Choking underwater

[soltari675]

I have chronic acid reflux and occasionally I'll have this happen when I'm asleep. Suddenly I will get acid coming up to my throat which is usually just inconvenient and solved with Omeprozol. But on rare occasions, my throat will have the same spasm. I find I have to get upright and swallow several times and it will release. It might take it a moment and I have to gasps breaths whenever I can, but it does let go. Spooks me each time as well to be honest.

If this happens to be the cause, try to remain just slightly head up after you eat. Keep your depth such that you won't bump a reef. If you need a level picture, try to find bare sand to rest your feet on so you can get lower and closer to the reef. Try to get head down as little as possible. It definitely helps. I second going to see a doctor to see if this is at all the cause of the problem, just what causes it for me every time. I know I have to take a Prilosec (Omeprozol) whenever I dive because of the reflux issue.

Great job to you and your buddy. You did an awesome job handling it!

 

[TracyN]

I had this happen to me once in a cavern when I was learning how to use my doubles. I inhaled some water which caused me to cough and have the laryngospasm. The coughing caused me to inhale even more water and I surely thought I was going to die. I even tried switching regulators thinking that something was wrong with the one I had but that didn't help. Bless the buddy that was next to me as he attempted to give me his octo which was not what I needed, lol. I was turtled on my back which made the problem even worse. I resigned myself to the fact that I was going to drown in the ballroom at Ginnie with nearly 200 cubic ft of gas in my tanks when my other dive buddy who was an instructor came over and got me to kneel on the bottom where I was able to gather myself and get my breathing back under control. It was the longest 45 seconds of my life.

 

[jamjam]

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?

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The most common reaction of the body is try and cough up the irritant. You can't 'swallow' it as the problem is that it it going down the trachea and not the esophagus. It's this coughing that often causes the spasms (think of it as closing to prevent more irritants in). Swallowing water def won't help since you're struggling to breathe and the last thing you now want is try and get your body to try and swallow water as well. (Think of it on the surface - when you're in the midst of a coughing fit cos you swallowed something the wrong way, you don't want to drink water until AFTER the spasm has eased a bit and the irritant is back up and out of the airways, and THEN you swallow water to get the irritant down the right way down the esophagus).

The only thing you can do is to try and breathe in as deeply as you can, staying calm. KNOW that you will NOT be able to breathe in deeply but it WILL improve with each breath.

Watboy did the right thing with ascending while this was happening since there is a danger of passing out, in which case mouth-to-mouth is needed. However, in most cases, spasms go away on their own.

And yes, it can be embarrassing once it's over cos there is no after effect once the spasm is over - person looks and feels normal. BUT it IS serious and should be treated seriously at the time.

 

[Sleepdr]

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.

There are more than a few grey hairs on my balding head from laryngospasm. The worst are the kids whose parents lie about recent colds/coughs so surgery doesn't get delayed. Second worst are adults who combine recent colds, reflux, and irritable airways from smoking.

We sometimes joke that all spasm relaxes eventually, but that's like saying all bleeding stops eventually. It sounds like the OP and buddy handled things very appropriately. Not being skilled in underwater intubation myself, I can't imagine doing much beyond making sure a buddy's second stage stays in the mouth and expediting him to the surface.

 

[billt4sf]

You can get laryngospasm from any number of things -- you don't even have to have an irritant in the pharynx to do it.

I wonder whether this type of spasm could be brought on from vomiting (esp. if some of the fluid goes back down the wrong way). My wife frequently has dizziness or vomiting from seasickness -- not only from our diving activities, but she can even get it from going around in a parking garage (or even turning around in the kitchen).

Thanks for the thread -- something to be aware of.

- Bill