Unconscious Snorkeler - POTS

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NewScubaDude

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Location
Folsom, Ca
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We recently took the kids on a snorkel tour boat the day before a dive in Hawaii and had a worrisome experience…

A seemingly fit young woman in her teens/20’s was suddenly unconscious in the water with no obvious reason. A couple people were struggling to get her onto a surfboard and keep her head above water. The boat crew did a fine job responding quickly and getting her back onboard the boat.

O2 was given and they put her in the recovery position. She regained consciousness briefly before nodding off again. Thankfully she never stopped breathing, though she was completely unresponsive for quite some time. After about 30 minutes we reached a dock with a waiting ambulance. She was now awake, sitting up, though very pale.

A doctor onboard who helped treat her said she’d recently had COVID and believes she experienced POTS as an after effect. Thankfully, she looks like she’ll make a speedy recovery, though without that quick response things could have been much different.

Keep postural hypotension in mind when swimming with others and keep their head above water if anything goes wrong. An unconscious person in water is absolutely helpless and much more difficult to maneuver than someone on land.

POTS: Causes, Symptoms, Diagnosis & Treatment
 
Just curious - was she using mask/snorkel or a full face snorkeling mask?
 
Just curious - was she using mask/snorkel or a full face snorkeling mask?
I wasn’t near her group prior to this happening so I can’t be sure, but I saw very few full face masks in use. I suspect it was a mask/snorkel setup (and if I’ve learned anything on this board probably split fins). Her family stripped her equipment as she started having an issue and I only noticed her once she was already unconscious.
 
If she was cruising around supine on snorkel and and became "unconscious", she may have been hpotensive and even tachycardic for some reason, but POTS would seem unlikely since by definition it implies an orthostatic change in posture: standing up after sitting, stooping, kneeling, etc.
 
I believe his thought was that she changed posture from snorkeling to an in-water upright position thereby causing the orthostatic hypotension. If she’d been gently kicking around/floating for a while and then stopped to adjust her mask, talk to a friend, etc. she’d be in a sudden upright position.
 
You wouldn't get orthostatic hypotension by going upright from supine in water due to the hydrostatic pressure on the lower portion of the body. I seriously doubt it was POTS from this scenario, unless there is something else about the story I'm not aware of. If she had a history of POTS my guess is the MD on board just assumed that's what it is. If no history, more likely to be something else. POTS is normally a diagnosis of exclusion.
 
Before I would accept a diagnosis of POTS I would want an eye witness saying that she was perfectly fine until she stood up. Additionally, I would want a full evaluation at the hospital to include recent and past health, medications, recent consumption, physical exam, lab work, snorkeling experience, and more, because going "unconscious", if that's what really happened, is obviously serious. And if I were the doctor on the boat, I wouldn't publicly speculate unless it determined emergency on-the-spot treatment.
 
You wouldn't get orthostatic hypotension by going upright from supine in water due to the hydrostatic pressure on the lower portion of the body. I seriously doubt it was POTS from this scenario, unless there is something else about the story I'm not aware of. If she had a history of POTS my guess is the MD on board just assumed that's what it is. If no history, more likely to be something else. POTS is normally a diagnosis of exclusion.

This, plus 30 minutes loss of consciousness isn’t particularly compatible with orthostasis or a cardiocirculatory problem that doesn’t require CPR…
 
That she was so unresponsive especially for so long had me doubting anything postural as well, but that’s the best the MD who spent quite some time with her and her family came up with. What could cause her to go lights out that suddenly and severely? It almost certainly wasn’t a diabetic issue and there wasn’t any trauma.
 

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