Dr. David Lyness Profile picture
Dec 6, 2021 β€’ 19 tweets β€’ 12 min read β€’ Read on X
Starting off with some physiology! Cold immersion and hypoxia survival. #SOA21 A thread πŸ§΅πŸ‘‡πŸ˜— Image
Drs. Tipton and Mekjavic with Mr Lemons talking at this session. #SOA21 ImageImage
Chris Lemons tells us his fascinating story about working as a commercial saturation diver, at the extremes of human exploration. He's going to tell us about back in 2012 - 'The Topaz Incident'. energyvoice.com/oilandgas/nort… #SOA21 ImageImage
Heliox is breathed in saturation dive situations, the helium replacing the nitrogen in standard air... pubmed.ncbi.nlm.nih.gov/32176950/ #SOA21
Chris's boat above him, with him on the seafloor, started to move away from him in a large storm... 😲and the 'umbilical cord' connecting him to the boat became stuck... and came apart.... so he now only has 9 minutes of gas left. #SOA21 Image
Emotively discussing now him counting down the minutes to his death, which as an experienced diver, he knew would be inevitable at the end of the timer... and he did indeed pass into unconsciousness. #SOA21 Image
Until his colleagues above got an ROV to him, coming across him on the floor bed... #SOA21 ImageImage
41 minutes had passed from the start of the incident before Chris was pulled into a 'diving bell' and received a couple of rescue breaths! ... and came round... Body temp of 35.5... #SOA21 Image
Most important piece of equipment for Chris's recovery was the tea cosy! πŸ˜‚#SOA21 ImageImage
You can watch this full story on Netflix actually! netflix.com/gb/title/80215… #SOA21
Now... on to a 'deep dive' into physiology.... #SOA21 @ICS_updates Using Chris's story as a platform to discuss physiology! #SOA21 Image
A ~40 minute, presumably hypoxic, rescue attempt with apparently no adverse sequelae...
How and why? 🀯🀯
Some key physiological clues, including what he was breathing... #SOA21 Image
Hypotheses? It's unlikely Chris was 'pre-cooled just by working in a cold environment. Hypothermia may be protective in drowning.... but here, particularly, why was Chris awake within 2 rescue breaths? The physiological sequelae of hypothermia aren't reversed this easily...#SOA21 ImageImage
Hypoxia however... we can see some of the jerks/twitches in Chris's video. "Like drifting off to sleep" certainly sounds like hypoxia. "Flashing lights" seen on recovery... an alarming phenomenon is how people report how 'comfortable' this type of hypoxia is: #SOA21 ImageImage
Could have been Chris's emergency oxygen supply? #SOA21 Image
So after the bail-out supply is gone... how much O2 do you need in the body? He did hyper-oxygenate prior to dive... was he o2-toxic? The bail-out supply is high conc O2... #SOA21 ImageImage
Exercise and immersion, breathing a high conc of O2, generally get O2 toxicity quicker. #SOA21 Image
There is (old!) discussion of rapid recovery from 1947! #SOA21 Image
So of all these potentials, what is likely? Timing is obviously very important here.

What do you think? #SOA21 Image

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More from @Gas_Craic

Dec 8, 2021
What were the most impactful non-COVID papers over the past 2 years? Let's delve in and take a look. #SOA21
Finally an opportunity to not talk about COVID! #SOA21
TOMAHAWK - immediate vs delayed/selective angio. 3 years to conduct the trial in 31 ICUs. 554 patients. 'Worse' survival in immediate angiograph? Not SS, but close... #SOA21
Read 27 tweets
Dec 8, 2021
We've looked at bats for a long time.... #SOA21 They have strong interferon responses, but not strong inflammation....
So what happens instead? #SOA21 They will tolerate high levels of viraemia with little symptoms. Bats are old... 65million years ago - they appeared at the end of the dinosaurs! They are far longer lived that other mammals. Senescence is late - more towards end of life.
Read 14 tweets
Dec 7, 2021
Organophosphate poisoning, toxicology, dengue, snake bites and malaria.... sure what could go wrong? #SOA21 @ICS_updates Drs. Chacko, Yacoub, Bhaumik and Dondorp tell us more.... πŸ§΅πŸ‘‡πŸ˜˜
Let's go to India - Tamil Nadu.
I'd advise anyone not overly family with Organophosphates to start here: ncbi.nlm.nih.gov/books/NBK49986… #SOA21
Read 43 tweets
Dec 7, 2021
Biomarker guided abx treatments in sepsis. We catch up with Drs/Profs: Paul Dark, Stacy Todd, Enitan Carrol, Jonathan Sandoe and Matthew Stevenson on this large area of research @ICS_updates #SOA21
So, do biomarkers have any utility in guiding abx use in sepsis? We can measure, usually, these ones fairly easily: #SOA21
In around 2014, commissioned review in PCT. Seemed to suggest a shorter duration in abx use when PCT used.... tenuous data though. #SOA21 Low quality. Little evidence from UK... how does this fit into NHS practice in the realms of stewardship?
Read 13 tweets
Dec 7, 2021
@iceman_ex, myself and @dr_mattmorgan talk about how to keep yourself intellectually safe on Social Media at #SOA21 (full talk at soa.ics.ac.uk)

A thread πŸ§΅πŸ‘‡
There's been a lot that's gone on over the past few years that's exposed the well known 'darker' side of social media. Traditional paradigms of knowledge dissemination have changed (if not disappeared). Much higher tech-savy population. #SOA21
This has democratised the discussion space to an extent. It allows for *anybody* (lit. anybody) to get involved. #SOA21
Read 17 tweets
Dec 6, 2021
Is COVID-19 hyperinflammation, or a cytokine storm in a teacup? @DrPujaMehta1 's fab talk from #SOA21 today! Image
Main Q = "Hyperinflation contributing to worse outcomes for some patients with COVID-19" - clinical similarities to sHLH seen. Viruses are the most common trigger of sHLH. Early reports from China suggested cytokine profile was similar to sHLH in terms of COVID severity. #SOA21 Image
We now know some things work and some things don't.... in certain populations. #SOA21 Image
Read 28 tweets

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