Diver Died In West Palm Beach, Fl.

[truck1]

[/QUOTE]Is it common practice for the AED's to no shock he victim if they are flatlined? I was unaware of this. I am not a Paramedic, but wouldn't a shock to reinstate rhythm be preferred?

The short version is that AEDS or even manual defibs when they deliver a shock, basically resets a hearts rythm.The heart naturally has electronic attachment points where a pulse is delivered to the heart in a specific order, for things to work properly.when the heart fires out of order is when the problems begin.A charge from an aed bascially reformatts the heart for lack of a better term.Assuming the pt has a correctable rhytm to begin with.when a pt is considered flat lined, the pt does not have a heart beat, and an AED will not advise a shock. It will say continue cpr.

 

[truck1]

I just finished my EFR/DAN O2 courses about a month ago and they showed us two medical oxygen regulators. As I understood it, one was the demand valve like you mentioned which was to be used for responsive victims only, and the other was a continuous flow which is for shallow breathing but responsive patients. You could attach the continuous flow hose to a pocket mask though and when you're giving rescue breaths, you integrate O2 into your rescue breathing. Feel free to correct me if I'm wrong.

Thanks for the info and advice on the AED's though. The one thing that we can all use in incidents like this is to stop and double check ourselves and make sure that we are all able to learn something or at least refresh related (EFR/AED) skills.[/QUOTE]


No problem.
If that is what they are teaching in EFR than stick with it. I did not have to take it as I am trained to a higher level.My cert actually supercedes it.
All of the boats o2 systems I have looked at have that system.
As firefighter/emt, I can honestly say that we do not use the demand style regulators anymore, because of the lung overexpansion injuries. What happens and it can happen in a respponsive victim also is that the rescuer gives to much oxygen too long and basically blows out one or both lungs. The ideal way to avoid it if you have no choice but to use one on a responsive pt would be to not seal the mouth so that there is less pressure going in to the lungs.Other than that, holding that button too long can and will hurt someone even more. The other issue is that that type of regualtor cannot differentiate between a smaller person or a larger person, and if you are a long distance from shore, and you run out of o2, then the device will no longer work.
The bag valve masks are sized for the person you are using it on.There has been many of times we have run out of o2 and had to swap bottles on scene for one reason or another and kept going with a bvm.

There is nothing wrong with using a pocket mask with supp o2. It will however get tiring over time.

The best thing to do and I do this all of the time at work and when I dive is this: Take a known situation that some one else has had. Find out what worked and what did not work. Then ask your self, what would I do in that situation?What can I do to better prepare. In this situation, I dont think there is anything that could have been done differently that would have changed the outcome.Short of divine intervention. If you have any questions, feel free to pm me.

 

[mkutyna]

Most O2 kits from DAN with demand valves don't have the purge button on them to protect against overexpansion injuries. DAN does have some with the purge buttons but I think you have to have more than the standard O2 provider certification to be able to buy them.

 

[Hetland]

In my first responder course through the dive shop I asked about AEDs on boats. They said many (most?) small boats don't carry them because there is water everywhere, makes sense to me./QUOTE]



Most AEDs are self grounded and as long as you are not touching the victim, they are safe. You are supposed to dry the victim's chest first but they can be lying on a wet metal floor and there won't be a problem. They only work if there is a shockable rhythm and will analyze the patient before recommending a shock. If the patient is flat line, they are of no help but CPR should be continued to try to get back a shockable rhythm where an AED would be of help.

They are safe in dive boats and the area need not be dry.

Most people do not understand this (even some people that have supposedly been trained in their use). An AED is not some silver-bullet resurrection machine. It's simply a "reset button" for the heart's electrical system. I've done CPR more times than I care to remember, and shockable ryhythms are not as common as prime-time tv would have you beleve. Requiring all boats to have them is overkill.

 

[pescador775]

I was a YMCA instructor and held classes for a couple years. In that time, and we are only talking about a 1/2 dozen classes, I observed a total of two female students exhibit distress in the pool and one woman panic in open water. The symptoms resembled a heart attack or extreme fright, or both showing hyperventilation, collapse and confusion. There was nothing wrong with the air supply or equipment. I insisted on, and got, additional opinions from physicians on all three. Nothing wrong (normal exams). Eventually, all certified. One drowned while on a charter and the others went on to dive without any further incident that I am aware of. In that time, there was also one male who panicked in open water. This incident did not resemble a heart attack, more like he had been hit on the head, and I was able to help him straighten out. He graduated without further incident. All four were in their twenties-thirties agewise.

 

[Iain Thysse]

Is it common practice for the AED's to no shock he victim if they are flatlined? I was unaware of this. I am not a Paramedic, but wouldn't a shock to reinstate rhythm be preferred?

Just a quick note on AED's and O2. AED's work by passing an electrical current through the heart to basically start it from scratch. The heart contracts to pump the blood around...this starts by bundles of nerves "firing" causing the heart to contract. Nerves "fire" using small amounts of electricity. The problem comes in when the electrical system in the heart gets confused and then the nerves don't "fire" in the right order causing the heart not to contract but quiver. At this point the AED would recognize this rhythm and deliver an electrical current to the heart causing all the nerves to "fire" at once, followed by a time with no "firing" and then the body should start the sequence in order again. The two pads are what deliver the current across the heart and thus even if the patient is lying on a wet deck there should be no current flowing to it. The problem would be if you were in contact with the patient as the current would then flow from the pad, through the patient, into you and down onto the deck causing you to have the full extent of the current and possibily doing the same to your heart as you were hoping for your patient.

Bag valve mask resuscitators are the best way of delivering O2 as you can get very close to 100% O2 to the patient. There is a technique to it as if the head is not properly positioned you can force air into the stomach and eventually cause the patient to regurgitate their stomach contense (vomit). This in turn could be aspirated (breathed or forced into the lungs), which is a serious problem. Please ask if the person who is doing your CPR resert is able to show you how this piece of equipment works before trying to use it.

I hope this is helpful to all. I have not gone into a huge amount of detail in this post as I am just trying to give a very basic understanding

 

[scubaman345]

This woman seems to have a lot of connections--- her death has been published 4 times in the st pete times. Today in the front page. It seems as though there will be a thorough investigation to this death, as it wasnt any medical issues as like a heart attack-- and many lawsuites I presume after.

 

[scubaman345]

It also says that she swam 250 laps a day, and was used to being in deep waters and in water in general. All very interesting. With no medical history.

 

[TexasFencer]

Well, I guess swimming on top of the water where air is right at the surface and swimming underneath it when you carry your own are fairly different things. It would be possible, I presume, for someone very comfortable at the surface to have serious problems diving. I would just wonder why no previous symptoms showed in the pool work or earlier dives.

 

[Randy43068]

Is it common practice for the AED's to no shock he victim if they are flatlined? I was unaware of this. I am not a Paramedic, but wouldn't a shock to reinstate rhythm be preferred?

Just a quick note on AED's and O2. AED's work by passing an electrical current through the heart to basically start it from scratch. The heart contracts to pump the blood around...this starts by bundles of nerves "firing" causing the heart to contract. Nerves "fire" using small amounts of electricity. The problem comes in when the electrical system in the heart gets confused and then the nerves don't "fire" in the right order causing the heart not to contract but quiver. At this point the AED would recognize this rhythm and deliver an electrical current to the heart causing all the nerves to "fire" at once, followed by a time with no "firing" and then the body should start the sequence in order again. The two pads are what deliver the current across the heart and thus even if the patient is lying on a wet deck there should be no current flowing to it. The problem would be if you were in contact with the patient as the current would then flow from the pad, through the patient, into you and down onto the deck causing you to have the full extent of the current and possibily doing the same to your heart as you were hoping for your patient.

Bag valve mask resuscitators are the best way of delivering O2 as you can get very close to 100% O2 to the patient. There is a technique to it as if the head is not properly positioned you can force air into the stomach and eventually cause the patient to regurgitate their stomach contense (vomit). This in turn could be aspirated (breathed or forced into the lungs), which is a serious problem. Please ask if the person who is doing your CPR resert is able to show you how this piece of equipment works before trying to use it.

I hope this is helpful to all. I have not gone into a huge amount of detail in this post as I am just trying to give a very basic understanding

I have to take issue with the idea of "The problem would be if you were in contact with the patient as the current would then flow from the pad, through the patient, into you and down onto the deck causing you to have the full extent of the current and possibly doing the same to your heart as you were hoping for your patient."

I don't see how that can happen from a battery operated AED. Where would the electrical path from the patient through the deck then back to the AED be?

The path for electrical current would be from one paddle to the other not to the deck of the boat, right? If you placed your hand between the paddles while touching the boat deck ( assuming metal, not fiberglass) then I could see how you could get a shock.

I'm not stating this as a fact but rather a question.