DAN has been presented a variety of cases this month, from suspected DCI to scorpion fish stings and mysterious insect bites.
Vanuatu: A 33-year-old female completed one dive to 62m for 59minutes on air. She completed all required deco, however post dive she felt fatigued. This Member is very experienced with 300+ dives as an instructor. Around 2-3hours post-dive she experienced tingling in her left foot which resolved. Then, 6.5 hours post-dive, she had tingling in the fingers of both hands. When she called DAN, she had not been on oxygen, so the DAN DES (Diving Emergency Service) Doctor recommended that she present at the local clinic to breathe oxygen. This diver was a Member of DAN America, who continued to liaise with the Member. We were advised by DAN America that the member received oxygen overnight and been advised to take ibuprofen*. The following day she reported that the tingling had resolved although she still did not have 100% normal sensation in those areas, and she also had body aches, which resolved with the ibuprofen. She was advised to contact DAN again if symptoms worsened or did not improve.
*Non-steroidal inflammatory agents, such as ibuprofen, are sometimes used to relieve mild pain and tingling associated with DCI as they reduce the inflammation. However, this should be done on advice from a diving doctor and not routinely used by divers without such advice, as very often other treatment is required.
Papua New Guinea: A 39-year-old male completed a night dive and two more dives the following day. On surfacing from the last dive, he felt weak with tingling all over his body, but mainly the chest.
He was put on oxygen, and when the call was made to DAN some 20-minutes later, his symptoms had mostly cleared. The member was advised to continue breathing oxygen for a further 3-hours and if the symptoms fully cleared it was recommended that he skip a day before resuming diving. The on-call doctor was not convinced of DCI and a wait and see approach was decided.
The member had a rest day and then completed one dive the following day. Symptoms returned 3-hours post dive with chest pain, burning on inspiration, and pain and tingling in both legs. He was unable to sleep due to the pain.
The DAN DES doctor didn’t feel that it was DCI but could not explain all the symptoms. He was advised to breathe oxygen overnight, take anti-inflammatories and present at the local clinic in the morning for assessment.
Although information is scarce at this time, we were told that he did visit a local clinic and no clear diagnosis was made. Several days later he underwent a medical assessment prior to trekking and was declared fit for the trek.
Philippines: A 73-year-old female diver was on a dive boat near Dumaguete. She was stung by “spiny devilfish” (a type of scorpion fish). Initially the pain was “excruciating” but it eased after hot water submersion. She was advised to go to nearest clinic for examination and medication. When DAN contacted the Member an hour later she was okay with the pain only minor and the swelling abated. She said she wasn’t going to the clinic, but DAN reinforced that she should to ensure the wound was cleaned and to consider a tetanus injection and antibiotic prophylaxis, to avoid any possible infection.
Thailand: A female diver completed two dives to 12m the previous day. She was on the dive boat to conduct further dives the day after but felt dizzy, seasick and her breathing was irregular. She describes being tired and noticed redness on her abdomen which was not itchy. Her symptoms were still present when she called DAN the following day: She described having 4-5 ‘bites’ that were 3cm long that looked like a burn, but she said couldn’t be sunburn. She was also dizzy, nauseated, and coughing. The symptoms she described could possibly be insect bites, sea sickness or ear barotrauma. She was advised to attend local clinic for assessment. As this diver was not a DAN Member, she did not choose to call back to update DAN or seek further advice.
Papua New Guinea
A 55-year-old had dived for three days without problem: Day 1: 1 dive, Day 2 and 3: 2 dives per day. On Day 4 she completed three dives each to around 30m. The first surface interval was for 1.5 hours, and the second for three hours. She spent little time at max depth and completed all safety stops. Between dives two and three she noticed some transient chest pain and headache with visual changes but wasn’t too concerned and completed the final dive.
Around two hours after her last dive she was sitting at dinner and noticed pain (stabbing) in her left breast, then general pain around her chest, abdomen, hips and thighs. She described the pain as ‘not far under the skin’. There was no visible rash described, although she later remembered that there was a transient rash on her thighs and chest. Other than these symptoms her husband described her as clear-headed and otherwise normal.
She had been breathing oxygen via a non-rebreather mask at 8 litres per minute (lpm) for one hour when the call was made to DAN. She was advised to breathe oxygen throughout the night. She was asked to increase the flowrate to 12-15lpm, then wind it back to 8lpm when she was ready to go to sleep.
The next morning, she was asymptomatic and felt well. She was advised to rest, stay hydrated, drink no alcohol, complete no dives and avoid all exertion. She flew home the following day and symptoms did not reappear.
REMINDER: All divers can call a DAN Hotline for advice, however, we can only co-ordinate an emergency evacuation, and treatment, and cover associated costs, for current members within the limits of their coverage.
As DAN AP emails are only monitored during business hours, and Facebook is not monitored daily, it is important that a DAN Hotline is always called in the event of an emergency.
If you are not yet a DAN AP Member, you can join via the DAN AP Website.
Image of scorpion fish by Carlo Pantanella, via Diveplanit App.