Using the Selfie as a Telemedical Tool

isolated hand holding smartphone or phone
Last April, a Canadian woman named Stacey Yepes experienced stroke symptoms, but by the time she made it to the hospital her symptoms were gone. Because her physicians could not find any signs of stroke, they believed that she was displaying symptoms of stress and released her home. A few days later, she had a similar attack and used her phone to tape herself during an episode in which she suffered from facial drooping and slurred speech. The video helped her doctors diagnose her with TIA (transient ischemic attack).

In many cases of diseases with transitory symptoms, physicians are unable to diagnose patients and opportunities for early treatments are missed. In the case of TIA, it is especially important to establish an early diagnosis and provide treatment to prevent the progression of symptoms and permanent loss of brain tissue. TIA can lead to blood clotting in the brain, but early administration of thrombolytic medication can prevent clotting and brain damage. Because of the transitory nature of TIA symptoms, some hospitals offer stroke telemedical consultations to enhance diagnosis of and establish early eligibility for thrombolytic medication. By using video connections, they establish a correct diagnosis in 96% of cases, as compared with only 83% of cases in which symptoms are only reported by phone.

Telemedicine is sometimes the only alternative for injured diver in remote areas. One common diving injury for which the selfie may be particularly useful is cutaneous decompression sickness (skin bends). In most cases, skin rash is not associated with any symptoms that would compel divers to seek medical attention, and skin bends can be confused with allergies, bruising, hazardous marine life injuries and other conditions. If divers call medical assistance, they will most likely be told that a skin rash could not be diagnosed at a distance and that they should visit a medical facility. Sometimes people will visit a doctor; other times their symptoms may spontaneously resolve before they arrive at the medical facility, in which case the diagnosis remains unknown.

Amazingly, while skin bends represent a common manifestation of DCS, we at DAN have a very limited collection of skin DCS photos. We propose that divers use their smartphones and digital cameras to document their skin rashes and send or bring the photos to their doctors for evaluation.

The reason why there are so few photos of skin bends is probably because skin rash is difficult to photograph, so we asked our expert photographer, Stephen Frink, for advice. Here are his suggestions:

“As for photographing skin bends with a smartphone, the best policy is to move the patient into an outdoor shaded area. Harsh sunlight might make contrast difficult, and photos taken inside with flash aren’t so great. The shaded area of a dive deck would be good. Just make sure there is no bright light in the background, as that might fool the camera. Uniform light in the shaded area during the daylight is probably best shooting condition”

If you have any skin change after dive, please take a shot of it, send it to DAN and call our emergency line (+1-919-684-9111) to report it and ask for help.

 

Post written by: Petar Denoble, MD, D.Sc.

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3 comments

  1. I had skin bends after a dive in Turks and Caicos. It was my 4th day of diving and I exhibited the skin bends about an hour after my 2nd dive after I was off the boat and resting on the beach. Both my dives were within limits that day and I did 5 minute safety stops. I felt fine leaving the boat but within 30-45 minutes I felt generally fatigued, a little warm, and my shoulders ached and it was later that a rash appeared on my torso and back. It looked like giant hives. DCS occurred to me but denial is a strong reaction and until I reviewed my DAN pamphlet did I realize what I was experiencing. I did not seek any medical attention as the symptoms resolved to only a rash for a few hours but if this ever occurs again I certainly will.

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