severe injury andshould be addressed early as in this case.Neurological symptoms may have been presentin this case, but a brief neuro exam was notdone on-site.Case 2 — Teenage diver with pain-onlysymptoms in first two dives after certificationThe diver was a 19-year-old male in goodhealth and physically fit. He had no history ofrecent illness or injury. To complete his openwatercertification, he first performed twodives to 30 feet (9 meters). On the followingday — his first day of diving as a certifieddiver — he performed two dives, the first wasto 80 feet (24 meters) for 20 minutes with athree-minute safety stop at 20 feet (6 meters).After a 60-minute surface interval, he made adive to a maximum of 70 feet (21 meters) for20 minutes, with a three-minute safety stop at20 feet (6 meters). When he left the water, hehad no symptoms and reported no problemsduring the dive. All ascents were normal andthere were no equipment problems.The diver continued on with his day afterthese dives, without symptoms until approximately10 hours later when he had the gradualonset of left knee and ankle pain, then rightelbow pain. In the next hour, his symptomsincreased in severity, and he contacted hisdive instructor. He was then referred to thelocal hospital for evaluation.He was placed on high flow oxygen in anemergency department and transferred to thehyperbaric center. He experienced minimalDAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2004 Edition 99
Appendix A: Injury Case <strong>Report</strong>simprovement on oxygen before being treatedwith a TT6. After this therapy, he experiencedpartial relief. During the next two days, hetwice received treatment via TT6. Symptomsimproved with each treatment, but he was leftwith mild residual pain in his left ankle.Symptoms completely resolved within 10days, and the diver elected not to return toscuba diving.Case 3 — Symptoms of cerebral and spinalcord decompression illness after a relativelyinnocuous diveThis 32-year-old male diver was in goodhealth; he had been certified for 11 years. Hehas performed more than 400 dives in the pastfive years and approximately 20 dives in thelast 12 months.An experienced deep and decompre s s i o ndiver, he decided to do a sight-seeing dive ona shipwreck to a depth of 89 feet (27 meters).The dive lasted about 20 minutes, with athree-minute safety stop at 15 feet. He experiencedno problems during the descent orascent phases of the dive. This windy daycaused a two-foot or more surface chop. Afterhe surfaced, he hung out on a line off the sideof the boat while other divers entered thewater.Within seconds of boarding the dive boat andtaking off his dive gear, he began to experiencesymptoms in the following order: left wristpain, stomach soreness with nausea and vomiting,slurred speech and then numbness andweakness in both legs. He received emergencyoxygen and was taken to shore; heexperienced some improvement in all symptoms.An ambulance met him and took him tothe regional hospital.diagnosed as having transient cere b r a lischemia, and he was discharged with onlynumbness in the left leg.He was taken off oxygen and discharged.About 30 minutes after discharge and duringthe drive home, all symptoms returned andhis leg numbness had progressed to weakness,which made walking difficult. He was takento a second hospital and again started on oxygen.To rule out neurological disease or injury,he received diagnostic procedures. These testswere negative.A hyperbaric service provider was then contacted,and he was referred to a third hospital.He began his first hyperbaric treatment 14hours after he had exited the water and firstexperienced symptoms. Although he felt significantrelief during the first half of his hyperbarictherapy, most symptoms returned tonear pre-treatment levels by the end of his firstrecompression treatment. In addition, weaknessin his lower extremity increased andincluded urinary retention. He was treatedwith a TT6 the following day and a U.S. NavyTreatment Table 5 (TT5) for the next five days,with gradual improvement each day. The seventhtreatment yielded no further change inthe diver’s symptoms.One year after his DCI, he continues to havesignificant numbness in his left leg and lessnumbness in the right. He cannot run, anduneven ground presents problems with balance.He intends to stay out of diving for onemore year, but he hopes to return to muchshallower and shorter dives. Urinary incontinencehas resolved but he still experiencesintermittent loss of urgency when his bladderis full.While at the hospital, he received oxygen, and,except for the numbness in the legs, all symptomscompletely resolved. Due to his shortprofile, he did not think he had DCI. He was100DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2004 Edition
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1. INTRODUCTIONDivers Alert Network
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Section 1. Introduction1.3 Diving F
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2.2 PDE 2003This report includes da
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Section 2 - Project Dive Exploratio
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Figure 2.4-2 describes the breathin
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Figures 2.5-2 and 2.5-3 indicate th
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Towards the end of the series, PDE
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Case #2The diver was a 29-year-old
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3. Dive InjuriesSection 3 - Dive In
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Section 3 - Dive InjuriesFigure 3.1
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Page 68 and 69: 4. Dive FatalitiesDeath while divin
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Page 74 and 75: Section 4 - Dive FatalitiesOur data
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Page 84 and 85: Section 4 - Dive FatalitiesConclusi
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Page 88 and 89: Figure 5.1-6 shows a comparison of
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Page 140 and 141: NotesDAN’s Report</strong
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Report on Decompression Illness, Diving Fatalities and Project Dive

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