Tilting Out of Trouble

The skindiving student had surfaced rapidly from the bottom of a 14-ft. training tank in Seattle, and despite his training, he had evidently held his breath all the way up. Within seconds, he was half unconscious, and his left side was paralyzed. The instructor and his diving comrades rushed the victim to General Practitioner Charles A. Kruse, who had two important qualifications for handling the case: his of fice was near by, and he is an enthusiastic skindiver himself.

Expanding Air. Dr. Kruse could see at once what the trouble was. The stricken diver was suffering from air embolism,* in which compressed air in the lungs expands rapidly, forces its way into pulmonary veins leading to the heart, and travels through the arteries to the brain, where it cuts off part of the circulation and causes unconsciousness and paralysis. Dr. Kruse told the diving crew to carry the patient to an examining room. Inexperienced at the job, they let the unconscious man's head sag forward until his chin touched his chest. At the same time, they were holding his waist and legs higher than his head and shoulders. Dr. Kruse noticed a twitching of the paralyzed side of the diver's face; there was a barely perceptible motion of the man's arm.

Standard treatment for air embolism is to put the victim into a recompression chamber, but Dr. Kruse did not know where the nearest chamber was. Fortunately, the twitch in the head-dropped position gave him an idea. By chance, the examining table had a tilting mechanism. The doctor propped up the diver's head until his chin rested on his chest--the same position that had produced the hopeful twitch. Then he spun the control wheel until the head end of the table had dropped about 15 degrees. As fast as he could, he spun the wheel again until patient and table returned to the horizontal. Dr. Kruse kept up this oscillating movement for 15 minutes. Slowly, the diver regained control of his face muscles and began to talk. Within two hours, he was well enough to go home, and he has since recovered completely.

Smaller Bubbles. Dr. Kruse discussed the happenstance treatment with another skindiving friend, Dr. James R. Atkinson, then at the University of Washington. Working with cats, Neurosurgeon Atkinson found that tilting succeeded repeatedly in clearing up air embolism. He now thinks that in the head-down position, the brain receives more blood, so that its small vessels dilate and are better able to push the air bubbles along. The bubbles then split up until they become so small that they can be dissolved in the blood.

Drs. Atkinson and Kruse do not recommend the tilting-table treatment as a substitute for recompression. But as a first-aid measure until the embolism victim can be hauled to a pressure chamber, which may be miles away, they think tilting may prevent many cases of permanent brain damage.

*Not to be confused with the bends, though both result from too-rapid decompression. In the bends, the source of the trouble is nitrogen, which has been dissolved in the blood and fatty tissues under continued high pressure, then, with rapid decompression, comes out of solution faster than the blood can carry it to the lungs. The bubbles press against sensitive nerves, causing excruciating pain, and may cause death by interfering with the nerves that control breathing.

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