DIVING

2. Dive Injuries
He had periods of visual disturbances and did not have sense of balance. He was placed on surface level oxygen and
immediately rushed to the local hospital.
The diver was diagnosed with decompression sickness (DCS) by a local physician and treated with hyperbaric oxygen.
After the treatment he reportedly had near complete resolution “except some weakness and mental cloudiness”, and he
was released to his bungalow. Later that night he developed twitching and scattered, superficial numbness in legs, continued
weakness, and difficulty walking but was able to sleep. The following morning he awoke to significant numbness
and tingling in legs, waist, groin, lower back and fingertips. The diver was convinced by dive staff that leg numbness was
normal due to excessive exercise so he wrongly dismissed his symptoms as overuse of muscles.
DAN was initially contacted by the diver’s father who was concerned after receiving an e-mail. Due to the diver’s remoteness,
communication both by phone and e-mail was substantially limited. It took two days for the diver to receive the
recommendation to return to the hospital for additional treatments. Signs and symptoms were more indicative of arterial
gas embolism (AGE) rather than DCS. Limited training of the local hyperbaric staff resulted in an incomplete evaluation,
incorrect initial treatment and an overly optimistic post dive evaluation and discharge despite the presence of significant
neurological symptoms. When the diver returned to the hospital two days later, the staff consulted with local specialists
and provided a four-hour hyperbaric treatment. Over the next several hours the diver recalls feeling 80-90% better, some
lingering patches of numbness and tingling, but otherwise back to normal in every other way with no more weakness
or mental cloudiness.
Four days after the initial injury the diver received one additional USN TT5 with a recommendation to travel to Singapore
for further evaluation prior to returning to his home in China. After the first treatment in Singapore the diver had constant
tingling in a few toes with patchy areas of transient numbness and tingling in right leg. The diver had one additional
treatment in Singapore with marginal improvement. Physicians in Singapore concurred with diagnosis of AGE, more
precisely CAGE (cerebral arterial gas embolism) and recommended no further diving.
Six weeks after the initial injury, and after what was thought to be almost complete resolution, the diver stated the right
side of his body was weaker than the left, exercise is more difficult on the right side, muscles felt more flaccid on the
right when resting, and continued superficial, transient tingling and numbness in patches on right leg.
2.1.5.4 Immersion pulmonary edema (IPE)
IPE, or swimming-induced pulmonary edema (SIPE), is fluid accumulation in the lungs that presents with shortness of
breath (dyspnea) difficulty breathing, and coughing sometimes accompanied by frothy and bloody sputum (hemoptysis)
during immersion. Symptoms typically resolve within 48 hours after exiting the water, but resulting complications and
fatalities have been reported. Since first described as a rare condition in cold-water scuba divers, cases have been
reported in various populations including triathletes, snorkelers, and combat swimmers in varying water temperatures.
IPE can affect healthy populations as well as those with underlying cardiopulmonary conditions, especially hypertension.
From 2010 to 2013 there were 34 calls to the MSCC regarding patients with possible IPE. Six cases were classified as
such by the treating physician and 28 cases were suspected cases of IPE based on reported symptoms. The diagnosis
may be difficult to make, especially in cases that spontaneously recover before admission. At the time of the call results of
clinical tests may not yet be available and follow-up information is limited in many cases. IPE could not be confirmed due
to limited information available in three cases. Two cases reported difficulty breathing after surfacing from a dive with no
additional details. One case reported shortness of breath but it was unclear if symptom onset occurred while immersed
or afterwards. Additionally, this patient had a confounding medical history of a previous spontaneous pneumothorax.
Of the suspected IPE patients, there were 20 males and 14 females. Eight calls were from the patient’s medical care
team for consultation. Seventeen cases reported the patient having had either a past history of cardiovascular disease
or evidence of cardiac dysfunction at the time of the IPE event (refer to Table 2.1.5.4).The other 17 cases had no known
cardiovascular history or was not reported. Two callers reported having had similar symptoms on separate occasions
while diving.
Annual Diving Report – 2012-2015 Edition
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