Choking underwater

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Good Question Fisheater. I might be inclined to stay put for a few.

I had it happen to me once when Kayaking...did an inverted exit in COLD Lake Michigan..took my time, exited the boat and got my head out of the water and couldn't breath at all....As TSandM said it is like a muscle spasm..I just waited a few seconds (maybe 25 seconds that seemed like minutes) and it passed. If I were submerged it would be very scarey but I would think the proper action would be to try to relax while you get your buddies attention as the OP did.
 
To be honest, my thought process never reached the point of getting my buddies attention. All I was doing was trying to breathe and maintain neutral buoyancy, there was nothing beyond that. Forcing to breathe wasn't working so I tried to relax a bit, it was at that point my buddy signaled me. No idea how long that took, could have been 10 seconds or 30 seconds. But it was my buddy who came to me.
 
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.

I must be a fool to argue with a doctor, but trying to swallow the irritant seems like a potentially more productive activity than waiting until you pass out.. right? I have had it a few times, where you "inhale" water, I assume it is sitting on the epiglottis, it cramps up, hurts like hell, you can't move any air in or out, but when you swallow it resets the "flap" and relases the spasm.
 
It doesn't matter whether you remove the irritant or not, the spasm may persist. My guess is that you were distracted by thinking about trying to swallow, and in the meantime, the spasm relaxed.

You can get laryngospasm from any number of things -- you don't even have to have an irritant in the pharynx to do it. The most frightening case I've been involved with was a woman who developed it as a side effect of an anti-nausea medication. We thought we were going to lose her (you can't insert a breathing tube through severe laryngospasm).

Regarding the question about ascending . . . in most cases, positive pressure will succeed in getting flow past the spasm, whether that's positive pressure from below or applied from above, by positive pressure ventilation. If the ascent were sufficiently rapid, however, the expansion might be faster than the ability to vent through the apposed vocal cords, so lung barotrauma is a DEFINITE risk of uncontrolled or rapid ascent in the face of laryngospasm.
 
What was the anti-nausea med that caused the reaction?
 
Inapsine. What made me shake my head was that her old chart came up about the time we were happy that she was okay, and sure enough, she'd had inapsine before and had the same reaction to it. She had not said anything about any allergies or intolerances when she came in. So, at the end of her visit, I went in and talked to her and told her that this was a medicine she could NOT take, because the next dose could kill her. I really stressed it, and even wrote the name of the medicine down on a piece of paper and gave it to her and told her to put it in her wallet, because it was clear that she was going to be treated for nausea and vomiting in the future, and this was a med we were very likely to use.

So the next time I saw her, she had told the nurse, "I'm allergic to some medicine, but I don't know what it is." Some people you just can't help . . .
 
Interesting. We used to carry Phenergan, but they replaced it with Zofran, mainly because of concerns about tissue extravasation. I think I give more Zofran in the field than any other medication, including nitroglycerin.
 
I must be a fool to argue with a doctor, but trying to swallow the irritant seems like a potentially more productive activity than waiting until you pass out.. right? I have had it a few times, where you "inhale" water, I assume it is sitting on the epiglottis, it cramps up, hurts like hell, you can't move any air in or out, but when you swallow it resets the "flap" and relases the spasm.
DD, I think your impression of the anatomy of the larynx is somewhat mistaken. I don't think the epiglottis causes the problem with laryngospasm, but that it is the muscles around the glottis that cause the problem. It is in the larynx itself. Here is a diagram of the structures of concern. And here is a You Tube video of these phenomina:

Laryngospasm and Vocal Cord Dysfunction - YouTube

Now, I have a question for DDM and TSandM; it appears that the structure of the larynx is close to what we use in double hose diving called a duckbill valve. The duckbill valve allows one-way passage of air, but closes down much more easily in the other direction. The larynx appears to have much the same structure, in which it would be much easier to pass pressurized air out than into the lungs. This is just an observation, and I have no studies or other information on this. But it is an interesting observation.

SeaRat
 
You're quite right -- it is easier to exhale with laryngospasm than to inhale. That's why positive pressure ventilation can sometimes succeed in supporting the patient through the issue, since the external positive pressure can get gas through the valve, and then the patient can exhale it.
 
So the correct course of action if you experience one of these spasms is to remain calm, avoid the temptation to try and forcefully inhale, secure your reg and begin a slow and controlled ascent?

If it is seawater or vomit that has caused it, can any harm be done by swallowing? It would make sense to try and remove any irritant.

If you do suffer a spasm for long enough and fall unconscious, will you naturally re-establish your airway without any assistance? or will you need mouth to mouth?

Sent from my iPhone using Forum Runner
 

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