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Scuba Forum / UK Scuba / November 2004First Aid for ACUTE interstitial emphysema
Fiddling around with some BSAC exam questions last night, one question suggested that a casualty diagnosed as acute interstitial emphysema should NOT be given O2. I had previously thought first aid treatment for all burst lung injuries was O2 followed by chamber. Suspect the "acute" make a difference, but don't know why. Can anyone enlighten me? David > Fiddling around with some BSAC exam questions last night, one question > suggested that a casualty diagnosed as acute interstitial emphysema > should NOT be given O2. Isn't that the condition where the breathing reflex is broken and the body is actually responding to low oxygen not CO2 build up to breath so if you give the oxygen they promptly suffocate on CO2? Also I seem to remember they wouldn't ever be diving in that condition. Walking is unlikely. Somebody will probably google it by now and show me I'm wrong again. nigelH >> Fiddling around with some BSAC exam questions last night, one question >> suggested that a casualty diagnosed as acute interstitial emphysema [quoted text clipped - 10 lines] > Somebody will probably google it by now and show me I'm > wrong again. Well, I followed Nigel's suggestion and Googled the topic. I suspect it would take several more years of college before I could figure out half of what I read. As near as I can tell, the problem is most common in animals, including cows. Perhaps the correct answer is, if the victim dies, you get a nice steak for dinner. On a more serious note, there were indications that the injury, at least related to diving, usually results from damage to the alvioli due to overpressurization. I suppose administering O2 might exacerbate the problem, but it would seem to the ignorant (me) that the benefits would outweigh the risks. I did find suggestions that positioning the victim in such a way that the undamaged lung or portions of lungs became primary was useful. Unfortunately, how you do that was unclear. So, I've neither proved, nor disproved Nigel's suggestion . . . unless the nice steak thing really is the answer. Lee >> Fiddling around with some BSAC exam questions last night, >> one question suggested that a casualty diagnosed as acute [quoted text clipped - 4 lines] > not CO2 build up to breath so if you give the oxygen > they promptly suffocate on CO2? No - you're thinking of chronic emphysema (a form of chronic obstructive airways disease in which the structure of the alveoli is gradually destroyed, leaving large air cells, rather than the small alveoli in the healthy lung) which results in the chronic hypercapnia (excess CO2) that you describe. Giving pure O2 to such a patient _can_ result in a reduction in hypoxic respiratory drive (which I have seen), but I'd not say that it quite merited a description as dramatic as "suffocating on CO2". > Also I seem to remember they wouldn't ever be diving in > that condition. Walking is unlikely. Wouldn't be diving. Walking is fairly common, though frequently involving stopping and puffing quite a lot. Iain > Fiddling around with some BSAC exam questions last night, one question > suggested that a casualty diagnosed as acute interstitial emphysema [quoted text clipped - 3 lines] > injuries was O2 followed by chamber. Suspect the "acute" make a > difference, but don't know why. No idea about the answer - just out of curiosity though, where does that appear in BSAC? I'm 99% sure its not anywhere up to from Ocean Diver up to Advanced Diver / OWI... seems a little obscure. Generally the advice is pretty much "O2 for anything", with very few exceptions and i've certainly never seen that mentioned before. David >No idea about the answer - just out of curiosity though, where does that >appear in BSAC? I'm 99% sure its not anywhere up to from Ocean Diver up to [quoted text clipped - 3 lines] > >David Agreed (hence posting the question!) Advanced diver exam paper. One from the "old", not "new" course. I was surprised as well. Suspect as Nigel has hinted that ACUTE IE may never be encountered whilst diving, thus O2 not appropriate first aid. David > >No idea about the answer - just out of curiosity though, where does that > >appear in BSAC? I'm 99% sure its not anywhere up to from Ocean Diver up to [quoted text clipped - 13 lines] > > David Which would fit with my DAN O2 provider card - I'm only allowed to treat diving related injury with O2. CAS >> Suspect as Nigel has hinted that ACUTE IE may never be encountered >> whilst diving, thus O2 not appropriate first aid. > > Which would fit with my DAN O2 provider card - I'm only allowed to treat > diving related injury with O2. Which fits with the name of the organization, Divers Alert Network. They only allow you to treat diving related injuries because that's all they certify for. Lee > >> Suspect as Nigel has hinted that ACUTE IE may never be encountered > >> whilst diving, thus O2 not appropriate first aid. [quoted text clipped - 5 lines] > only allow you to treat diving related injuries because that's all they > certify for. Indeed, I did ask though, while doing the course and was told that there are certain conditions that can be worsened by high fraction O2 and certain persons who can take a reaction to high fraction O2 but as we dive we are being exposed to this anyway so it shouldn't be an issue. I suppose the only exception would be a newbie who hadn't been exposed to the critical PPO2 (through only completing shallow dives) but I guess that's acceptable risk... CAS The point could be that you should not use oxygen with positive pressure (press on the baloon) to worsen the damage. O2 could then leak through the airways breaks in the surroundind tissues or mediastinum and deteriorate the breathing condition. "Free O2" is OK. Now on the field is the breathing status of the victim is unefficient then what to do is certainly very hard to decide. St?phane Havard www.watalibi.com > Fiddling around with some BSAC exam questions last night, one question > suggested that a casualty diagnosed as acute interstitial emphysema [quoted text clipped - 7 lines] > > David Stéphane, could you ping me, please? Is this your correct email-adress? > The point could be that you should not use oxygen with positive pressure > (press on the baloon) to worsen the damage. O2 could then leak through the [quoted text clipped - 5 lines] > Stéphane Havard > www.watalibi.com > Fiddling around with some BSAC exam questions last night, one question > suggested that a casualty diagnosed as acute interstitial emphysema [quoted text clipped - 7 lines] > > David I am not 100% sure on this but is it not due to the way the lung is damaged and Air / Gas is leaking into the lung cavity between the lung and the inside of the chest. If there was a rise in this pressure possibly caused by administering O2 then this could cause the lung or lungs to collapse. taz. >> Fiddling around with some BSAC exam questions last night, one question >> suggested that a casualty diagnosed as acute interstitial emphysema [quoted text clipped - 16 lines] > >taz. Possibly, except we are advised to administer O2 for non-acute interstitial emphysema. This exam question was the first time I had come across the term "acute IE" and I am still curious as to why the apparent difference in first aid treatment. I can just about accept "you will not come across Acute IE in a diver, so shouldn't treat it as you are only certified to treat divers", but still interested if any of the medical fraternity here can provide a clinical (probably the wrong term!) reason. David > Possibly, except we are advised to administer O2 for non-acute > interstitial emphysema. > David Where is that written ? Chronic emphysema can't dive. St?phane. www.watalibi.com >> Possibly, except we are advised to administer O2 for non-acute >> interstitial emphysema. [quoted text clipped - 6 lines] >Stéphane. >www.watalibi.com Think we may be at cross-purposes. Interstitial emphysema is one possible "burst lung" scenario if a diver ascends too quickly without breathing out. In that event, BSAC teaches that the casualty should be given 100% 02 as a first aid measure, and transferred to a chamber for re-compression. David That is acute ... St?phane >>> Possibly, except we are advised to administer O2 for non-acute >>> interstitial emphysema. [quoted text clipped - 15 lines] > > David ----- Original Message ----- From: "rads" <radsxxunspamxx@davidradley.freeserve.co.uk> Newsgroups: uk.rec.scuba Sent: Thursday, November 11, 2004 2:21 PM Subject: Re: First Aid for ACUTE interstitial emphysema > Interstitial emphysema is one possible "burst lung" scenario if a > diver ascends too quickly without breathing out. In that event, BSAC > teaches that the casualty should be given 100% 02 as a first aid > measure, and transferred to a chamber for re-compression. Correct answer. Interstitial emphysema means gas in the tissues. In the diving scenario, almost always related to a lung overpressurisation injury. First aid for this should *always* include oxygen. I expect someone in BSAC has got confused. Again. There is no diving-related illness or injury in which it is dangerous to administer oxygen at 1 bar. Andy >----- Original Message ----- >From: "rads" <radsxxunspamxx@davidradley.freeserve.co.uk> [quoted text clipped - 19 lines] > >Andy Apart from an O2 hit. >> There is no diving-related illness or injury in which it is dangerous to >> administer oxygen at 1 bar. >> > Apart from an O2 hit. HEY???? If somebody had an O2 hit and you now have them on the surface they will need all the O2 you have. Think about it. It was a much higher ppO2 than 1 bar that caused the convulsion. You have managed to get them out but that was probably a fast ascent with a near drowned patient and by now all that O2 in their blood is used up and they are in trouble from the ascent and the speed of things. O2 at one bar is all positives. Only under pressure does it cause problems. The only time you don't give it is when everybody is all happy, well inside tables and having a post dive cup of tea and chat. nigelH >>> There is no diving-related illness or injury in which it is dangerous to >>> administer oxygen at 1 bar. [quoted text clipped - 17 lines] > >nigelH Then again, what would someone at the surface be doing having an O2 hit? Aaaaaaargh bum. I'm having a bad day. Please ignore anything I may say in the next couple of hours. >>----- Original Message ----- >>From: "rads" <radsxxunspamxx@davidradley.freeserve.co.uk> [quoted text clipped - 21 lines] >> >Apart from an O2 hit. Oooops. Sorry. O2 hit AT THE SURFACE. Not a zilion m down. > Possibly, except we are advised to administer O2 for non-acute > interstitial emphysema. > David Where is that written ? Chronic emphysema can't dive. St?phane. www.watalibi.com > Fiddling around with some BSAC exam questions last night, one > question suggested that a casualty diagnosed as acute > interstitial emphysema should NOT be given O2. > I had previously thought first aid treatment for all burst > lung injuries was O2 followed by chamber. Suspect the "acute" > make a difference, but don't know why. > > Can anyone enlighten me? Going back to my old DL workbook (as in the 1996 Novice/Sports/DL edition), it is suggested that emphysema (by which it means acute interstitial, not any other type) may resolve over time but that the the first air treatment for all forms of burst lung is pure oxygen and evacuation to a recompression facility. Currently, BSAC does not place any emphasis on diagnosing the different types of lung injury as, for a first aider, the treatment is identical - pure oxygen and evacuation to professional medical help. I can think of a theoretical reason that might cause someone to think that administering O2 would be a bad idea (in that initially, any air bubbles present may swell due to oxygen diffusing in to the bubble faster than inert gases are reabsorbed), but this is a transient effect and is an issue that should have been discussed on the oxygen administration course (it's why the casualty should be warned that they may feel initially worse after going onto oxygen, but that this is temporary). There is no recreational diving condition in which oxygen at atmospheric pressure is contraindicated. Iain >> Fiddling around with some BSAC exam questions last night, one >> question suggested that a casualty diagnosed as acute [quoted text clipped - 28 lines] > >Iain Understood. Many thanks to all who replied. David |
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