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In-Water Recompression

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In-Water Recompression

Post Number:#1  Postby SeaDemon » Fri Jan 12, 2007 10:53 pm

You are on a live aboard (LOB) and diving in international waters because the ikan puyu (Anabas testudineus) there look better than the ones in the rice fields near Hollowman's kampung. Your buddy photographs this ikan sepat (Trichogaster trichopterus) down at 55 meters and stayed down there for 30 minutes taking 900 images of this fish with his Mickey Mouse camera.  After doing so, realising he has 10 BAR of air left, goes straight up to 5 meters for his 3-minute safety stop.

Later after doffing his equipment, he was joking with you about the pink barracuda he saw down there. Minutes later you see him wagging his tongue at you and his face looks like he had just suffered a stroke. Then he loses control of half his body...you see his skin looking like something out of the X-files had marbled inside.

The LOB's top speed is 7 knots and it will take more than 10 hours to landfall, and a further 15 hours to the nearest chamber.

There is no chamber on board. There however is two huge tanks filled with O2, and several dive tanks (18 liters) filled with 100% O2 that can last some 10 hours...but no full face mask.  Your friend is now screaming as if Jack the Ripper disecting him alive and without anaesthetic.

Would you attempt an in-water recompression?  If yes, which table would you follow?  What are our two docs views on IWR and what would they advise?
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#2  Postby mocha » Sat Jan 13, 2007 8:18 am

i will sit down and do nuthing!! coz i know nuts bout IWR.... how can i gain some knowledge in this?? what i mean is a formal knowledge and not by reading up some articles form the net..... any IWR courses that we can do??
mocha
 
Topic author

Re: In-Water Recompression

Post Number:#3  Postby SeaDemon » Sat Jan 13, 2007 8:56 am

Hahaha...go do Decompression Procedures. It'll change the way you conduct your dives and safety stops
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#4  Postby mocha » Sat Jan 13, 2007 9:06 am

haha.... let me check Kod AT no1 for free courses... hehe.....  :D cant afford those commercial ones... hehe
mocha
 
Topic author

Re: In-Water Recompression

Post Number:#5  Postby evo5555 » Sat Jan 13, 2007 9:37 am

i will sit down and do nuthing!! coz i know nuts bout IWR.... how can i gain some knowledge in this?? what i mean is a formal knowledge and not by reading up some articles form the net..... any IWR courses that we can do??


apa ni bro?belajar nitrox sama wa aper pun tak tahu?cis...hehehe..at least tolong la kasi dia isap 100% oksigen kot.
evo5555
 
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Re: In-Water Recompression

Post Number:#6  Postby mocha » Sat Jan 13, 2007 9:49 am

i will sit down and do nuthing!! coz i know nuts bout IWR.... how can i gain some knowledge in this?? what i mean is a formal knowledge and not by reading up some articles form the net..... any IWR courses that we can do??


apa ni bro?belajar nitrox sama wa aper pun tak tahu?cis...hehehe..at least tolong la kasi dia isap 100% oksigen kot.



haha...isap 100% O2 kat atas boat dun think will do him any good either!! what he needs is IWR! btw... nitrox sampai 40% je.. haha.... u cant administer 100% O2... amacam skarang?? ada berani?? tshirt bila mau angkat??
mocha
 
Topic author

Re: In-Water Recompression

Post Number:#7  Postby evo5555 » Sat Jan 13, 2007 10:56 am

i will sit down and do nuthing!! coz i know nuts bout IWR.... how can i gain some knowledge in this?? what i mean is a formal knowledge and not by reading up some articles form the net..... any IWR courses that we can do??


apa ni bro?belajar nitrox sama wa aper pun tak tahu?cis...hehehe..at least tolong la kasi dia isap 100% oksigen kot.



haha...isap 100% O2 kat atas boat dun think will do him any good either!! what he needs is IWR! btw... nitrox sampai 40% je.. haha.... u cant administer 100% O2... amacam skarang?? ada berani?? tshirt bila mau angkat??


ah bro, sapa ckp mau kasi 100% atas bot?heheh..kita kasi la kat 1-2m ke...masih belum violate law lagi ma hehe..sapa cakap won do any good bro? at least dia isap 40% ke 100% better than 21% rite?hehehehe..ish u ni mesti kes tiru ni amik nitrox kekekeke..the teacher must b very dissapointed hehe..
evo5555
 
Topic author

Re: In-Water Recompression

Post Number:#8  Postby SeaDemon » Sat Jan 13, 2007 12:31 pm

ah bro, sapa ckp mau kasi 100% atas bot?heheh..kita kasi la kat 1-2m ke...masih belum violate law lagi ma hehe..sapa cakap won do any good bro? at least dia isap 40% ke 100% better than 21% rite?hehehehe..ish u ni mesti kes tiru ni amik nitrox kekekeke..the teacher must b very dissapointed hehe..


Kekekeke...takat 1-2m apa yang recompress bro?  Kalau ikut Table 6 punya recommendation, mula-mula dia kena breathe 100% O2 kat 18 meters [highlight](PPO2= 2.8!)[/highlight] for 20 minutes. Bukan PPO2 1.6 dah. Followed by a 5-minute air break. Repeat the process 3 times.  Then when elapsed time dah 1 hour 15 minutes, ascend s-l-o-o-o-o-o-o-w-ly to 9 meters. bantai 100% O2 for 30 minutes lagi (PPO2 1.9). Lepas tu 15 minutes on air break, followed by 60 minutes on 100% O2 again; 15-minute air break again; lepas tu another 60 minutes on 100% O2. Bila elapsed time dah 4 hours 15minutes, ascend from 9 meters to the surface at a rate of 0.3 meter per minute while breathing 100% O2. It will take you half an hour to get to the surface.

Cuma problem is - tak ada full-face mask. So how do you do it safely for 4 hours 45 minutes?
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#9  Postby mocha » Sat Jan 13, 2007 8:30 pm

haha... 1-2 m as good as lepak on the boat.... kasik sejuk badan je.... haha....

SD : is that what u learn during decompression prosedure??they teach u on IWR?
mocha
 
Topic author

Re: In-Water Recompression

Post Number:#10  Postby evo5555 » Sat Jan 13, 2007 8:51 pm

ah bro, sapa ckp mau kasi 100% atas bot?heheh..kita kasi la kat 1-2m ke...masih belum violate law lagi ma hehe..sapa cakap won do any good bro? at least dia isap 40% ke 100% better than 21% rite?hehehehe..ish u ni mesti kes tiru ni amik nitrox kekekeke..the teacher must b very dissapointed hehe..


Kekekeke...takat 1-2m apa yang recompress bro?  Kalau ikut Table 6 punya recommendation, mula-mula dia kena breathe 100% O2 kat 18 meters [highlight](PPO2= 2.8!)[/highlight] for 20 minutes. Bukan PPO2 1.6 dah. Followed by a 5-minute air break. Repeat the process 3 times.  Then when elapsed time dah 1 hour 15 minutes, ascend s-l-o-o-o-o-o-o-w-ly to 9 meters. bantai 100% O2 for 30 minutes lagi (PPO2 1.9). Lepas tu 15 minutes on air break, followed by 60 minutes on 100% O2 again; 15-minute air break again; lepas tu another 60 minutes on 100% O2. Bila elapsed time dah 4 hours 15minutes, ascend from 9 meters to the surface at a rate of 0.3 meter per minute while breathing 100% O2. It will take you half an hour to get to the surface.

Cuma problem is - tak ada full-face mask. So how do you do it safely for 4 hours 45 minutes?


itu apa plan kita tak tahu, we just do what we know ma...hahaha..main boh juga nanti mati...baik lepak bot.tapi with that plan anytime convulsion tuh...no mask no gas..calling la DAN apa lagi?
Last edited by evo5555 on Sat Jan 13, 2007 8:53 pm, edited 1 time in total.
evo5555
 
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Re: In-Water Recompression

Post Number:#11  Postby SeaDemon » Sun Jan 14, 2007 1:15 am

Actually there are many schools of thought on IWR.  Masa deco procedures dia tak ajar pasal IWR...but it was discussed as one of the methods of minimizing permanent damage to your tissues.  Deco procedures only teaches you to plan and manage your decompression methods so you minimise the risk of suffering from all forms of DCS. But IWR is considered as "field" treatment for DCS only to be used if you are many hours away from the nearest chamber.

Usually a full-face mask is used, if possible, have two-way radio comm or direct comm...and 100% O2 administered as surface-supplied.  This is because as DCS Type II symptoms increase, the chances of the victim to be paralysed or incapacitated is also high. So if you're using regulator, he might not be able to breathe in on his own and drown.  By having comms,you'll be able to ask him questions pertaining to symptoms and how he feels.

On top of that, you'll need a line of about 20 meters for the victim to hang on to, and if possible, have knots for the victim's harness's clip to hang on to for safe ascent. You'll also need a safety diver with him to monitor in case he convulse from O-tox, or suffers incapacitating pain due to the DCS.

So,since our two doctors are and were with HAT Lumut, where deep stops are not of favour of the Navy (yank the divers up and stick them into a chamber), what are their thoughts on deep stops, and also IWR?
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#12  Postby drhalimm » Mon Jan 15, 2007 10:43 pm

Sea Demon and friends, that diagnosis is Acute Neurological Decompression Sickness (DCS). I would not recommend in-water recompression at all, because:
1. Worsening of paralysis underwater. This can lead to drowning. In cases of DCS, there is a likelihood of the paralysis getting worse.
2. Decreased conscious level underwater. This will lead to drowning. In cases of DCS, there is a likelihood of the diver getting drowsy, confused, delirious, and total unconsciuosness.
3. Oxygen toxicity. This will lead to convulsions and drowning. Yes, you guys are right, the treatment table USN 6  will give you pO2 = 2.8 ATA. This is okay when you are in a dry, warm, controlled hyperbaric chamber with a paramedic and doctor looking after you. Not so okay when you are underwater, using SCUBA and sick.
4. Worsening of general condition. Being sick and cold and dehydrated underwater for prolonged periods will worsen the diver’s general condition.

Are there any variants of IWR that you can use?
1. Air? Air treatment tables takes too long underwater, and it is much less effective than oxygen. Too much trouble for too little benefit.
2. Use Deco stops as treatment? This is not likely to give any relief – a deco stop is used to prevent DCS, but it is insufficient to be used as treatment of DCS. Risks of being underwater still apply.
3. Short table? Again, questionable benefit. Short tables (e.g. USN 5 or 18:60:30) will still give you pO2 = 1.8 (risk of O2 tox), but will not relieve

Other problems?
He will need a buddy. The buddy can't breathe O2 (risk of oxygen toxicity). So you will need to consider his/her decompression schedule. Look at the USN 6 profile (18m max depth for 4 hours 45 minutes) and you realise it is not a conservative No-D dive for the buddy. You can end up bending this otherwise healthy buddy.

What do other diving doctors say?
The diving doctors did have a long, scientific discussion and workshop about this a few years ago - at the Undersea and Hyperbaric Medicine Society Annual Scientific Meeting. Their discussions, references and recommendations are now published in a scientific book and is available for purchase at www.uhms.org. I do not suggest buying it, as it is full of unreadable medical stuff. There is a copy in Lumut though, if you are still interested. But in short, it says that in order to do IWR, you have to have some very specialised equipment, very knowledgeable and experience people – such that it is almost impossible to have all that during an emergency.

So, in that scenario, I'd recommend:
1. Lying the diver flat
2. Give fluids (by mouth if fully conscious, by iv if there is a paramedic around)
3. Give oxygen - for as long as your supplies last
4. Call the Malaysian Emergency Hotline
5. Get the diver to a medical facility / recompression facility (as advised by no. 4)

This should be easier and safer than IWR, even if it is leads to a longer delay before you start his recompression treatment.
Last edited by drhalimm on Mon Jan 15, 2007 10:45 pm, edited 1 time in total.
drhalimm
 
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Re: In-Water Recompression

Post Number:#13  Postby SeaDemon » Tue Jan 16, 2007 3:08 am

Thank you Caduceus for the lengthy reply. So would your answer differ slightly if the victim is on full-face mask on surface supplied O2 and air (for air breaks), with direct comms with topside,and has a supply of safety divers to monitor him, and the boat's like 20 hours away from land?

Katakpink, I told you to stop diving 100% O2 at 30 meters. Lu ingat lu punya tissue cells boleh remain refreshed ke at that depth with pure O2?
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#14  Postby divedoc » Sat Jan 20, 2007 7:16 pm

...So, in that scenario, I'd recommend:
1. Lying the diver flat
2. Give fluids (by mouth if fully conscious, by iv if there is a paramedic around)
3. Give oxygen - for as long as your supplies last
4. Call the Malaysian Emergency Hotline
5. Get the diver to a medical facility / recompression facility (as advised by no. 4)

This should be easier and safer than IWR, even if it is leads to a longer delay before you start his recompression treatment.


I would agree with Caduceus..i wouldn't recommend IWR AT ALL for recreational divers like us. Even the Navy does not like to practice IWR after deco dives due to the numerous risks involved. Even when i go for diving medical covers with the Navy, whenever they do deep dives (exceeding 50m) with surface supplied O2, they still wouldn't risk doing an IWR. Applying this procedure (Basil Life Support for Divers):

1. Lying the diver flat
2. Give fluids (by mouth if fully conscious, by iv if there is a paramedic around)
3. Give oxygen - for as long as your supplies last
4. Call the Malaysian Emergency Hotline
5. Get the diver to a medical facility / recompression facility (as advised by no. 4)

is still the most appropriate way for us divers who have no specialised equipment and technical expertise on LOB.

Toksah susah2kan diri...
divedoc
 
Topic author

Re: In-Water Recompression

Post Number:#15  Postby SeaDemon » Sat Jan 20, 2007 7:38 pm

Okay. Thanks for the lengthy explanation.

Just for the uninitiated: IWR is not the same as deep stops (staged decompression stops). It is the attempt to minimise the damage and pain caused by DCS Type II by jumping back into the water and recompressing the body while administering 100% O2 to help rid of the bubbles causedby inert gas(es).
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#16  Postby GOD » Sun Jan 28, 2007 2:59 am

IWR ... only if you know the correct & safe way of doing it, the diver are able to have direct communication & able to do the IWR...in water treatment are lenghty process, cold & can lead to other complications which is hard to deal with underwater...even death.

You can control the diver but not the underwater conditions.

My take:

a. 100% O2
b. Call DAN-Malaysia & seek for help
c. Give fluid ... IV would be good
- Asprin/Panadol 2 tab.
d. Ask question about the pain & history
- Note it down  
- Dive Profile & Gas
e. Get to the nearest chamber ASAP ...even if it will take 24hrs

IWR - Not recommended at all.

Need Treatment => Hyperbaric Chamber

;D
GOD
 
Topic author

Re: In-Water Recompression

Post Number:#17  Postby bubble » Sun Jan 28, 2007 10:50 am

call DAN Malaysia /?

Until now I still can not find their contact number .

I think their respond is worst then 999
bubble
 
Topic author

Re: In-Water Recompression

Post Number:#18  Postby GOD » Sun Jan 28, 2007 6:37 pm

call DAN Malaysia /?

Until now I still can not find their contact number .

I think their respond is worst then 999


If you are a DAN member, you will have the number ... are you a DAN member? You can ask if you want to know the number.

How would you know if their respond is worst then 999?

;D
GOD
 
Topic author

Re: In-Water Recompression

Post Number:#19  Postby bubble » Sun Jan 28, 2007 7:15 pm

oops I dont know

Can someone try and let me know ? ;)
bubble
 
Topic author

Re: In-Water Recompression

Post Number:#20  Postby turbius » Sun Jan 28, 2007 11:33 pm

IWR recompression is not a recommended method but is it an altenate options. Want to know about IWR, kena ambil course commercial diver la then you will learn more...

DAN No...try out with your nearest dive centre, operators of diving industry normally have it cause it come in hand unlike it will be needed OR check on the DAN website...with AUD75 you can become a silver member and insured to 40m depth with compressed gas.....visit their website bro for more info....

Hope it helps....
turbius
 
Topic author

Re: In-Water Recompression

Post Number:#21  Postby bobo » Mon Jan 29, 2007 5:47 pm

i have DAN Malaysia number and DAN Dr. number hehehe... but you have to be DAN member first la...  ;)
bobo
 
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Re: In-Water Recompression

Post Number:#22  Postby SeaDemon » Mon Jan 29, 2007 6:25 pm

Lorong Haji Taib also got ponDAN Malaysia
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#23  Postby bubble » Tue Jan 30, 2007 12:32 am

Lorong Haji Taib also got ponDAN Malaysia



Jalan Ah Fook ,JB also have a lot DAN members
bubble
 
Topic author

Re: In-Water Recompression

Post Number:#24  Postby SeaDemon » Tue Jan 30, 2007 1:55 am

Lorong Haji Taib also got ponDAN Malaysia



Jalan Ah Fook ,JB also have a lot DAN members


I wonder how they price the treatment there in JB...
SeaDemon
 
Topic author

Re: In-Water Recompression

Post Number:#25  Postby bubble » Tue Jan 30, 2007 9:35 pm

I have not idea, I need to ask DAN member first

by the way

I called 05-XXXXXXX DAN Malaysia number , but no body pick up the phone.
bubble
 
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