Perfect day of scuba diving ends in disaster! (Decompression Sickness & Paralysis!)
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- Опубликовано: 30 июл 2024
- Perfect day of scuba diving ends in disaster! (Decompression Sickness & Paralysis!) Recently a serious and life threatening event happened to our own co-host, Lyell, while on a liveaboard trip in the Pacific, he suffered a heart attack even with no coronary artery blockages. Today, you will meet a man who had a catastrophic injury that occurred during a normal routine day of diving and changed his life forever! Dr. Eric Wagner is a retired dentist, who learned to dive in the army, while stationed in Puerto Rico in the mid 1980's. He had been a recreational diver for over 20 years when one day on a dive trip in Belize, he completed three perfectly executed dives, but nevertheless became a victim of a severe decompression injury! But there is more to Dr. Wagner's story that we can all learn from.
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0:00 Intro
0:41 Lyell's recent heart attack.
1:20 A remarkable story!
1:52 Meet Dr. Eric Wagner
2:43 Trained by aNavy Seal in the 1980's
3:30 Decision to go visit and Scuba Dive in Belize.
4:00 3 dives in a day...the last one was his last dive ever!
5:05 Last dive ascent and getting on the boat....DCS symptoms begin.
7:30 Race back to the dock and into the chamber.
8:30 Life Flight to Houston and when he woke up!!!
9:40 What did they find in Houston that caused the DCS? (What is a PFO?)
11:39 Decompression Chamber Treatments
12;40 Made it home and back to work!
13:04 Residual symptoms.
13:23 The financial cost of a diving accident.
14:08 Dr. Wagners words of advice to divers.
14:38 You can't plan for the unexpected but we should be aware of risks.
15:07 Divers Alert Network & Dive Accident Insurance
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Another good reminder to take symptoms seriously and get help right away. Thanks for sharing this. I am a member of DAN and am looking forward to hearing what they have to say on your next video. Glad to hear your cleared to dive again Lyell! Have fun!
Holy yoli that story makes me wanna go get a health assessment done 🤯 I’m glad both of you are 👌
Wow Lyell, thank God you’re ok. Please keep safe.
Awesome update
I was always trained to plan the number of dives at the start of the day so you could plan your surface times accordingly. My training was from BSAC while I was in the Army. Some minor incident occurred during that time which shows even with the best planning things can happen. I’m so glad you are both ok. Very informative video, many thanks
Traveller473, the interesting thing really is when you talk to hyperbaric medicine physicians, the majority of DCS cases they treat are divers who followed their plan correctly. We agree, even with the best planning, incidents can and do occur. Thanks for your comment!
Thank you for sharing this experience. I know now to get heart checked and make sure it’s in good condition to handle diving sport.
Diver with a TBI here. Thank you.
Crazy story
Would you please go over the dive profile on these dives and verify surface interval with dive tables? Thank you
Great video and story. And glad to see you doing so well. Be back underwater in no time!
Just got cleared to return to the water! Thanks Mike!
@@everythingscuba Fantastic news! Looking forward to new video of you blowing bubbles!
@@mikesbigadventures194 - he dives CCR 🤣
@@elmo319 Well then I look forward to new video of him NOT blowing bubbles. 😂
@@mikesbigadventures194 - let’s hope so 👌😁
Tks God you made it!
Almost die too, só painful!
Wow, what a news, in 2021 he know about pfo....
Wow!!!! Never take anything for granted. What was his dive profile for his dives for that day so we can learn from that. (I am a 4 year member of DAN)
First dive of the day was 90 feet reef dive. Second and 3rd dives were both no greater than 60 feet.
@@everythingscuba Deco can be sneaky especially past 60 ft I love deep diving
I had a DD after one dive at 25 meters. We doubled the safety stop waiting our friends so 6 mins at 5 meters. We later discovered a pfo
Good to see you both sitting and talking. Scary stories. I missed a few things. Was this dive done without a computer?? Did they have computers 12-13 years ago? Second, why would you consider this dive past his limits. Did he have a 2-dive limit because that was what his calculations said he was capable of, or because that was just common practice for him. Lastly, it was unclear what injuries resulted from the dive itself, versus walking around with them already. I mean, did he have that hole in his heart already? Or the embolism in his lung? Or were these things that resulted from the decompression sickness? It was difficult to follow whether this was truly dive related. Thanks.
"Hole in heart" or more precisely PFO comes with you when you are born. For ~20% of people that hole does not close properly. For some of us it is worse (="more open") than others. So yeah you carry PFO around all of your life. You might have it!
Where did he get lung embolism I have no idea. Could it have been a very tiny embolism that on a good day goes without notice?
Also he mentioned heart-attack but there was no description how they got to that conclusion. Was it result of bubbles forming because of DCS?
Anyhow I had 2 diving incidence because of PFO. I'd call them serious ones as wasn't able to stand the day after and needed to learn to walk again (it hit my inner ear balance centers). After the first one I did not fully understand what it was but I loved diving. So after >1 year and full recovery I went on a diving trip. I decided I will skip every 2-nd dive and do additional 3 minutes (total 6+ minutes) in safety stop. But then I got Nitrox and felt sooo good after dives (I was used to diving with air only) and skipped my plan - did normal diving schedule as everybody else. Aand ofc. I got hit again finally on my 4-th day of diving, even the ~6 minute safety stop on that final dive didn't help. This illustrates that I was somewhat aware that my limits are even smaller than is "normal" but I still failed to follow them. Anyhow the limits taught in diving classes are just limits for normal average person ... yours might vary depending on circumstances. Decide your own limits and stick to them!
PS: before getting DCS on both of my dives I managed to utter the words "my life-s best dive", just like our hero here in this video . Be warned :P
PSS: my PFO was closed and am fully diving now again with also some (light) technical/decompression diving in the mix
Sounds like he was in a pretty warm area. Anybody know how hydrated (or lack thereof) he was going into the dives that day? Was he staying hydrated throughout the dives during his intervals?
Don’t know about hydration status. But there are multiple and many recorded dives where the diver does everything according to the plan and still gets bent. We know a lot about decompression theory these days but there is also a lot we don’t know and a lot of individual variance within each divers’s personal physiology. We can’t always predict every outcome unfortunately.
I’m currently at week 5 of no diving after getting bent. I was teaching a deep class, am an avid technical cave diver and have done many much more aggressive dives than the two class dives. I discussed in depth with the hyperbaric doc what he thought the causation for my DCS hit was. He pointed at the dives and said they were “provocative” dives. I told him I felt my hydration level was not what it should have been, I also take a medicine that has been linked to DCS, and after the second dive I pushed a pair of LP120’s up a pretty steep hill shortly after the second dive. I didn’t feel any kind of symptoms until almost 24hours later. It was 5 days later before I did a 6 hour chamber ride navy table 6. My entire daily hydration plan has changed. I am released to go back to diving after 90 days out.
A diver with 25 plus years and have never done more then two tanks in a day? Wow!
I wish you mention the dive profiles that day for Dr Wagner…5 min safety stop? We do 3 min usually. That’s also my dive computer recommended interval. This video leaves some room for clarification..
Three dives, none greater than 65 feet. Tables were used for dive planning, no computers, this occurred prior to routine dive computer use. Each surface interval was minimum 45 minutes, and I’m fact 2nd surface interval prior to last dive was nearly 90 minutes. This river was NAUI trained and routine safety stop for them was 5 minutes. In fact some divers still routinely do 5 minute SS given that theoretically this adds conservatism to end of dive.
Must likely reason for this was undiagnosed PFO in the heart. Allowed bubbles to shunt from venous side to arterial side.
25-30% of population may have undiagnosed PFO.
@@everythingscubaI think it does bring up the importance of planning a gradually decreasing dive depth as the day progresses. Even though the PFO heart issue is documented as a risk an is probably the culprit, it does bring to light the importance of diving standards. I would add "Heart Echo" test for every scuba medical test starting today :-). I had one years ago unrealted to diving...it take 10 minutes...
@@sfiron unfortunately a standard cardiac echocardiogram will miss most PFO’s. Since many PFOs are very small. A “bubble test” is required to fully evaluate the potential for PFO under echo. Lyell had one of these performed after his cardiac event last year. Thanks for your comments and thanks for watching. We appreciate it.
what kind of trip insurance and dive insurance do you recommend?
Check out Dan.org. They have most everything you’d need for dive and travel insurance.
If he did his safety that long i really wonder why this happends to him ??
I dived 3 tanks a day many times .
Just curious 🧐 thank you .
Safe diving .
Because people are built differently and they have different tolerances to it. I was surprised when I heard that, because I assumed the time limits would be the same for everyone. The charts show the limits and people should stay within the limit, but avoid approaching the limit. He also had a condition of the heart called PFO so maybe that was also one of the reasons.
I was taught that Oxygen is toxic above a partial pressure of about 1.6 atmospheres (6m / 15ft depth) but this guy claims he was breathing 100% O2 at two atmospheres as chamber treatment? Is that right?
I would like to have known the dive time and depths that led up to this event too. Was it beyond the NDL or simply because the heart issue?
Thanks for sharing and stay safe.
+Elmo you are correct Oxygen has the potential for CNS toxicity over 1.6. We aren’t hyperbaric medicine doctors so I can’t confirm if that is an accurate statement that Dr. Wagner made. In regards to NDL. The first dive was to 90 feet, the next two dives were both no deeper than 60 feet. Dr Wagner assured me that none of the three dives violated their decompression limits and in fact they took an almost two hour surface interval between the second and third dive that day. They believe the PFO was partially responsible for his injury. But remember, although we know a lot these days about decompression theory, we don’t know it all and there are many case reports of divers performing virtually perfect dive profiles who still incurred DCS. You just never know. That’s why it’s always best to be conservative. Thanks for your comments.
I'm not a hyperbaric physician either, but pO2 of 2.0 isn't outlandish. In the navy, dives with pO2 at 1.9 to 2.0 for less than an hour could be signed off on provided the physical stress isn't too high and pO2s of 1.8 are relatively normal. The navy diving manual also discusses decompression at 9m with pure oxygen at length. The important thing to keep in mind with chamber recompression is the risk reward calculation. In the chamber, there is no risk of drowning and the process is fully monitored with medical assistance at hand. So the risk of oxygen toxicity is much more manageable with much less serious outcomes in the chamber. So for diving, we want to ensure that it just does not happen and that break point is 1.6. So we add a safety margin to make it 1.4 which is in line with observations of oxygen toxicity on dives exceeding normal workloads.
Now, for the interesting part: how high a pO2 can we use in DCI treatment? DCI treatment as outlined in the navy diving manual has pO2s up to 2.8. In that sense, pushing him to 2.0 is nowhere near the levels. In fact, the here described case is considered as an example recompression treatment plan.
- initial compression to 18m (pO2 = 2.8)
- if severe symptoms (e.g. paralysis, major weakness, memory loss) are unchanged or worsen within the first 20 minutes at 18m, assess the patient during descent and compress to depth of relief (or significant improvement), not to exceed to 50m
- if a chamber is equipped with a high-O2 treatment gas, it may be administered at 50m and shallower, not to exceed a pO2 of 3.0
So yeah, had he been in the Navy and treated accoding to the Navy dive manual, he'd be pushed to a pO2 of 3.0, not just 2.0.
@@tobiashartung856 wow! Thanks for that awesome explanation! Fascinating that we can tolerate such high PO2 but given the lack of the fear odd downing I can see how beneficial it would be in such cases. Thanks for you comment!
Thanks both for great explanations, very interesting discussion.
I’m glad you mentioned about the surface interval as I had forgot that. 🤦🏼 ☺️
What an unfortunate incident .. thank you for the informative content .. and the great effort paid to keep this channel interesting..
If i may suggest a funny yet interesting subject to cover ..
Oversized drivers!!! Yes .. just like myself i have been oversized person for years now, ain't no sham about it .. by default, there is no much Adventurer activity for fat people like me, that's why i am so in love with scuba diving .. its just makes me feel good and special about myself and the sense of accomplishment is just addictive that i never skip a weekend without diving! I am a DM that making good income in DSD's and fiscally challenged champs .. planning for IDC in November..
Bottom line .. scuba diving is one spot/activity that can be suitable and rewarding for all types of body sizes .. please review my suggestion as it's never covered before and its rather interesting..!
Not to take away from the seriousness of this video I would love to be on that discussion about big and tall divers
So he would've likely been fine had he not dived a third time? I have no idea how this works and why a third time could cause you to suffer this to be honest.
So I'm assuming you can feel it when you get out of the water and it should be a clear warning to not go again, and probably worse the faster you ascend.
The main issue here was the fact that he had an undiagnosed PFO. This was the most likely reason for his incident not the number of times he had been diving.
I know this was caused by the PFO but I also know a lot of of school divers that still rely in the tables, mental planning and their quick manual and potentially inaccurate calculations instead of using computers to calculate their decompression limits. Not sure if this is the case but I have seen old school divers still thinking they know more than anybody else and not using the last tech for their safety.
They didn't use computer. I guess they didn't have the tech.
It sounds like none of this would have happened had he not had the very unfortunate pfo…
how deep were the 3 dives?
The first dive was to 90 feet (27m) and the second and third dives were each no deeper than 60 feet (18m).
$250k? Just kill me!
We want you to be a diver!!! You can do everything correctly and wind up broke due to treatment, become paralyzed, have a heart attack or an embolism and wind up dead.
Seems like it takes the kind of person that likes to bang their head on the wall to get rid of a headache to go for this.
Nope. Im fine right here on land.
What was the length of each dive? From the sounds of it, there was no mandatory deco but were they pushing the NDL bottom times? All dives on air? Or was there nitrox used at all?
Each dive was 46-60 minutes. First dive to 90 feet and second to 60 with 45 minute surface interval. Then a 90 minute surface interval before the third dive to 60 feet. Nothing unusual about the profiles. All dives were on air.
surface times sounds short to me. could you provide a calculation? according to my calculations this isnt well planned. i may be doing it wrong as i am not as experienced as you guys.
@@sefapepe2073 actually based on the depths of the dives the surface intervals were all well within acceptable levels.
@@everythingscuba 45 minutes at 90ft???
@@IDive2 read my comments more accurately. Max depth was 90 feet. (He did not stay at 90 feet for 45 minutes.)
Nitrox, Nitrox, Nitrox.
Nitro does not save you when you have a PFO!
Nitrox reduces the risk of getting DCS@@everythingscuba
Missing information, what was the dive planning info? Depth, time. No one gets that symptons by diving a 40 ft.
Actually we have that information during the video. Max depth of 65 feet on both dives. Stayed within planned NDL on both dives.
Also there are multiple and many cases of reports of DCS occurring in dives less than 40 feet.
He has a significant PFO. All bets are off regarding decompression theory when a person has a large PFO. They can get bend on dives that are extremely conservative.
So this was caused by pre-existing conditions he had? If so could he have found out about them from some doctor?
It is thought that approx 25% of the general population have PFOs and as such general screening for this condition is not typical.
@@everythingscuba Thank you for the reply. My question is is it possible to screen for it & find it before an accident happens? Also what about was in his lung? What caused that?
Daniel you can screen for a PFO. Lyell actually had this done after his heart problem last year. It entails undergoing a cardiac echocardiograph and saline with micro bubbles is then injected via IV and the heart is imaged to see if there is a PFO that allows blood to shunt from the venous side to the arterial side.
In terms of what was in this divers lungs, I’m not sure I can fully answer this. I do know they found some bubble emboli on the arterial side which caused some of his symptoms.
@@danieltakawi9919, as stated above, a PFO can be screened for. Most likely a cardiologist would perform that procedure. However, it's likely that insurance won't cover it under those circumstances. PFOs are not uncommon, but they are usually too small to be an issue. Larger PFOs are a lot less common, but for divers they can be a serious issue. They can also be repaired with a pretty simple outpatient procedure.
The issue with his lungs was a pulmonary embolism which is an air bubble (or blood clot) in the arteries in his lung. In this case if would have been a complication of the decompression sickness which seems to have been caused by a large PFO causing inadequate decompression. He had bubbles in lots of places (based on his symptoms) which were cutting off circulation so it's not surprising that one of those bubbles was detected in his lungs.
Obviously this was probably before a dive computer or he didn't have one and he simply went too deep and stayed down too long or came up too quick. I don't believe he was within dive limits when this occurred.
He had an undiagnosed PFO. That was the probable cause.
If 25% of the population has a hole in the heart. How about Scuba divers get checked for this condition ahead of time? That's micro bubbling Nitrogen getting pumped directly ack into the arterial system and not getting cleared out via the lungs, not good! Also, the time timing is interesting showing you the most dangerous bubbling occurs right at the surface after a dive. After a week of diving in Caribbean, I noticed I always needed to pee so badly after I surfaced, yet I never had much urine, no I didn't have any issues with prostate before or after, possibly cold related? I had been under for a long time and didn't feel super warm either
25% of the population have a PFO, but the vast majority of them are too small to be an issue. A larger PFO is a lot more rare, but for those that have one all bets are off in regards to decompression theory. My girlfriend has a small PFO and does decompression diving. She has gotten a few medical opinions on her PFO and three cardiologist have said it's a non-issue even for the diving she is doing. Having said that, I dive a more conservative profile when diving with her.
Don’t understand the point of these video:
You mean the extreme sports are dangerous?
Do you need to do a check up on your health condition ?
Or someone can hit the jackpot?
And by the way ,
In a 90 feet &46 -60’ dive u shuld go on Deco if not And you’re lucky you shouldn’t dive fo24-48 hour.
The point is...
- You probably won't find out you have a condition like a significant PFO until you get bent. This is not part of a normal health screening and your private-for-profit-US-insurance is not going to pay for the test procedure out of the goodness of their hearts.
- It's a good idea to have DAN insurance if you are a regular diver (or maybe if you dive at all). One treatment in a recompression chamber can bankrupt most people. A helicopter ride is often needed to get to the nearest recompression chamber since most hospitals don't have them. Helicopter EMS rides will also bankrupt most people.
- You can do everything by the book and still get DCS because of unknown factors like this. Don't assume it can't happen to you.
- Know what the symptoms of DCS are so that you can recognize them quickly if you or a dive buddy experience them.
- If you do have symptoms of DCS, get on oxygen and get medical attention immediately. It could be the difference between a full recovery and paralyzed for life or worse.
As for the dive profile and decompression, you are assuming a square profile with the full bottom time at 90 feet. It is likely that they only hit that depth at the beginning of the dive and then worked their way to much shallower water as the dive progressed. This is a pretty common profile when diving a wall or similar. This dive was in 2009 so modern dive computers were very common by then. He said he wasn't in deco on any of the dives and I'm sure his computer was scrutinized at some point during his many recompression therapies. I don't see any reason to question his dive profiles given he ended up having a PFO which explains his DCS by itself.
An echocardiogram can be done to diagnose a PFO. If the PFO is not easily seen, a cardiologist can perform a "bubble test." Saline solution (salt water) is injected into the body as the cardiologist watches the heart on an ultrasound (echocardiogram) monitor.
Reminder to never go scuba diving.
I’ve noticed that many Armed Forces trained folks seldomly, if ever, use computers.