diver passes out at 10mt

[lamarpaulski]

I'm wondering if she told the Doctor the same near-deadly story you relate here. Hard to believe Doctor would OK further diving without a battery of tests and a time period of monitoring. I have a friend who simply passed out at work one day. It was a total medical mystery. Doctors were unable at first to identify anything wrong. Nothing happened for quite awhile then it happened again. He was an otherwise healthy 45 year old male. I noticed he really minimized the first incident as opposed to what witnesses described. It took them (host of Doctors) a long time to identify a heart valve irregularity and he continued to ride motorcycles, against advice, in the interim ! He has since been fine with a precautionary pace-maker and medicine. Still rides every day.

 

[uncfnp]

Agreed. The most common cause for syncope for young adults is neurocardiogenic (vasovagal, fainting). But this episode sounds too long for a simple faint. And the OP reports no activity during or post event to suggest seizure (on a side note, fainting can sometimes cause movements that can be confused with a seizure). With a simple faint the physical exam will be normal making the diagnosis one more of exclusion when history and physical make other causes unlikely and the circumstances of the event support the diagnosis.

The two most worrisome causes for syncope in a young diver would be seizure as TSandM pointed out or a cardiac arrhythmia (especially one associated with sudden death such as prolonged QT or Brugada Syndrome) as Lamar wrote. I hope that a thorough personal and family history was done and that the patient was honest with her answers. And absolutely an EKG. If it is an option, at the very least, I think I would require a cardiac clearance prior to resuming diving.

 

[Peter_C]

CO does affect people in different ways. If there is a way to test the tank I would strongly recommend it. Rule everything out possible, especially something as easy and cheap as testing a tank. Heck one could buy a CO meter for less than a doctors bill. Then you can test all your tanks. Fire departments often have CO testers too. ALL dive shops that do fills should have a CO meter on their compressors. Maybe, just maybe you can find a dive shop that owns a CO meter. A kit could also be ordered and send an air sample out for testing from her tank.

Otherwise the medical personal above covered the physical problems very well.

 

[eternaljonah]

doctor, thinks its dehydration and lowish sugar levels but says she is fine. She is convinced that she's fine.

there was no convulsions she was totally relaxed, it was almost as if she had fallen asleep underwater.

i'm still trying to figure it out but most other people think she's fit to dive again, i'm still not sure, may take her on a test dive alone ….

 

[TSandM]

I'm sorry, but a healthy young woman does not become and remain completely unresponsive for five minutes or more from dehydration OR low blood sugar levels. Unconsciousness due to dehydration requires SEVERE volume depletion, and even worse depletion to occur underwater, where blood volume centralizes. It's the same with blood sugar levels - the person will feel shaky and ill long before losing consciousness, and to get your blood sugar that low really requires a drug. We're built to mobilize sugar rapidly, even in the face of major exertion (people run marathons!) and it takes a serious problem to prevent that from happening.

I will, as a medical professional, make a strong statement: This is NOT a normal occurrence and cannot be easily explained. Losing consciousness underwater is potentially lethal. This young woman should undergo more medical evaluation, to include an EKG, and possibly an echocardiogram. I would recommend at least several months of avoidance of scuba unless a clear explanation of the event has been found AND resolved.

 

[eternaljonah]

I Agree with what has been posted so far and am a little surprised how most people involved seem to think she'll be ok. i have made here go and get an EKG and then we may know more. but she has had a complete medical blood test and the like. we do not have any doctors here that are qualified for diving medicine. so its very much of a guessing game. 2 different doctors have cleared her. if after that all seems fine i'll take her on a test dive alone and see what happens.

or does any one else have any idea how I could test it.

 

[knotical]

Seconding what victor said in post #4, it might be instructional to find out what Divers Alert Network Asia-Pacific says: info@danasiapacific.org

 

[diving4ever]

I've had two friends both relatively young (under 40) who experienced bouts of unconsiousness that were never defininitively explained. Both are fine now. The first began passing out while standing. Not while walking, working out, or doing anything strenuous...it was just...TIMBER. She had CatScans, an EKG, and lots of other tests. After a couple of months of tests and 6-7 episodes, the episodes became less frequent. At that point her internist suggested it might be a virus that was impacting her VesoVagal nerve (or something like that). She had a couple more incidents and then it stopped and has never reoccurred. This was years ago.

The second was a friend who couldn't be woken from sleep one morning. She was breathing but wouldn't respond to her husband, open her eyes, or move. This went on for long enough (more than 5 minutes) that he called 911. By the time they arrived, she was awake and fine. Tests revealed nothing and she never had another incident.

I'm not making light of this incident (it sounds scary as hell) and obviously she needs to continue getting tested, but sometimes things resolve themselves before the Dr. can make a diagnosis. If I was that diver, I'd get every test I could and I'd refrain from diving until I knew what had happened and/or enough time had passed that I knew it wasn't likely to be something chronic. Even then, I'd want to move forwad with diving in a very careful and transparent way. But at some point I would want to try again--whether or not the incident was diagnosed and treated.

Melissa

 

[eternaljonah]

Cheers!!! have sent Dan a mail and am getting the EKG done will share once i know more

---------- Post added July 18th, 2014 at 03:40 PM ----------

[FONT=Calibri, sans-serif]Below is DAN's reply [/FONT]
[FONT=Calibri, sans-serif]" This sounds very bad and it’s lucky she survived. It’s hard to suggest what happened as there are a variety of factors that can cause unconsciousness underwater and unless it was an astute diving physician who gave her a “clean bill of health”, there could have been underlying problems. It could be epilepsy, diabetes which a good medical history and assessment should exclude. It’s possible that she might have had a vasovagal event (faint) from dehydration after the long snorkel swim. In any event, she should be seen and carefully assessed by a good dive doctor (if there is one in that area) before diving again. "[/FONT]

[FONT=Calibri, sans-serif]the EKG report says she's clear and healthy [/FONT]

[FONT=Calibri, sans-serif]now what?she has been wanting to dive again and get the experience behind her. i guess its normal [/FONT]

 

[Duke Dive Medicine]

I agree with TSandM and uncfnp. The fluid volume redistribution that occurs with immersion decreases the likelihood that this was a vasovagal response. I would lean toward transient cardiac dysrhythmia as TSandM and uncfnp mentioned. If she has a low panic threshold it could be psychogenic. I doubt that it's related to dehydration, again because of the immersion factor. If she was dehydrated enough to become unconscious under water it's unlikely that she would have recovered spontaneously on dry land after her blood redistributed itself into her extremities.

ECG will catch an ongoing dysrhythmia but may not detect one that's transient - for that she would need a 24-hour Holter monitor or the equivalent. In any event I agree 100% with TSandM in that this diver should not dive until the cause of this event is determined. She was very fortunate that you were right there and probably owes her life to you.

Best regards,
DDM