SAFETY continued jects under the age of 40. The intensity of symptoms was similar between the two groups, but the duration of med- ical care was significantly longer for the recreational diver subjects. One such study reported that 46% of those who encoun- tered IPE were women. Compared to men, women have smaller lung volumes and narrower airways, leading to in- creased mechanical ventilatory limitations during exercise. Additionally, women may be more susceptible to hypox- emia, possibly due to their increased mechanical ventilatory constraints increasing the likelihood of fluid buildup in the lungs. Signs and symptoms of IPE include wheezing, trouble breathing or shortness of breath, cough, frothy sputum ap- pearing bloody or pinkish, and elevated blood pressure. Since there is no chest pain normally associate with this condition it is differentiated from pulmonary decom- pression sickness (DCS – Chokes) and arterial gas embolism (AGE).
a dive may increase blood pressure in the alveolar capillaries and inducing IPE. Divers and snorkelers can reduce the risk associated with IPE by using the appropriate thermal protection, using only properly tuned regulators, using snorkels with the ap- propriate bore size, avoiding extreme effort in the water, maintaining good physical fitness and addressing any health-related risk factors before diving or snorkeling. In the November issue of Scuba Diving Industry Magazine, I wrote an article, “Sipping Your Way To Safety,” address- ing proper hydration and its relationship with diving safety. Concern, however, should be raised regarding divers who intentionally drink too much fluid (water or other non-al- coholic, non-caffeinated beverages) prior to a scuba dive, in the belief that it will protect them against decompression sickness (DCS). There is evidence that hyperhydra- tion may increase the risk of IPE in scuba divers and snorkelers. Hyperhydration can increase alveolar capillary pressure resulting from immersion and body fluid shift to the body core. Divers are strongly advised not to hyperhydrate before diving. Since there is so little known about the like- lihood of recurrent IPE once a diver has been diagnosed with IPE, it is difficult to suggest when a diver can return to diving following a diagnosis of IPE. Whether or not a diver should return to diving after being diagnosed with IPE should be determined by a healthcare professional. The decision should be based on the diver or snorkeler’s phys- ical condition and whether or not there is a history of un- derlying health issues such as hypertension or cardiovascular disease. Any diver or snorkeler who suspects they have had IPE is encouraged to discuss options for re- turning to the sport with their healthcare professional with possible input from the Divers Alert Network Medical De- partment. I emphasize in my webinars and writings that scuba div- ing should be considered a safe sport when the diver is properly trained and qualified to scuba dive. It is important to remember that not all safety hazards and risk factors in recreational scuba diving are easily recognized. To be safer divers, we must continue to take advantage of all forms of continuing education. Continuing education is the pathway to diving safety. Scuba diving safety, after all, is no accident!
If you experience any of the signs or symp- toms of IPE, you should terminate the dive or snorkeling experience at once. If scuba diving, make a controlled ascent to the surface and exit or remove the injured diver from the water immediately. Symptoms may continue to worsen in the water, even on the surface. Once out of the water, the injured diver or snorkeler should be given emergency oxygen first aid. If comfortable, maintain the injured diver in an upright position while providing
emergency oxygen first aid. Rescuers should continue pro- viding emergency oxygen first aid regardless of any per- ceived improvement and access the local emergency medical services for definitive care. A number of factors may increase the risk of IPE. Divers and snorkelers with pre-existing conditions such as heart disease and hypertension may have an increased risk be- cause their alveolar capillary pressures are often higher than normal before immersion, and they get more vasoconstric- tion with exposure to cold water. Older divers and snorkel- ers may also be at greater risk of IPE because they have higher alveolar capillary pressures, making IPE more likely. Immersion in cold water may be a significant risk factor for IPE because constriction of peripheral blood vessels is greatest in the cold, but IPE can occur in warmer waters as well. Exertion and physically stressful situations during
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