Vomiting UW question

[TMHeimer]

If you vomit underwater I've heard the reason you keep the reg in is because you involuntarily inhale immediately afterwords. Is it possible to mentally stop this inhale? I of course would not advise anyone to not have the reg in, just wondering about the physiology. I haven't thrown up since about 1982 so I have no reference. Thanks in advance.

 

[Duke Dive Medicine]

I think it comes from the idea that it's (a) possible to vomit through a regulator and (b) in circumstances where the body is doing something that's beyond conscious control, it's probably better to have the regulator in than out. I don't think that there's an involuntary inhalation after every emesis event, and I'm quite sure there are people out there who have removed a regulator, regurgitated under water, replaced the regulator, and lived to tell the tale. Still, IMHO it's better to keep the breathing gas source in place and then give it a thorough rinsing afterwards. Let the stories begin...

Best regards,
DDM

 

[Pedro Burrito]

I remember reading an article about the Guardian Blue Hole in the Bahamas. There is a hydrogen sulfide layer that the diver has to pass through and new divers to the hole are advised to vomit through their regulators, blow the vomit out and then shake the regulator out once they are through the hydrogen sulfide layer.

I put this to practice once during a side-mount quarry dive when I got a case of acid reflux. I was at 18m depth, had to vomit, looked up and realized that only way to handle this was to vomit through my regulator. I vomited, blew the vomit out, switched regulators and shook the other out. I don't think I could have stopped that first inhale just after I was done vomiting.

I tell all of my students this story and remind them to vomit through the regulator then shake it out.

 

[Soloist]

Many years ago on my very first OW dive trip down in the Keys I got seasick on day one during the surface interval. The dive op owner said the best thing to do is get back in the water for that second dive. He was right of course. He said it’s not a problem to throw up in your reg if you have to. Fortunately it didn’t come to that. Later I was talking to him about regulator maintenance and he told me a story about one of his second stage rentals that was malfunctioning a while back. He said he opened it up and found a piece of ham! Enough said.

 

[tbone1004]

I'll second even though he and I can never get our schedules together to drink some of his seemingly delicious homebrew..... yeah I'm calling you out! and I also know it's 100% my fault....

I think it comes from the idea that it's (a) possible to vomit through a regulator and (b) in circumstances where the body is doing something that's beyond conscious control, it's probably better to have the regulator in than out. I don't think that there's an involuntary inhalation after every emesis event, and I'm quite sure there are people out there who have removed a regulator, regurgitated under water, replaced the regulator, and lived to tell the tale. Still, IMHO it's better to keep the breathing gas source in place and then give it a thorough rinsing afterwards. Let the stories begin...

Best regards,
DDM

The recommendation in my experience is a CYOA policy as stated above though I do know many that have removed their regulators. All about your personal in water comfort. What is important to note though is what @Soloist said above and it's possible that some chunks may get stuck in the exhaust diaphragm which will cause wet breathing. What I tell my students is that if they have to hurl, keep the primary in and as soon as everything is out, switch to their secondary on their neck which is guaranteed to work. Clear out the housing of the primary and then try to switch back once you are stable again.

 

[TMHeimer]

Thanks folks. So it is a consensus that it is possible to throw up without the reg in and not immediately inhale, no?
Keep in mind that I don't at all disagree with keeping it in and would advise all to do that.
It is purely a medical question.
As Duke Dive Medicine says he thinks there is not an involuntary inhalation after every throw up, and tbone1004 says he knows many that have removed their reg and it's all about your comfort in water-- I'll go with it's not necessarily always involuntary.
Make sense?

 

[Akimbo]

I've heard the reason you keep the reg in is because you involuntarily inhale immediately afterwords. Is it possible to mentally stop this inhale?

Yes it is possible, but it takes a great deal of awareness, concentration, and discipline.

The risk of aspirating acidic fluids and solids is a very real possibility when barfing into a regulator, or worse, using a FFM (Full Face Mask) and/or rebreather.

Still, IMHO it's better to keep the breathing gas source in place and then give it a thorough rinsing afterwards.

Probably true for the vast majority of recreational divers. However there is still substantial risk as evidenced by an accident that happened aboard the Monterey Express. @Captain Tim told me about a diver who barfed in his regulator and aspirated some chucks, which blocked his airway. He was on the bottom and couldn't inhale or exhale. He was forced to make the conscious decision to embolize himself. Fortunately he surfaced very close to the boat off Cannery Row (which is pretty close to the harbor) and the DM got him onboard. Amazingly he survived. Maybe Tim can tell us how they got is airway open and to the hospital before it was too late. For that matter, what did he do with the divers that were still in the water? He probably told me but forgot.

This was a fairly long running discussion when the Navy first started using FFMs with demand regulators, at least on the dive system I was on. All the Navy FFMs before the late 1960s were freeflow only so the solution was simpler. Did the subject come up in your training?

The procedure that the Master Divers came up with for us was to look face-down, slide the FFM up to expose your mouth, barf, slide the mask back down, and push the purge or open the free-flow valve. One guy actually did it during a testing/training dive, and after a night of excessive celebration. He didn't have time to warn topside verbally over the comms but did have the presence of mind to pull off the procedure. There was still a lot of coughing in the mask but no chocking.

After hearing Captain Tim's story and taking the above experiences into consideration I decided to modify the procedure for Scuba:

• I went horizontal on a sand bottom in water shallow enough to stand up in.
• I removed the regulator, pressed the mouthpiece against my right cheek (mouthpiece up), and with a finger on the purge button
• I did my best to simulate projectile vomiting by forcefully exhaling as deeply as I could
• I pressed the purge and shoved the regulator in my mouth, still face down, and delaying inhaling long enough to be confident that most of the water was out of my mouth and regulator.

The basic idea is to take the best of the "take it out" versus the "barf in regulator" arguments. At least aspirating a little seawater is less caustic and can't block your airway. HOWEVER, I probably wouldn't recommend it to an new diver or someone who hasn't practiced it. Either way, it could get dangerous pretty fast.

I don't recall any "barfing on Scuba" training in Navy Scuba school, probably because there weren't many good options on double hose regulators... no purge/freeflow option beyond laying on your back.

 

[Manwork]

Just keep in mind that you likely will have no air left to purge the regulator when you put it back in the mouth. I did it once and had a laryngospasm, which is very unconfortable. I am not sure, but I believe I inhaled very little water which triggered the reflex.
I managed to open the glote a few seconds later but it hurts, like when you swallow too much water.
So I suggest you to keep the regulator in mouth anyway, because the reflex to inhale after vomiting is really strong.

 

[Manwork]

Sorry I was answering the op, we wrote simultaneously

 

[Akimbo]

Just keep in mind that you likely will have no air left to purge the regulator when you put it back in the mouth.

Absolutely! That why it is important to be able to rapidly replace the regulator and press the purge button. Thinking back to my few projectile vomiting experiences, I could hold my breath for a few more seconds but could not exhale any more.

Edit: Looks like multiple simulposts.