pete340
Contributor
divemed06:
Even if the person you're talking to doesn't get your point there are many lurkers who do. Don't let it bother you.
Unconsciousness/Blocked Airway/Embolism
- Thread starter Rick Murchison
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Even if the person you're talking to doesn't get your point there are many lurkers who do. Don't let it bother you.
divemed06:
Doc,
We value our Diving Docs very highly here, because we are well aware that the average practitioner, through no fault of his or her own, knows very little about the peculiar physiological effects of the watery world.
We appreciate your contributions. We hope that you will continue to participate regularly.
Thanks!
BJD
wolf eel
Contributor
Ok Listen all I ever said was that it most likley will not happen. The other came from another thread about a person who lived with others there to aid him. He lived. Under the same reason we have gone over a hundred times. I have been under the gun for some time and to say you will have a embolism is wrong you may. That being said then you may not most likley not. Is a better answer. Sorry for my bad english but well that is the way it is.
I never ever said I was a doctor. I never pretended to be a diving doctor either I aslo never said anything about tec diving and all others. Can you please explain to me what you are talking about as I am now at a complete loss does the throat stay closed or will it remain open and if it does stay closed then why is there so many people who live because air expanded out the of the lungs with out lung damage.
I know you can have damage I know you can have all kinds of different injuries I know all kinds of poop can go wrong but what about what can go right. All this thread was about was embolism thats it. None of the other million and half other things that can go wrong.
All I ever said is it is better to leave the bottom in a hurry and that MOST LIKLEY the victom will not embolise. IS THIS WRONG ?
Derek
wolf eel
Contributor
You do know that he is only a MD and not a diving Doctor right ?. That is my point. !!!!
wolf eel
Contributor
No worries as I will be calling DAN or another diver related doctor.
And if you ever come to the west coast please do call e-mail me and lets go diving. And maybe have some fun.
You do dive that again is not an insult but a question as you have none mentioned on your profile. I know that does not mean a thing.
Please do come on out and dive the coast I hear it's cold out your way. Today i dove and it was 20 C nice and warm.
Derek
Scuba
Contributor
wolf eel,
If the diver is not breathing underwater, inhaling and exhaling, which is the only way to know for sure underwater if the airway is open, then:
I believe this is an accurate statement coming from various doctors and people knowledgeable on this subject, and the best we have to go by. Unfortunately, this situation presents a degree of uncertainty, all we can do is take the best odds.
If my recollection is correct, regarding the accident Dr Paul suffered, he was unconscious underwater for about 20 minutes without breathing. Regardless of recovery method taken, long before this length of time without breathing, there is only one option, immediate ascent. He was extremely lucky to survive and recover to the degree he has. He is the exception to the norm.
Thank you Doppler for posting your assisstance protocal regarding a controversial issue many don't even want to disccuss.
If the diver is not breathing underwater, inhaling and exhaling, which is the only way to know for sure underwater if the airway is open, then:
by BillP, from the thread I posted a link to.
I believe this is an accurate statement coming from various doctors and people knowledgeable on this subject, and the best we have to go by. Unfortunately, this situation presents a degree of uncertainty, all we can do is take the best odds.
If my recollection is correct, regarding the accident Dr Paul suffered, he was unconscious underwater for about 20 minutes without breathing. Regardless of recovery method taken, long before this length of time without breathing, there is only one option, immediate ascent. He was extremely lucky to survive and recover to the degree he has. He is the exception to the norm.
Thank you Doppler for posting your assisstance protocal regarding a controversial issue many don't even want to disccuss.
wolf eel
Contributor
I understand and I truly mean no harm but look at what i have said and please tell me if I am wrong . I know it may not be open I know that. That is why I have repeated most likley will thats all I ever said.
I then get all this attitude direct at me and statments that do not include what I said or agreeing but disagreeing. OK all I have said is you are right it may happen as there is uncurtainty in what may happen. But we have one man who did live Thats supports the idea as he is alive. I wonder what his doctor would say about it ?.
Derek
Ps I think all along I have said it may happen. Either way.
pufferfish
Contributor
Another board member asked if I might comment on this thread so here is my two aspirins worth. I dive recreationally and have taken a few diving medicine courses but no, I am not an official diving doc.
It seems to me two scenarios are being addressed here:
1) Unconscious non-breathing diver at depth
2) Diver having a convulsion at depth (i.e. ox tox)
Scenario #1
Typical causes: arrhythmia (heart attack), hypercapnia (high CO2), contaminated gas (CO, CO2, etc.), CVA (stroke), hypoglycemia (low sugar) if diabetic. I think in the case of Dr. Thomas he feels he had a paradoxical emboli from a PFO which embolized to the brain resulting in loss of consciousness.
Once the diver is unconscious and non-breathing any kind of laryngospasm will relax usually from the hypoxia (low O2) and hypercapnia (high CO2). Most of those cases of 'dry drowning' are folks who were rescued early, either on surface or partially submerged where their reflex ventilation drive was still present. During this short initial period there appears to be a period of laryngospasm which may keep water out of the lungs although the concept of a 'dry drying' is still controversial. Once however, the diver is non-breathing and unconscious then the spasm would resolve and the relaxed larynx would allow gas to escape.
If I recall correctly in this fatality the diver was unconscious and non-breathing and sinking, but it is not known at this point what lead to his loss of consciousness.
Given this scenario I would suggest that the thing to do is 'load and go' with a controlled emergency ascent as this person needs definitive medical care on surface and you are his ambulance. Surface at a safe rate while trying to keep your own wits about you. This scenario for anyone, even a trained instructor would be very difficult if not practiced beforehand.
I would have to agree with Dr. Paul Thomas and Wolf Eel that once the diver is unconscious and in a relaxed state an embolism from pulmonary barotrauma would be highly unlikely, and hence why one should head to the surface asap. Any expanding air on ascent would expand right out the diver's mouth assuming the diver's head is kept in a position so as to optimize the airway in the open position and allow the gas to escape.
Personally I would come at the diver from behind as I think it would be easier to hold his regulator in his mouth in order to prevent water from entering the airway (expanding air may delay this), and secondly one can actually do a reasonable head tilt (move chin away from chest) easier from behind than in front of the victim so as to maintain a patent airway.
Could someone still embolize in this scenario? Possible but very unlikely. If the diver's head remained flexed forward with his chin on his chest then the airway might remain obstructed by the tongue, or if the person had a tight fitting hood on with no reg in their mouth the hood might force the mouth shut preventing air from escaping. Your job will be to put the reg in the mouth, come from behind with a hand on both sides of the mandible and extend the neck while holding the reg, and then begin your ascent while controlling the buoyancy for you and the victim.
A difficult maneuver and easier said than done, but one with a bit of practice in the pool you could master.
Scenario #2
I don't know what the most common cause of a seizure in divers would be but my guess would be an ox tox followed by anything else that might cause hypoxia or hypercapnia,...heart attack, contaminated air, etc.
The management of this scenario is just a variation on the above.
The diver is unconscious but is convulsing about in the water.
In this case as the airway is often closed during the seizure you should wait until the seizure has stopped up to a reasonable time limit, say three minutes. Most seizures will resolve spontaneously and those that dont need definitive medical care anyway on surface, not more time at depth with the divers brain anoxic. There is a good possibility early in the seizure with a closed airway that ascending with the diver may result in pulmonary barotrauma including an AGE. Again coming in from behind the diver will allow proper control of the airway and regulator, and more importantly prevent you from being injured by the flailing arms and legs if the diver is seizing. As the seizure activity declines with time and the patient relaxes this is when to begin your ascent as in scenario #1.
One should remember that both these situations are very rare and not something I suspect most recreational rescue courses even delve into. Probably more the realm of technical diving but it never hurts to think about these things ahead of time as they do happen from time to time as the Lillie fatality showed. From what I read in the newspapers it sounded like the Lillie diver was unconscious and non-breathing before he was brought to the surface.
Hope that helps but remember the management of many of these rescue scenarios is not set in stone. There are not enough of these cases in real life to do any proper studies on procedures so we must rely on common sense and what we know from experience at 1 atm.
It seems to me two scenarios are being addressed here:
1) Unconscious non-breathing diver at depth
2) Diver having a convulsion at depth (i.e. ox tox)
Scenario #1
Typical causes: arrhythmia (heart attack), hypercapnia (high CO2), contaminated gas (CO, CO2, etc.), CVA (stroke), hypoglycemia (low sugar) if diabetic. I think in the case of Dr. Thomas he feels he had a paradoxical emboli from a PFO which embolized to the brain resulting in loss of consciousness.
Once the diver is unconscious and non-breathing any kind of laryngospasm will relax usually from the hypoxia (low O2) and hypercapnia (high CO2). Most of those cases of 'dry drowning' are folks who were rescued early, either on surface or partially submerged where their reflex ventilation drive was still present. During this short initial period there appears to be a period of laryngospasm which may keep water out of the lungs although the concept of a 'dry drying' is still controversial. Once however, the diver is non-breathing and unconscious then the spasm would resolve and the relaxed larynx would allow gas to escape.
If I recall correctly in this fatality the diver was unconscious and non-breathing and sinking, but it is not known at this point what lead to his loss of consciousness.
Given this scenario I would suggest that the thing to do is 'load and go' with a controlled emergency ascent as this person needs definitive medical care on surface and you are his ambulance. Surface at a safe rate while trying to keep your own wits about you. This scenario for anyone, even a trained instructor would be very difficult if not practiced beforehand.
I would have to agree with Dr. Paul Thomas and Wolf Eel that once the diver is unconscious and in a relaxed state an embolism from pulmonary barotrauma would be highly unlikely, and hence why one should head to the surface asap. Any expanding air on ascent would expand right out the diver's mouth assuming the diver's head is kept in a position so as to optimize the airway in the open position and allow the gas to escape.
Personally I would come at the diver from behind as I think it would be easier to hold his regulator in his mouth in order to prevent water from entering the airway (expanding air may delay this), and secondly one can actually do a reasonable head tilt (move chin away from chest) easier from behind than in front of the victim so as to maintain a patent airway.
Could someone still embolize in this scenario? Possible but very unlikely. If the diver's head remained flexed forward with his chin on his chest then the airway might remain obstructed by the tongue, or if the person had a tight fitting hood on with no reg in their mouth the hood might force the mouth shut preventing air from escaping. Your job will be to put the reg in the mouth, come from behind with a hand on both sides of the mandible and extend the neck while holding the reg, and then begin your ascent while controlling the buoyancy for you and the victim.
A difficult maneuver and easier said than done, but one with a bit of practice in the pool you could master.
Scenario #2
I don't know what the most common cause of a seizure in divers would be but my guess would be an ox tox followed by anything else that might cause hypoxia or hypercapnia,...heart attack, contaminated air, etc.
The management of this scenario is just a variation on the above.
The diver is unconscious but is convulsing about in the water.
In this case as the airway is often closed during the seizure you should wait until the seizure has stopped up to a reasonable time limit, say three minutes. Most seizures will resolve spontaneously and those that dont need definitive medical care anyway on surface, not more time at depth with the divers brain anoxic. There is a good possibility early in the seizure with a closed airway that ascending with the diver may result in pulmonary barotrauma including an AGE. Again coming in from behind the diver will allow proper control of the airway and regulator, and more importantly prevent you from being injured by the flailing arms and legs if the diver is seizing. As the seizure activity declines with time and the patient relaxes this is when to begin your ascent as in scenario #1.
One should remember that both these situations are very rare and not something I suspect most recreational rescue courses even delve into. Probably more the realm of technical diving but it never hurts to think about these things ahead of time as they do happen from time to time as the Lillie fatality showed. From what I read in the newspapers it sounded like the Lillie diver was unconscious and non-breathing before he was brought to the surface.
Hope that helps but remember the management of many of these rescue scenarios is not set in stone. There are not enough of these cases in real life to do any proper studies on procedures so we must rely on common sense and what we know from experience at 1 atm.
My $.02 I am a CDMT Dive Medical Technician. I was on a Dive team for 5 years. Can a conscious diver embolize on too rapid of an ascent,yes, and therefor so can an unconscious diver. Is it unlikely one would bring up a diver too fast, I think not, nobody wants to embolize. It was said earlier in this thread and I have to BUMPTY BUMPTY, the lesser of two evils is to get the diver to the top ASAP CAUSE I CAN'T PUT A DEAD GUY IN MY CHAMBER. I can punch him/her to 165fsw in about 5 seconds once in the chamber and reduce all air in any tissue, and then spend hours learning about why he was a dumb*** and embolized himself. BUT I cannot bring a dead guy back to life. JMHO
If this was already a dead subject sorry but I skipped a couple pages of Bantering
If this was already a dead subject sorry but I skipped a couple pages of Bantering
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