DIVING

2. Dive Injuries
Case 2-10. Seizures Should Not Prevent HBO Treatment of AGE.
This caller was a physician from a well-staffed and equipped hospital in Asia. He was seeking consult for 14-year-old
boy who was injured while diving. While performing a safety stop at 5 msw (16 fsw), the boy panicked and surfaced in
a rush. He seized on the surface multiple times. At admission, the patient was hypoxic, had cortical blindness, evidence
of aspiration, and lesions on his chest and abdomen. His vitals were stable, but he continued to experience seizures.
The local MD wanted to delay hyperbaric treatment due to the persistent seizure activity. The DAN consultant advised
that HBO treatment should not be delayed. In the meantime, it was established that the patient had bullae in his lungs.
The advice again was to recompress with a surgeon standing by to intervene with a chest tube if necessary. The risk of
bulla perforating was small and HBO was likely lifesaving.
There were several cases of AGE with seizures. Less experienced physicians in substandard facilities fear convulsions
in a patient while under pressure. However, when the patient is continuously attended by trained medical staff and under
the supervision of a physician, seizures should not delay the treatment.
Case 2-11: AGE and Pre-Existent Seizures or Just Atypical Seizures?
The caller was a nurse practitioner at an emergency department. She had in her care a male diver in his thirties who
had been participating in an advanced open-water dive class. During one exercise he became entangled in a rope and
as a result made an uncontrolled ascent to the surface from a depth of 22 ffw (7 mfw). Upon surfacing he appeared
disoriented then became unresponsive. Bystanders delivered rescue breaths. It was unclear if the diver was breathing
spontaneously. After a few breaths the diver regained some degree of responsiveness but continued to be disoriented
to place, time and others. He was provided high flow oxygen and transported by EMS to the Emergency Department. At
admission he had difficulty following commands. Despite continued oxygen administration the patient was not improving.
The caller suspected a possible arterial gas embolism (AGE) and was seeking the location of the nearest chamber that
accepts emergent patients. DAN provided directions and the patient was transferred.
At the hyperbaric facility the patient was treated with a USN TT6. He had nearly complete resolution and returned to his
baseline mentation. The plan was to treat again the next day with a USN TT5. Sometime prior to his scheduled treatment
the patient exhibited another period of unresponsiveness in his hospital room. It was decided instead, to administer
an additional USN TT6. The patient returned to his baseline mentation but within several hours after the USN TT6, he
exhibited another period of unresponsiveness. Further diagnostic tests of the brain were ordered including CT, MRI and
EEG. Both CT and MRI were negative but the EEG did detect a slight abnormality in signal transmission within the frontal
lobe of the brain. The patient was treated with a USN TT5 the next day. Several times in the hospital he experienced
short periods of unresponsiveness. No further treatments were planned pending further evaluations and diagnosis.
The patient’s family volunteered information regarding his history. For an unknown period of time prior to the incident, the
patient would randomly experience periods of “blank stares” with no awareness or memory of the events. After consulting
with a neurologist it was opined that the patient has and was experiencing a form of seizure activity. He was placed on
an anticonvulsant and continued the medication after discharge.
Blank stares are usually a manifestation of special form of epilepsy commonly referred to as “absence seizures” or “petit
mal”. They usually last a few seconds to 30 seconds during which time the subject is unresponsive. The consciousness
returns to normal immediately. In this case, the confusion after absence was protracted and it is not clear if that was an
atypical absence seizure or possibly an AGE combined with the pre-existing condition.
Case 2-12: Be aware of substandard medical care opportunities in developing countries
A 43-year-old male diver in excellent general health who lives temporarily in China was on holiday in Indonesia. He
enrolled in an Open Water Diver certification course. The diver completed a series of five dives over three days. He was
not using a computer to control his dives; he was guided by his instructor instead. No information is available about the
first four dives. The fifth dive was 24 msw (79 fsw) for 45 min on air, one-on-one with the instructor.
After surfacing from the safety stop, the diver developed weakness, could not climb the ladder, suffered a syncopal
episode while attempting to board the boat and required a rescue to bring aboard. He appeared to have suffered a
right-sided paralysis (the duration not reported), tingling and numbness. He was able to see and hear but not move.
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Annual Diving Report – 2012-2015 Edition