Written by DAN Staff
On the second day of a week-long liveaboard trip, a 68-year-old diver had significant problems during a couple dives. The water temperature was approximately 27°C/80°F, there was a strong current and the diver was accompanied by an instructor. During the trip, the diver had self-reported being inactive and not physically fit.
The first dive was to 18 metres/60 feet and part way through the dive, the diver gave a “something wrong” signal, so the accompanying instructor separated her from the group and began a slow ascent. During a three-minute safety stop, the diver attempted to bolt to the surface but was slowed by the instructor. Upon reaching the surface, the diver spat out her regulator and flopped on her back, exhausted. After being towed to the boat, the diver was positioned upright and coughed up approximately 1/3 litre of clear liquid and foam.
After resting for about five hours the diver decided to attempt another dive, to the same depth but at a site with less current. Toward the end of the second dive, the diver looked panicked and gave the signal for ascent. She did not do a safety stop and went directly to the surface. Again she flopped on her back and was towed to the boat.
On the boat the diver appeared to be responsive but not entirely cogent and making a constant gulping motion. She were placed on oxygen in an air-conditioned room while the onboard physician consulted DAN. The diver’s condition improved over the course of the week, and the diver did not attempt to dive again.
Immersion Pulmonary Edema (IPE)
This case illustrates a classic case of immersion pulmonary edema (IPE) – a condition in which fluid enters the lungs due to the effects of immersion combined with specific risk factors. It’s characterized by shortness of breath, coughing and frothy (and sometimes pink) sputum. Common risk factors include, but are not limited to, high blood pressure, overhydration and exertion in cold water. Divers who display symptoms of IPE during or after a dive should immediately end their dives, receive emergency oxygen and be transported to qualified medical care. Although symptoms may resolve quickly they can reoccur. IPE can itself be fatal, and pulmonary edema can be caused by serious medical conditions unrelated to diving that may require immediate intervention.
The boat crew in this case were prudent to put the diver on oxygen but should have identified the symptoms after the first dive and prevented the diver from reentering the water. IPE is often reoccurring and because it can be fatal, a diver should not return to diving before undergoing a thorough medical evaluation.
For more information about IPE, visit DAN.org/Health.
