Report on Decompression Illness, Diving Fatalities and Project Dive

Appendix A: Injury Case <strong>Report</strong>sCase 5 — Neurological DCI after a deep,decompression technical diveThe diver, a 27-year-old female scuba instructor,who had been certified for four years, hadmade more than 250 dives since certification.She was also a technical dive instructor.She had no history of injury and was in goodphysical health. She was taking an anti-anxietymedication. She planned to do her first150-foot decompression dive on air, usingopen circuit scuba and a dry suit. She followedher dive computer to perform this diveand made her required stops. After the dive,she only commented about the extreme narcosisshe had felt during the dive.Approximately one hour after the dive shenoticed a dull ache in her right hand; it wasaccompanied by mild numbness and tingling.Twenty minutes later, she noticed a throbbing,dull, cramp-like ache in her right wrist andelbow. She mentioned this to a fellow instructorand was placed on 100 percent oxygen viademand valve regulator. During the next 30minutes, she experienced aching in her rightshoulder and a generalized itching over hertorso. This was followed by a red, marbledpatternedrash on the back of both shoulders,her abdomen, her right leg and arm. She alsoexperienced nausea.Placed on oxygen, she experienced slightimprovement of her symptoms. Still on oxygen,she was then transported to the nearesthospital for evaluation. The initial assessmentat the hospital also noted extreme fatigue anddizziness. She was transferred to a secondhospital that had a chamber for tre a t i n gdivers.By the time she was first recompressed, herskin symptoms had greatly lessened. Shereceived a TT6, with favorable results and aresolution of her aches, tingling and numbnessand skin rash. The following day, sheagain experienced mild pain in the same jointsfrom the day before. She traveled home andpresented herself to the local medical centerand hyperbaric facility for a second evaluation.When she stood or walked, she wasslightly unsteady due to her dizziness. Shealso experienced joint and muscle pain. Shewas given a second TT6, with minimal resolutionof muscle and joints and dizziness. All hersymptoms resolved over the next three weeks.In this case symptoms occurred shortly afterthe dive with deterioration until recompression.The early onset and progressive evolutionindicate serious decompression sickness(DCS). First aid surface oxygen administeredearly may have slowed down the progressionof symptoms; however, it is not possible tojudge about efficacy of surface oxygen basedon one case. This diver returned to poolinstruction in two months and to deep divingin four months. When she resumed diving,she had no return of symptoms.Case 6 — Cerebral and spinal cord DCI afterrepetitive deep divingThe diver, a 58-year-old male scuba instructor,who had been certified for 30 years, had completedmany hundreds of dives and more than100 in the past year. He had a history of lowerback pain, he was overweight for his height,but he lead an active lifestyle. He used nomedication other than occasional ibuprofenfor his back pain.During a weekend dive vacation in islandsoffshore from the United States, he performedsix dives over two days. On the first day, hedid three dives with no required decompression.His deepest dive was to 110 feet (34meters). The second day he performed threedives; all were multilevel, with no requireddecompression. The first dive was to 100 feet(30 meters), and the last two were to nogreater depth than 81 feet (25 meters). Heplanned all dives using his dive computer; he102DAN’s <strong>Report</strong> on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2004 Edition