Steven P. Hughes
Lance’s Age: 57
Experience: PADI Rescue Diver with Over 50 Dives in Cold Water
Medical History: Immersion Pulmonary Edema One Year Ago
Lance and Dave loved to dive together on the weekends. They had been buddies for a couple of years and always looked out for each other. They geared up for a dive on the rocky shoreline in California, performed a quick buddy check and swam out to their descent point. Then the friends slowly descended through the murky water.
They stayed between 60 and 75 feet and had some fun encounters with sea lions zooming in and out of the kelp strands. After 45 minutes of typical cold-water diving, Lance decided to call the dive since the visibility was poor, and the buddies signaled that they would ascend to 15 feet of depth for their safety stop. That’s when things started to go wrong.
Lance felt himself breathing harder and harder. He felt like he couldn’t catch his breath, even though he was holding still at the safety stop. Quickly looking at his gear, Lance noticed that he had left his regulator on its “predive” setting.
Related Reading: The Danger of Diving Without a Backup Regulator
The predive setting creates extra resistance to air flow to help prevent free-flow before the dive, but it also makes it more difficult to draw in a breath. Lance switched to the “dive” setting on his regulator. However, by this point he knew that he was feeling something more than just regulator resistance. He recognized the feeling as something familiar and signaled to Dave that he wasn’t feeling well.
The year before, he had experienced immersion pulmonary edema (IPE) during a dive. IPE is a relatively rare condition where fluid from the blood builds up in the lungs during or after a water immersion event, like swimming, snorkeling or diving. During water immersion, blood flow is concentrated in the central parts of the body, which can increase pressure in blood vessels in the lungs, resulting in leakage of fluid into the alveoli. This disrupts normal gas exchange in the lungs and can cause serious problems.
The symptom of shortness of breath felt exactly as it had a year ago, and once they were at the surface, a crackly sound coming from his lungs confirmed the self-diagnosis. In extreme cases of IPE, coughing or loss of consciousness may occur. On the surface, Lance informed Dave of the situation immediately, and they called for help as soon as they made it back to shore.
Related Reading: How Your Fitness Impacts Diving
Fortunately for the pair, they were at a popular dive site, and another diver had an emergency oxygen kit in their car. Lance started breathing 100 percent oxygen within minutes of their ascent. Soon, the ambulance arrived at the beach, and Lance explained to the EMTs that he had a history of IPE and that he had been treated the previous year with Lasix, a diuretic that reduces fluid retention.
The EMTs received permission to administer the drug on the way to the hospital. Because of his self-advocacy and clarity around his treatment protocols, Lance was able to be treated quickly and released from the hospital the same day.
IPE is hard to predict and can occur in any depth of water. There are several risk factors, including immersion in cold water, hypertension, high breathing resistance (like leaving your regulator on its predive setting), being overly hydrated and experiencing heavy exertion. Divers should be aware of the condition so they can be ready to seek medical attention if they experience IPE symptoms.
Related Reading: How to Dive Safely in Cold Water
Lessons for Life
1 Know the signs of diving injuries.
Educate yourself on the types of diving injuries and signs and symptoms to look out for. Self-advocacy can make the difference in speed of treatment.
2 Have an emergency action plan.
For every dive, know how you would respond in an emergency and where the nearest emergency facilities are located. Discuss previous dive incidents and what to do if you experience a recurrence with your buddy.
3 Check your gear.
Before getting in the water, test all of you and your buddy’s gear for proper functioning and familiarize yourself with any settings.
