Diving Accident, Self-Responsibility and Balance

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It is not peer reviewed scientific research and in any event it does not conclude that panic attack cause cyanosis or that cyanosis is a symptom of panic attacks.
Right. Whatever you have to tell yourself to believe you're right. Vasoconstriction can cause cyanosis, and is present in panic attacks. I've posted the mechanism the body uses. You can deny, deny, deny all you want; but it doesn't make it real. You compain about this being self-reporting; what do you think her report is? As I said many times, at this point there is no indication of a medical event; however EVERY symptom fits perfectly with panic.

We're all still waiting on you to tell us how her panic helped her survive. Would you care to elaborate on this; or continue to expound on your foolishness?
I really think you need to take a Stress and Rescue class before you continue with your belief that panic helps divers survive.
 
I'm going to step in here for a moment.

First: There is a difference between what happens when you breathe rapidly on SCUBA, and what happens when you breathe rapidly on land. The reason for this is the increased work of breathing on SCUBA, which is likely to cause both a rapid and SHALLOW breathing pattern. This can lead to CO2 retention, shortness of breath, anxiety, and panic. On land, the work of breathing is almost zero for someone with normal lungs, so someone who is panic-stricken is likely to hyperventilate and DROP their CO2, causing the arterial pH to climb. Such patients may complain of tingling around the mouth, or cramping of the hands and feet (I've seen people whose hands we couldn't open). This does NOT drop arterial oxygen saturations, where the HYPOventilation on SCUBA conceivably could (although, because you are breathing such high oxygen concentrations at any depth at all, it doesn't happen in practice).

Second: Adrenaline affects blood distribution, causing it to centralize. Under the influence of sufficient adrenaline, skin vessels constrict, shunting the blood to vital organs and muscle, which if you think about it, is exactly what you would want if the T. rex was chasing you. Under most circumstances, even a very frightened person or someone in extreme pain will not have blue extremities -- but if you add in being cold as well, it's quite conceivable. In fact, as anyone who spent too much time in a swimming pool as a kid knows, cold patients can have blue extremities (and lips) without any adrenaline or hypoxemia involved. Cold patients are EXTREMELY difficult to get accurate pulse ox readings from, and I have seen plenty of people whose pulse ox showed spurious hypoxemia as a result of peripheral shutdown. Pulse ox is a very valuable tool that we use all the time, but any readings have to be interpreted in view of the quality of the waveform and the overall state of the patient, and if in doubt, they need confirmation by arterial blood gas.

Third, lots of things cause bronchospasm. Salt water aspiration can do it. Exercise can do it in some patients. Pulmonary edema can do it -- it can present looking for all the world like a bad asthma attack. Allergies can do it -- bronchospasm can be a primary manifestation of a severe allergic reaction. Direct pulmonary irritation, as in smoke inhalation, can do it -- I get wheezy if I have to stay in a room with a lot of smokers.

The bottom line is that we do not know whether this person had a primary medical event (eg. aspiration, IPE) which caused shortness of breath and panic as a result, or whether she had an emotional reaction to her situation in the water, that caused hyperventilation. We don't know how good the information from the pulse ox is (and that, along with response to a bronchodilator treatment -- which could be just time and reassurance -- are the only pieces of information that point to a true medical problem). We just don't know, and can't know, what actually happened.

There are a lot of good ideas and issues that have been brought up here. Points about dive planning, dive procedure, self-assessment of readiness to dive, health maintenance, etc. have all been good. It's clear the OP has learned a great deal (and has shown amazing grace while doing so) and I suspect other divers reading the thread have been given food for thought, as well.

I doubt it serves a great deal of purpose to continue to argue, either with the OP or with one another, about what exactly happened. Absent the medical record, it will remain unknown (and perhaps even WITH the record, as some things I think should have been done appear not to have been). I agree with the other medical professionals in this thread that pulmonary function testing is not only appropriate but probably absolutely required prior to the OP's return to diving.
 
Let there be light! You really earned your keep today... :)
About all I ever say to her posts, on anything, is "Thank you." Expert advice in many fields, and she's humble about it. :thumb:
 
Right. Whatever you have to tell yourself to believe you're right. Vasoconstriction can cause cyanosis, and is present in panic attacks. I've posted the mechanism the body uses. You can deny, deny, deny all you want; but it doesn't make it real. You compain about this being self-reporting; what do you think her report is? As I said many times, at this point there is no indication of a medical event; however EVERY symptom fits perfectly with panic.

We're all still waiting on you to tell us how her panic helped her survive. Would you care to elaborate on this; or continue to expound on your foolishness?
I really think you need to take a Stress and Rescue class before you continue with your belief that panic helps divers survive.

If the amigdala triggered her fight or flight response this gave her the extra energy and will to summon for help and keep her airways above water while someone actually came to her rescue.

In the gene pool there may be those who instead of being triggered into action by the amigdala full of energy go instead passive and freeze.

She did not go passive and freeze, and she dealt positively with her situation. She dealt positively cognitively and in part driven by emotions by making this post and learning from people's comments.

She was in no position to self-rescue and summoned for help at the time and wants to share, learn, and understand.

She is a survivor.

Also she did not self-report cyanosis and low O2 blood reading - a trained nurse and professional assessed that (and she was not cold water diving in a cold climate).
 
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I read the link which Tony Chaney posted.
However, my internet friend, respectfully, cyanosis is not a symptom of panic or hyperventialtion.

Thea had both cyanosis and low oxymeter readings one confirming the other, and this points to low O2 in the blood (which you do not get from panic or panic induced hyperventilation).

It is not, but she did not hyperventilate. Hyperventilation requires fast and large amplitude breathing. If you have just fast and shallow or large amplitude and slow, you are not hyperventilating. In her case, the fast shallow breathing wasn't moving enough air from and to her lungs to get enough fresh oxygen and the work produced by the fast breathing exacerbated the problem. This leads to an increase of CO2.

If the amigdala triggered her fight or flight response this gave her the extra energy and will to summon for help and keep her airways above water while someone actually came to her rescue.

Her flight response caused the several problems and would probably not be enough if there weren't other people around her to help.
As T.C. said, it did more bad than good.
She didn't need extra energy to keep her airways above the water, she needed simple basic functioning to inflate her bcd, which she wasn't even able to do. That was caused by the panic.
 
It is not, but she did not hyperventilate. Hyperventilation requires fast and large amplitude breathing. If you have just fast and shallow or large amplitude and slow, you are not hyperventilating. In her case, the fast shallow breathing wasn't moving enough air from and to her lungs to get enough fresh oxygen and the work produced by the fast breathing exacerbated the problem. This leads to an increase of CO2.



Her flight response caused the several problems and would probably not be enough if there weren't other people around her to help.
As T.C. said, it did more bad than good.
She didn't need extra energy to keep her airways above the water, she needed simple basic functioning to inflate her bcd, which she wasn't even able to do. That was caused by the panic.

Increased heart rate and breathing difficulties reduce dexterity and ability to execute learned and well-practiced tasks (otherwise performed regularly and very well under normal body functioning).

Your SCUBA externally learned skills won't save you because under those circumstances you can't carry them out.

That is why she needed help.



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Lots of interesting discussion. Some a bit harsh IHMO. Some great advice from highly qualified Medical Doctors as well. I am impressed that Thea has taken the somewhat heated discussion so well. Many new members can be put off by the rather blunt and enthusiastic posting styles.

I'm going to agree with the path she seems to have committed to. Proper Medical investigation by appropriate qualified professionals.

More bottom hours and appropriate training are also great suggestions but how practical it is in her location:idk:

My suggestion is that if you are cleared to dive get more of your own equipment. You mentioned that you couldn't work out how to inflate your BCD. How was the reg breathing? I remember on my OW course I was really struggling to breathe my reg. I figured it was all my fault so I didn't mention it until I had used it for the first 3 dives. I made a comment that my instructor picked up on so he decided to try breathing off my reg. He immediately took it away from me and got me another. He then went and ripped a strip off the service teck for allowing a reg breathing that bad to be put into the rental/school gear!

If you enjoy diving it is worth it to put out the money to have the gear that is right for you! I would suggest you get your own regs and BCD. Nothing beats comfortable gear that you KNOW. You mentioned a back inflate. I personally love the back inflate but some people say they find they get pushed forward face first into the water on the surface. I don't find this but they do work different from the jacket style. Another issue is that it can be a bit more difficult to get all the air out contributing to bouyancy issues. Not being familiar with your gear can also increase task loading.

Reading your posts I also wondered. If there was a lot of serge and you had air trapped in your BCD could there have been some upwelling along the face of the reef? Could that have contributed to you ascent?
 
Also she did not self-report cyanosis and low O2 blood reading - a trained nurse and professional assessed that (and she was not cold water diving in a cold climate).
Who do you think is telling you this? Is her nurse posting, or her? You’re also dealing with self-reporting. You are a fool if you can’t see this.

In the gene pool there may be those who instead of being triggered into action by the amigdala full of energy go instead passive and freeze.
And there are those who do not let the panic control them, and instead respond to rational thought. Those are our ancestors.

The others are lion poop.

We survived, not because we can out-run and out-fight wild animals, but because we can think. By saying that we should abandon that when in trouble, you give up on thousands of years of evolution…and common sense.

She did not go passive and freeze, and she dealt positively with her situation. She dealt positively cognitively and in part driven by emotions by making this post and learning from people's comments.
No, she didn’t. It took other divers to deal with her situation positively, by inflating her BCD and dropping her weights.

She was in no position to self-rescue and summoned for help at the time and wants to share, learn, and understand.
Yes, she was in position to self-rescue. All it would have taken was for her to remember her training and inflate her BCD, drop the weight like she was trained, and retain her regulator.

That’s it.


Increased heart rate and breathing difficulties reduce dexterity and ability to execute learned and well-practiced tasks (otherwise performed regularly and very well under normal body functioning).Your SCUBA externally learned skills won't save you because under those circumstances you can't carry them out.
So, by your “thinking”, when I was in Afghanistan, at 6,500 feet, running with 45 pounds of gear, and breathing hard, my externally-learned skills and ability to think could not function? I know you’re wrong; because my team was able to precisely execute those tasks and close with the enemy.

As a matter of fact, your externally-learned skills are the ONLY thing that can save you. A panicked diver will thrash around until physically exhausted, then, without any energy left, slip underwater and drown. This is well-known and reported.
That is why she needed help.
NO. In fact, she needed help because of the panic. A rational response of slow, controlled ascent, ditching weights, inflating BCD, and retaining regulator would have placed her in far greater stead than panic.

She wouldn’t have even needed rescuing in that case. Instead, the panic required a rescue to save her life.



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WOW.
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I don’t think I’ve read anything so…stupid…before as what follows.
If the amigdala triggered her fight or flight response this gave her the extra energy and will to summon for help and keep her airways above water while someone actually came to her rescue.
NO. It impaired her ability to execute the tasks that REALLY would have kept her on the surface and breathing; namely, dropping her weights and inflating her BCD. These two externally learned skills would have done far more than any amount of panicking to save her.

Panic, in NO POSSIBLE WAY, has ever helped her, or anyone else. In this case, it could have killed her, by preventing execution of the tasks she was trained to do. As I said, her panic almost killed her. It compelled her to make an uncontrolled ascent. It prevented her from properly dropping her weights and inflating her BCD. It prompted her to remove and discard her regulator. It dictated a response that could have been fatal if not for the intervention of nearby divers- who did not panic.

Panic NEVER helps to survive in the water. It blocks the rational thought, focuses on ineffective solutions. It wears you out, depletes your resources in a frantic attempt to escape the water, and causes death. By your (il)logic, every diver in trouble should just panic and shoot to the surface like she did. The better response is a rational problem solving one that identifies the problem and a solution, followed by a controlled ascent, and positive bouyancy. Instead; panic dictates a rapid, uncontrolled ascent and flailing around the surface, often without the regulator or mask, trying to escape the water...until someone rescues them or they die.

Stress and Rescue classes focus on PREVENTING panic. There is a very good reason for that. Panic kills. It NEVER helps.

NEVER.

PLEASE, if there are any new divers reading this thread; this “diver’s” views are NOT endorsed by ANY training agency, group, or even common sense. Please do not think panic will help you.

And, gianaameri, you live in Mallorca? Please let us know if you come to dive in the Americas. We’d ALL like to stay away from you in the water. And, as I said, you REALLY need to take a Stress and Rescue class.

Well, maybe not flots; he did say he likes to keep his rescue skills sharp.
 
I was in Afghanistan, at 6,500 feet, running with 45 pounds of gear, and breathing hard, my externally-learned skills and ability to think could not function? I know you’re wrong; because my team was able to precisely execute those tasks a
nd close with the enemy.

As a matter of fact, your externally-learned skills are the ONLY thing that can save you. A panicked diver will thrash around until physically exhausted, then, without any energy left, slip underwater and drown. This is well-known and reported.

I am on a bus to a place where in addition to the external training you are accustomed to they adopt internal training and code the primitive brain.

Because the srimulus is processed by the primitive brain first, coding from internal training gives a small but effective advantage where the opponent has only received external training.

This works in war and violent confrontations including underwater, but I am not aware of internal training methodologies for non-combat recreational diving.

So, for SCUBA we are stuck/limited with/by external training teaching/learning methods.

Thea could not do much better than she did under the circumstances.



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