Maryland woman dies in Key Largo 12-30

[fisherdvm]

Clissold told deputies his wife had no major medical problems, but had been taking ibuprofen for a chest cold in which congestion was so bad she had torn cartilage from her ribs while coughing, Monroe County Sheriff's spokeswoman Becky Herrin said.

I kinda question a husband's diagnosis of a "chest cold" implies obstructive pulmonary disease. In the same way, how do you diagnose "torn cartilage from her ribs". Certainly bronchitis, laryngitis, pneumonia, and even sinusitis can cause chronic coughing. But to go from a husband's report to pulmonary embolism make me question it.

I would still bet a myocardial infarction .... But only an would tell us. It is unsusual to see an MI in a 50 year old woman, but the last code I ran was on a 45 year old woman with an autopsy proven MI.

In either case, MI or pulmonary emboli, the woman suffered cardiac arrest soon after boarding the boat. The only thing that would have saved her is an AED.... And all the oxygen and CPR you do will not reverse cardiac arrest.

 

[RasRitz]

What is an AED??

 

[deepstops]

What is an AED??

Automated External Defib machine, more info here:
Automated external defibrillator - Wikipedia, the free encyclopedia

 

[GoBlue!]

I kinda question a husband's diagnosis of a "chest cold" implies obstructive pulmonary disease. In the same way, how do you diagnose "torn cartilage from her ribs". Certainly bronchitis, laryngitis, pneumonia, and even sinusitis can cause chronic coughing. But to go from a husband's report to pulmonary embolism make me question it.

As several have said, an autopsy is necessary to make this diagnosis, but I think you're reading too much into what the husband said. From this quote, he's saying that his wife had one heck of a cough, enough to make her ribs hurt bad...probably some costochondritis (come on, let's not knock the grieving husband for saying "torn the cartilage from her ribs") that she was treating with ibuprofen. As I'm sure you well know, bronchospasm is an incredibly common component of a viral respiratory infection; she very well could have been the victim of air trapping and pulmonary barotrauma.

I'm not saying that CAD/MI isn't possible, but the husband's account raises the pre-test probability of a pulmonary event.

Just to nitpick, let's remember that if she DID have a tension pneumo that led to her collapse, all the AEDs in the world wouldn't have helped.

Jim

 

[fisherdvm]

I don't know how we went from an arterial embolism to a tension pneumothorax.... If she did have an arterial embolism, an AED certainly can help.

An embolism to the brain will not cause cardiac arrest, but symptoms of a stroke.

An embolism to the heart will cause an MI, then v fib, then death. Which an AED can help.

A tension pneumothorax will cause respiratory distress, which might precipitate an MI, then v fib, then death, which an AED can help.

Again, only an autopsy can help, and hopefully one will be performed. If she did have a tension pneumothorax, oxygen can help initially, but an ACLS/ATLS provider could do a needle paracentesis and help.... But in the case of a dive boat, oxygen and stand by AED is the best we can hope for.

If she had a gun shot wound, and is in cardiac arrest, only an AED can help... Then you can worry about the rest later. If she had massive blood loss, and had cardiac arrest, only an AED can help.

The bottom line is - the best any boats can do for either victims in cardiac arrest is defibrillation with an AED. CPR is worthless, considering that they are at least 20 minutes from shore.

Sure, you can argue that other rhythms might be present.... But, before that heart stop.... It is still V-fib... Why waste time .... An AED is what you need.

 

[DiverBizz]

Well no matter what the possible cause...I do question someone diving while so ill that she coughed until her ribs hurt enough that her husband thought she tore her cartilage. It is a terrible lose to the family no matter what. I do wonder why the instructor who just certified her few days ago didn't notice how sick she was if she was coughing so much? Just wondering. I understand that both deaths are tragic and very difficult for the families.

 

[mania]

There is though one point that horrified me. She just finished her OWD and was diving without an instructor with 13 yo kid, freshly certified as well?????
This is highly irresponsible to be honest.

Mania

 

[tonka97]

More reasons for dive boats to purchase an AED. They are down to about 1000 bucks now. Idiot proof and requires no training whatsoever. Older models with older protocols can be had for about 500 bucks, but still work.

Batteries are good for 3 years installed, and 5 years in package.

I'd say, if you advertised that your dive ops have aeds on board, you'd increase traffic flow that might make the investment worthwhile.

Agreed.
In fact every home and vehicle should have one.

Traditional CPR is important, but an AED is vital to save lives and preclude brain damage to survivors.

Don't wait for someone to die to get this understanding.

Been there, done that.

 

[NancyLynn]

There is though one point that horrified me. She just finished her OWD and was diving without an instructor with 13 yo kid, freshly certified as well?????
This is highly irresponsible to be honest.

Mania

Why?

Although I certainly advocate caution, without knowing more than I have been able to find I would not label it "highly irresponsible."

I have been diving twice with someone identified as an instructor since I finished my OW - both times in connection with my daughter's certification (i.e. she was not certified and I was diving once as a companion for her first open water dive post - Discover Scuba Dive which required she be accompanied by an instructor, and later as an extra set of certified eyes during her OW checkout dives.)

I have not, for myself, sought out the company of an instructor since I was certified. I sort of thought that was part of the point of certification - you need to be accompanied by an instructor until you are certified and it is not required after that. (When I travel and cannot find a local dive club going out at a convenient time, I do often contact local dive shops to rent a buddy - but so far as I know the buddies are not instructors.)

There were three certified adults and one child - not an unreasonable ratio.

The location they were diving (according to anything I have been able to find) is described as an easy dive - and is reportedly used for certification checkout dives because it is a relatively safe site.

I have seen nothing to indicate that diving skills had anything to do with the incident - she was described as climbing up the ladder to the boat when she stopped breathing. Although it may ultimately turn out to be dive related (in the sense that perhaps a better pre-certification physical might have turned up health barriers to diving), I haven't otherwise seen anything to indicate that the family's diving skills were not appropriate for the dive they undertook.

 

[ffestpirate]

Agreed.
In fact every home and vehicle should have one.

Traditional CPR is important, but an AED is vital to save lives and preclude brain damage to survivors.

Don't wait for someone to die to get this understanding.

Been there, done that.

I fully agree and advocate the use and necessity of an AED. But you really have to stop and remember that sometimes it just doesn't matter. People die and nothing in the world that you do can save them. I really get tired of everytime there is a death in Scuba, it posts here and people spend the next several weeks speculating about what and why. Sh#@ happens. People die crossing the street, people die sitting on their couch, people die sleeping in their bed. and you know what, nobody spends the next month talking about why on the internet. It is incrediblly easy to be a monday morning quarterback. Sometimes there are no answers. They have a name for that. It's called life.