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BY DICK CLARKE, CHT
A CRISIS
IN THE
MAKING
Case studies
A retired nurse suffered decompression-induced cerebral
arterial gas embolism (AGE) while diving off Florida’s east coast.
She was urgently evacuated from the scene to a nearby hospital,
one that offered HBOT and had been actively promoting
its presence in the community. Consistent with many other
recreational diving accidents, this one occurred on a weekend.
Emergency-department (ED) personnel unsuccessfully
attempted to summon their hyperbaric medicine colleagues.
The ED was eventually advised that the hyperbaric service was
only available during business hours on weekdays. Furthermore,
and by design, they would not offer care to injured divers even
if they presented during normal working hours. Following what
were described as desperate attempts to locate a hospital that
would accept and treat this patient, contact was established with
DAN
®
, which was able to identify an available hospital in south
Miami. After being supported for several hours in the ED, the
patient was duly transferred. HBOT began soon upon her arrival
at the receiving hospital. Unfortunately, she died during her
initial hyperbaric treatment.
A middle-aged male patient underwent heart surgery
to remove a tumor. During surgery there was inadvertent
introduction of a considerable amount of air into his
brain’s arterial circulation, causing AGE. This is essentially
the same problem that can be experienced by divers
who hold their breath during ascent. Immediate, severe
neurological collapse occurred. This event also took place
on a Saturday in a large city in Georgia that is home to some
12 hyperbaric medicine facilities. None would accept the
patient. Eventually, a hospital in an adjacent state agreed
to accept him. Following a determination of the risks and
benefits associated with a somewhat lengthy transfer of this
recent heart-surgery patient, the transfer was conducted.
Unfortunately, and despite an aggressive course of HBOT,
the patient failed to improve to any measurable degree. He
was committed to long-term supportive care. Treatment
delay was a likely contributing factor to this poor outcome.
A recreational scuba diver suffered decompression
sickness (DCS) following ascent from a freshwater lake in
central Florida. It was a weekday, so the odds of available
S T E P H E N F R I N K
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