Fluid administration to a DCI victim

[John Gulliver]

Following the recent discussion on this subject under the "DIR or not" thread on the Equipment board, I had a look at what the Internet says. Although fluid replacement (by i.v. infusion) is an essential part of chamber treatment and people are recommended to drink plenty of fluids AFTER chamber treatment, the question of oral administration of fluids as part of first aid treatment of DCI victims is apparently still very controversial. For example, Dr Simon Mitchell http://www.divenewzealand.com/48divemed.html writes as follows:
"For a variety of reasons, divers tend to be dehydrated. Dehydration is thought to be a risk factor for the exacerbation of DCI, although there is little solid evidence. Nevertheless, correction of dehydration is a priority in treatment at hyperbaric units. The aggressiveness with which rescuers in the field should attempt to correct dehydration has always been a controversial subject. If someone qualified to initiate and maintain an intravenous fluid infusion is present, then this should always be done. The situation is less clear for oral fluids. There is a risk that if oral fluids are taken and the patient’s condition deteriorates, then they might become unconscious and aspirate the fluids into their lungs. If the patient’s level of consciousness is decreased, or if they have rapidly progressive disease, then I would withhold oral fluids. I would also advise against oral fluids if the diver is likely to be in the care of someone qualified to start an intravenous infusion within 45-60 minutes. Where the patient is fully conscious and stable, and rescue is likely to be delayed longer than 45-60 minutes, bland oral fluids should be given in frequent small amounts. The horizontal position should not be compromised in order to administer fluid. In this regard, those trendy water bottles with straws (which are otherwise only useful for passing disease from person to person!) can come into their own. The amount given should always be recorded."
As regards what to give (if anything), I suspect the recommendation to give apple juice (or other fruit juices) rather than water, as discussed previously, is actually based on the assumption that a person who is dehydrated probably also has an electrolyte disturbance (potassium deficiency etc) but, surely, this is unlikely to be the case unless he or she has diarrhoea or has vomited heavily. Failure to drink enough fluids before diving, especially in hot weather, may well lead to dehydration but I'd have thought a DCI victim would be unlikely to have sweated so copiously in normal Northern European weather conditions as to have developed a serious electrolyte imbalance, or am I wrong about this?

[Chris Hall]

<font color='#FF00FF'>Interesting read.

I suffered from dehydration as a result of a hard days diving in a drysuit. Boat into the water, load the boat, kit &amp; de-kit divers, lug cyls back into the boat, dive with deco, back to shore anf finally boat back on thr trailer.

As I took off my drysuit, my undersuit was soaking, I became very dizzy, had a dry mouth and my skin was hot &amp; dry. I hadn't even need a pee all day!!

That evening I drank somewhere between 6-8 pints of orange squash, but didn't feel 100% until the next morning.

A good idea is to lay off the booze the night before, been there, done that, and SUFFERED!!

Add all this to the fact that a lack of fluid in the body can make you more prone to DCI.

Dive safe &amp; always come back up with your bubbles outside

[Phill]

No simple hard and fast answer I'm afraid.
Yes, we immediately, usually, put 2 litres i/v in once at the chamber, but we can also cope with loss of bladder function, unconciousness etc.
Ideally don't be dehydrated, but if you dive you are. (Lack of gravity leading to lack of blood pooling, 100% humidity inside a dry bag, breathing through your mouth, dry air, plus - of course - the night before).
I would tend to administer non fizzy, non alcoholic, non hot fluids in moderation to a casualty who had full conciousness. But concentrate more on oxygen.

[Dr Stevil]

<font color='#0000FF'>BSAC's fluid admin guidelines , as part of the O2 admin course are:

&quot;Still isotonic drinks are preferable, but failing these
water/squash drinks can be used. The fluid should be administered in small quantities at a rate totalling approximately 1 litre/hour. With a nauseous casualty care should be taken to ensure that drinking the fluid does not make them vomit as the resultant fluid loss would further
aggravate their condition.&quot;

However, in the event of barotrauma (ie burst lung) you may not want to administer that much fluid as the inevitable surgery will be delayed.

Chee-az
Steve

[Finless]

Originally Posted by [b

Quote[/b] (Chris Hall @ June 12 2003,08:51)]Dive safe &amp; always come back up with your bubbles outside

The CCR boys and girls might be a bit worried if that happened.

[Hyperbaric]

<font color='#0000FF'>DCS itself can cause dehydration due to the effect bubbles have on the lining of blood vessels. Also, overloading with fluids before a dive in order to combat dehydration may lead to an increased risk of DCS (assuming the theory of dehydration increasing the risk of DCS is correct) because that extra fluid will increase circulating and interstitial (in the tissues) volume and promote gas loading. As fluid is lost during the dive, the risk of that gas causing problems increases (assuming the theory is correct...)

Remember too that cold exposure can encourage dehydration through increased production of urine. The casualty's soggy drysuit should be changed for warm, dry clothes. It can be a long time before they are scooped up from that cold, wet concrete and whisked to the appointed chamber in a cold, breezy helicopter. Divers are commonly hypothermic on arrival.

[Laurence]

<font color='#0000FF'>Hi, One of the things too think about is if you give water in DCI will it do them any harm, whether the water helps them, no one is sure.

I would always give fluid in a potential DCI, as i believe it helps them and untill someone provides me proof that it does hurt or hinder them, i will continue to give fluids.

At the end of the day its your call, if you the person dealing with them its your choice.

I worked for Stoney Cove for 3 years and saw many DCI incidents and worse, and to the best of my knowlege, fluid was always given ASAP and throughout there DCI treatment.

And im sure they still do and they follow the latest reccomendations.

ALl the best.

Laurence

[Dr Stevil]

Originally Posted by [b

Quote[/b] (Laurence @ July 03 2003,11:44)]I worked for Stoney Cove for 3 years and saw many DCI incidents and worse, and to the best of my knowlege, fluid was always given ASAP and throughout there DCI treatment.

And im sure they still do and they follow the latest reccomendations.

<font color='#0000FF'>Even in the event of barotrauma? The argument against giving fluids when there is BT (which will undoubtedly have an associated DCI component) is that it will delay the surgery necessary before recomression treatment can be started
rdgs
Steve

[Tim Ingmire]

Interesting that the article says there is little solid evidence for the role / increasing risk of DCI thro. dehydration - my understading was the dehydration was one the leading risk factors for DCI? &nbsp;However, unless there is a clear contra-indication then it seems best to re-hydrate suspected DCI casualties.

Given my (not far-off) laymens view of the subject I would take the cas, lie them down and give them O2 as well as fluids (water / apple juice / Lucozade sport) for a short periods, if they are not peeing (after 30mins) then stop. If they can pee, then continue in small, frequent amounts. &nbsp;Clearly they would have to concious to do this as I'm not qualified, prepped to do anything IV. &nbsp;Having not had to do this yet for real, its difficult to say how the advice I've been given would really work.

I noticed that in Kevin Gurrs book his team (on the Britannic expedition) were rehydrating by IV after each dive as well as having doppler analysis - which must be nice if you can get it.

Comments?

[Dr Stevil]

<font color='#0000FF'>I believe IV rehydration is a common thing with young doctors, after a night out on the lash, hook youself up to the IV drip and come morning time - no hangover! couple of times recently I've been tempted to use my 100% O2 after overindulging, haven't yet learned how to do IV drips but may do in the future, can recommend the Wilderness Medicine people for extending abilities beyond the range of regular CPR/AV etc
Chee-az
steve