56
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FALL 2012
RESEARCH, EDUCATION & MEDICINE
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I N C I D E N T I N S I G H T
T
he diver was a 58-year-old male with more than
400
lifetime dives. His only known medical history
was hypertension, which was well controlled
with a single prescription medication. His general
health was good, and he was reasonably physically fit.
THE DIVE
The diver performed a single boat dive in calm, warm (81°F)
water to 80 feet for 30 minutes on air. Neither he nor his
buddies experienced any problems during the dive, and they
performed a three-minute safety stop at 15 feet. After surfacing
they returned to the boat and began to remove their gear.
Within five minutes of being back on board, the diver
lost consciousness and collapsed onto the deck. His buddies
determined he had a pulse and was breathing on his own.
Emergency oxygen was not available, and the two buddies
immediately weighed anchor and headed for shore. While en
route, one of them called 911. The trip back to the dock took 15
minutes, and an ambulance was there when they arrived. After
securing the vessel, the buddies drove to the hospital, just a few
minutes behind the ambulance.
The Complication
When the buddies arrived, the emergency-department staff
were expeditiously evaluating the diver. He responded only
to pain, and his strength on his right side was markedly
diminished relative to his left. His left pupil was of normal
size and reactive to light; his right pupil was dilated and
responded sluggishly to light. He had a strong, regular
pulse and spontaneous respirations, but after a short period
his respirations began to grow shallower and less regular.
When the buddies inquired about their friend’s condition
they were informed that he was on his way to radiology for
a CT scan of his head.
The diver’s buddies were disturbed to learn he was not
already on his way to a hyperbaric chamber. They were
understandably and appropriately concerned that their
friend may have sustained an arterial gas embolism (AGE),
and they took issue with the doctor’s decision to perform
a head CT rather than immediately referring the diver
to a hyperbaric chamber. Both buddies, independently
of one another, contacted DAN®. They each expressed
concerns about the loss of time, but both DAN medics
Diagnosis Before Treatment
B y M a r t y M
c
C a f f e r t y , E M T - P , D M T
STEPHEN FRINK