Choking underwater

[watboy]

Had my first real incident underwater. Was on a live aboard doing a 4-5 dives a day schedule. Boat had excellent food, but being my 6th live aboard now, I know not to eat too much. Went on a night dive, 3 hours after lunch, and everything was going well. But I started feeling a little indigestion and had an urge to burp. But instead I ended up vomiting a small amount. Not sure what happened next, but something came back down my throat and it just squeezed shut. I couldn't breathe. I was swallowing air as my throat was just seized shut, nothing was getting into the lungs. Stress levels shot up... tried breathing again and could only get a little bit in... all the air in my stomach made me want to puke again. I was at 16 meters, I grabbed my reg to make sure I didn't spit it out. I needed to breath but could only get a little bit in at a time, so was taking lots of little breaths. My buddy noticed this quickly and came over asking if i was ok. I signaled I had problems and needed to ascend. Dropped my camera (its on a leash) and ascended slowly with my buddy. At this point all I was trying to do was to manage my ascent rate and to try to breathe. Not sure if i would describe it as panic, I mean I was really stressed and increasingly scared to terrified and step 1 in stressful situation is breathing, which I could barely do. But I was able to signal my buddy and manage my ascent. At the surface I puked a 2nd time, but was finally able to breathe. On the boat, buddy asked what happened and I told him. He said I looked fine and didn't know why I was aborting the dive, but aborted as soon as I signaled "problem, ascend". I was pretty freaked out, but by the time I got my wetsuit off, I was more embarrassed then anything else.

I've had a history of stomach problems (ulcers and indigestion), but that was 10 years ago. I've since learned to better manage my diet and work stresses and not to lay down after meals. Maybe it was because my new camera and macro lens has me angled down so often as I get the camera in position but keep my feet up to stay off the coral.

 

[fjpatrum]

Sounds like you handled the issue appropriately. Good job. Hopefully I won't puke in a reg again... the last time didn't taste so good breathing for a couple days.

 

[Duke Dive Medicine]

Watboy,

Ditto fjpatrum above - nicely handled. From your description, you did everything right and were entirely correct in aborting the dive. It sounds as if you experienced a laryngospasm, which is where the muscles in the throat constrict in reaction to some sort of irritant. It's a protective mechanism designed to prevent aspiration of foreign matter into the lungs. It relaxes eventually, as you also experienced.

Some people with chronic GERD (gastroesophageal reflux disease) have problems with this and can actually aspirate stomach contents. Opinions are mixed as to whether a head-down position increases the risk for reflux. It would be a good idea to address this with a health care practitioner; there are medications that can be helpful.

Best regards,
DDM

 

[John C. Ratliff]

Watboy,

I would also say that you handled it well, and ditto what DDM said above. In addition to GERD, get checked for a hiatal hernia. I have this condition, and take omeprazol, 20 mg each day. There is a surgical procedure to correct hiatal hernia, but because of my age (67) my physician did not recommend it. The diagnostic test was interesting. I was put on a table that tipped head-down after having ingested a barium solution to see whether stomach contents went where they were not supposed to--they did. Because of this, I don't eat prior to diving. I have continued my diving, and have no problems now. I never got to a "chock" situation before the diagnosis, but was near having an ulcer due to the stomach contents coming up into my esophagus.

SeaRat

 

[dumpsterDiver]

Watboy,

Ditto fjpatrum above - nicely handled. From your description, you did everything right and were entirely correct in aborting the dive. It sounds as if you experienced a laryngospasm, which is where the muscles in the throat constrict in reaction to some sort of irritant. It's a protective mechanism designed to prevent aspiration of foreign matter into the lungs. It relaxes eventually, as you also experienced.


Best regards,
DDM

I was taught a long time ago that the approrpiate response to this spasm is to swallow. Even if you have to swallow contaminated saltwater or worse... the appropriate response to this kind of choking situation is to try to swallow whatever is causing the spasm... to allow youself to breath. It sounds like it must have partially relaxed since the diver could get some air.

Does nobody teach this?

 

[DivemasterDennis]

I agree with the others but also want to add a gold star award for the dive buddy who did not debate the issue but readily ascended with his buddy watboy when watboy gave the indication. Good examples from BOTH divers in this story. Thanks for sharing.
DivemasterDennis

 

[freewillie]

Doctors are now doing trials with LINX system for GERD. They are magnitized titatium balls, think of medical Buckyballs for the esophagus. It is showing a lot of promise as a less invasive surgery for heartburn/GERD.

 

[John C. Ratliff]

I was taught a long time ago that the approrpiate response to this spasm is to swallow. Even if you have to swallow contaminated saltwater or worse... the appropriate response to this kind of choking situation is to try to swallow whatever is causing the spasm... to allow youself to breath. It sounds like it must have partially relaxed since the diver could get some air.

Does nobody teach this?

DD, I have not heard of this as a way of coping with laryngospasm. Frankly, I don't think it will work either. My reasoning is that the muscles are spasming, and when doing that it would seem impossible to have coordinated muscle activity. However, I'll let DDM chime in on that one too.

SeaRat

John C. Ratliff, CSP, CIH, MSPH

 

[TSandM]

When you experience laryngospasm, it is a spasm, and it is not amenable to voluntary control. Swallowing may remove the irritant, but persistent presence of the irritant is not required for maintenance of the spasm. It doesn't take a corrosive like stomach acid to do it, either -- water can be enough. My friend NW Grateful Diver had an experience with this during one of his cave classes, where he inhaled water from an unpurged regulator and went into laryngospasm.

It WILL generally relax, given enough time, but the question is whether the person experiencing it will remain conscious until it lets go. Vigorous attempts to inhale don't help the situation, because they drop the pressure below the larynx, and tend to perpetuate the spasm. Positive pressure, as with someone doing mouth-to-mouth or bagging with a mask, can sometimes break the spasm, but that's not generally an option while you are underwater!

Sounds to me as though this was handled perfectly.

 

[fisheater]

What are the dangers of ascent to a person with an active laryngospasm?

Will the expanding air in the lungs be able to escape through the spasm? Or does it act as if one is holding one's breath?


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