Finding into death of Reagan Leon Milstein

14y · Male·complications of cerebral arterial gas embolism due to SCUBA incident

Reagan Milstein, a 14-year-old certified junior open water diver, died from complications of cerebral arterial gas embolism (CAGE) sustained during a recreational dive in Malaysia. He became unconscious during his second dive and was retrieved from the water, but treatment was severely compromised by multiple preventable factors: no 100% oxygen was available on the dive boat; he received inadequate oxygen therapy in hospital (less than 40% inspired oxygen); treating physicians had no experience with diving illness and did not diagnose decompression illness for 6 hours; and critically, a decompression chamber was not accessed until 32 hours post-incident. The underlying cardiac cause (PFO, ASD, or other) could not be definitively identified without autopsy. Clinical lessons include the importance of immediate high-concentration oxygen provision, rapid specialist consultation (DAN emergency hotline available 24/7), and early hyperbaric therapy for suspected diving emergencies.