UNCERTAINTY AFTER DIVING: Case Report and Recommendations #4

A group of friends in their early 30s was on a dive vacation on a Caribbean island. They did four dives on their first day; their first dive was to 85 feet, and the next three were to 60 feet or shallower. They waited at least an hour between each dive, breathed air and had bottom times that were all within their dive computers’ no-decompression limits. All dives were uneventful.

The group went out for dinner and drinks that evening. The next morning they met for breakfast prior to boarding the dive boat. A 33-year-old male member of the group was absent. His roommate reported that when he left, the friend was in the bathroom and was expected to join the group later. After eating, the roommate and two others went to check on their friend.

He was in bed and appeared pale. He complained of a severe headache, nausea, weakness and feeling “totally out of it.” The headache was severe enough that he was sensitive to light. He also reported vomiting “once or twice.” The group decided to take him to be evaluated at the local clinic; because they had been diving they were concerned about DCS. The diver had a slight stagger when walking but required no assistance. The clinic was a five-minute cab ride away from the resort.

 The physician on duty and her assistant obtained the diver’s vital signs and conducted a neurological examination. The physician also obtained a history of events. The diver denied any symptoms prior to going out for the evening. He also admitted that the events following dinner were not clear to him because he had consumed “a lot” of alcohol, which his friends confirmed. The physician ordered the administration of IV fluids, acetaminophen and meclizine (antinausea medication). The doctor also instructed the man to avoid diving for the next 24 hours and to return to the clinic if he didn’t feel better that day. The diver rested and  was able to eat and drink (nonalcoholic beverages) over the course of the day, and he felt much better by that evening.

The next morning he was feeling 100 percent better and resumed diving with no further issues. Having a good time on vacation is part of the experience, but  overindulging in alcohol during a dive vacation is not prudent. There is suspicion that alcohol consumption before or after diving could contribute to DCS, but more importantly, the aftereffects can easily be confused with DCS. Many divers in similar situations have needlessly undergone hyperbaric treatments.

CONCLUSION
The signs and symptoms of DCS are not exclusive to that condition. However, when a person experiences signs or symptoms after diving, DCS is very often presumed to be the diagnosis. This is not all bad, because it encourages divers and dive staff to administer oxygen and ensure the injured diver gets prompt medical care. But it becomes a problem when divers refuse to accept alternative explanations and become fixated on the need for chamber therapy at the expense of other diagnostics and/or treatments that may be delayed.

In addition, the diversion of a nondiving-related emergency from appropriate medical treatment for an unnecessary recompression treatment, especially by air late at night, can introduce additional risks to the patient as well as the aircrew. There are many medical conditions much more serious than DCS for which timely treatment is critical. In the event of symptoms after diving, provide oxygen and get the injured diver to the closest medical facility.

Don’t hesitate to call EMS if the situation is serious, and feel free to call the DAN Emergency Hotline (+1–919– 684–9111) at any time. Tell the doctor that the person was diving, and encourage him or her to contact DAN for consultation. But keep in mind that there are more dangerous ailments than DCS, some of which must be considered first.