Scopolamine and Narcosis

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Jandee

Contributor
Messages
132
Reaction score
7
Location
Waterford,Wi, about 25 miles from the Milwaukee Ha
# of dives
1000 - 2499
Last weekend my husband and I dove on the Milwaukee Car Ferry in Lake Michigan. We have been on this wreck many many times and were diving nitrox. Since we were getting to the end of the Lake Michigan dive season we decided to go out in 4 foot waves. Before I went out I took oral scopalamine to prevent sea sickness and have taken this medication many time without a problem when diving in the Carib. I usually get narced at about 100 feet in cold water (45 degrees) and react by being a little nervous, breathe a little faster and be over cautious. This time I was at 110 feet, at the end of my dive, had about 1400 pounds of air and was following my husband back to line to begin our ascent. Viz was about 20-25 feet. This wreck is a tangled mess of steel and can be very confusing. Somehow I lost sight of him, this has never happened to me before. I just waited for him to come back but he couldn't find me. I was so disoriented, I was midship but thought I was on the stern. I knew the boat runs almost east to west, all the ascent lines are on port side, and there is a huge propeller on the back of the boat. I looked at my compass, facing south and wonder why I couldn't find the line or the propeller on the boat. I still had no sense or urgency. All of a sudden I realise I am into deco, have less then 800 pounds of air, and I'm not a deco diver. I had to ascend all by myself, in a current without a line from 110 feet. Fortunately I was so narced, I had no fear, and didn't panic, I was able to understand my computer once it went into deco and able to make the first deco stop without a problem, the second stop was at 10 feet for 10 minutes. I ran out of air after 7 minutes and had to go to the surface. My dive time was 58 minutes compared to the usual 35 minutes for this dive. My husband was in the boat waiting and had already called the coast guard and reported I was lost. He pulled me in the boat, changed my tank, and I went back into the water, went down the mooring line to 30 feet and stayed for 30 minutes and then went up to 15 feet for another 10 minutes. It wasn't until the scopalamine wore off that evening that I realized how serious this was. If I had not listened to other divers talk about deco diving, I would not of known what my computer was telling me to do. I learned a couple of very improtant lessons, bad things can happen to experienced divers, and scopolomine can kill you. A medication that is fine in warm water and at shallow depths can act very differently when the body is under stress because of cold water and narcosis.
 
I have used the same med many times and have dived to 130+ feet with it with no consequences but I dive in warm water in Florida. The coldest I've dived with it is 62 degrees at 126 feet in February, 30 minutes bottom time.
 
@Jandee: I'm glad that everything turned out OK. Based on your story, I think it's difficult to determine whether the confusion you experienced at depth was due to narcosis, the oral scopolamine, or a combination of the two. FWIW, even without any meds on-board, divers have reported very similar experiences of confusion/disorientation/memory loss/bizarre behavior/cognitive deficits at depth.

Very few clinical studies have looked at the cognitive effects/side effects of medications at ambient pressures greater than 1 atm. I guess that's why we, as divers, should be careful when we dose with prescription or OTC meds while diving.

I'm curious why you opted to go back into the water to do a 30 min stop at 30 feet and a 10 min stop at 15 feet. Is this standard operating procedure onboard that boat? Did anyone else go down with you? Considering the relative proximity to medical care, I believe that many experts would advocate simply breathing O2, monitoring for signs of DCS, and reporting to the nearest hyperbaric chamber if necessary.

FWIW, depending on the dive computer you were using, missing 3 minutes of the 10 ffw deco stop might not have been that big of a deal. I might even go so far as to say that you placed yourself in greater danger by re-descending to do the additional stops. I'm sure others might have differing opinions.

The last comment I'll make is that I hope that more scuba manufacturers develop PC-based tutorials so that divers can learn how to use their computers in a simulated environment. Many newer divers have no idea how to interpret "deco" mode. I believe that Oceanic in collaboration with DiveNav is the first to do this.

Once again, let me say that I'm really glad that you came out of this OK. Dive safe out there...
 
My husband went back in the water with me. At the time I didn't know how badly I screwed up and we were 30 min. from the dock and the coast guard wasn't there yet. This was just a decision that was made quickly, maybe not the best decision. I'm certain this was caused by the scopalamine. I dive every weekend in Lake Michigan at 100+ feet and the narcosis was so different from what I usually experience.
 
Last weekend my husband and I dove on the Milwaukee Car Ferry in Lake Michigan. We have been on this wreck many many times and were diving nitrox. Since we were getting to the end of the Lake Michigan dive season we decided to go out in 4 foot waves. Before I went out I took oral scopalamine to prevent sea sickness and have taken this medication many time without a problem when diving in the Carib. I usually get narced at about 100 feet in cold water (45 degrees) and react by being a little nervous, breathe a little faster and be over cautious. This time I was at 110 feet, at the end of my dive, had about 1400 pounds of air and was following my husband back to line to begin our ascent. Viz was about 20-25 feet. This wreck is a tangled mess of steel and can be very confusing. Somehow I lost sight of him, this has never happened to me before. I just waited for him to come back but he couldn't find me. I was so disoriented, I was midship but thought I was on the stern. I knew the boat runs almost east to west, all the ascent lines are on port side, and there is a huge propeller on the back of the boat. I looked at my compass, facing south and wonder why I couldn't find the line or the propeller on the boat. I still had no sense or urgency. All of a sudden I realise I am into deco, have less then 800 pounds of air, and I'm not a deco diver. I had to ascend all by myself, in a current without a line from 110 feet. Fortunately I was so narced, I had no fear, and didn't panic, I was able to understand my computer once it went into deco and able to make the first deco stop without a problem, the second stop was at 10 feet for 10 minutes. I ran out of air after 7 minutes and had to go to the surface. My dive time was 58 minutes compared to the usual 35 minutes for this dive. My husband was in the boat waiting and had already called the coast guard and reported I was lost. He pulled me in the boat, changed my tank, and I went back into the water, went down the mooring line to 30 feet and stayed for 30 minutes and then went up to 15 feet for another 10 minutes. It wasn't until the scopalamine wore off that evening that I realized how serious this was. If I had not listened to other divers talk about deco diving, I would not of known what my computer was telling me to do. I learned a couple of very improtant lessons, bad things can happen to experienced divers, and scopolomine can kill you. A medication that is fine in warm water and at shallow depths can act very differently when the body is under stress because of cold water and narcosis.

First of all, thank you for this open-hearted account of your dive. Sometimes it's hard to put yourself "out there" on the internet because you know people like to get all puffed-up and macho about what you did wrong and how they never make mistakes and all that.... We learn the most from reading how real people deal with real problems and I think I speak for all of us when I say "thank you".

About your dive. A couple of things are readily apparent to me.

1) disorientation is common on wrecks. Even to the point of being expected. Navigation on wrecks is notoriously difficult and it sounds like a combination of conditions, depth and the condition of this particular wreck wasn't helping you. That's understandable.

However,

with a little more experience, navigating difficult wrecks can be somewhat simplified. If you don't know where you are you can always tie off a reel and just swim in what seems like a logical direction. If you swim a short distance and the wreck ends then you can go back and try the direction 180 opposite what you just swam. If that also ends after a short distance then you found out that you were swimming the breadth of the wreck. If not, you're swimming in the length. Just knowing which way the wreck "goes" helps a lot in regaining your bearings and finding the up-line again.

2) your reaction to your situation came a little on the late side but your handling was spot on. You made your ascent, you did whatever deco you could do and you waited as long as possible before surfacing. The fact taht you weren't injured has a lot to do with how you handled yourself once you knew you were in the ****.

However,

It obviously would have been wise to get that alarm bell a little earlier. You know that and I'm sure if you find yourself in a similar situation in the future you will. Once crucial piece of the puzzle is knowing how much air you need to make a clean ascent. Learning a bit more about gas management might be a good idea.

3) after you exited the water you got back in with your husband and re-did some of your deco. This might help and it might not. In any case, all's well taht end's well and it's clear that you have an understanding of deco theory if you did this.

however,

You missed 3 minutes of stops. In that same situation I *personally* wouldn't have gone back in the water to re-do 40 minutes of deco. I would have stayed onboard, breathed 100% oxygen and hydrated as much as possible. IWR (in water recompression) which is what you did, does have risks associated with it and in a marginal case like yours I"m not sure the benefits outweigh the risks. Next time, if there is a next time, consider the possibility of "treating" a few minutes of missed stops with O2.

4) I'm not a doctor but if you suspect the drug you took then it's a good idea to ask about it in the medical forum. I would be interested in hearing what the doctors think of it. Just using google it looks like the kind of drug that can make you feel dizzy and drowsy so not the kind of thing that you want to be jacked-up on when you're on a deep wreck..... I would advise you to post something about it in the medical forum too so we can see how your experience compares.

R..
 
wow that's a scary story. glad you've overcome the situation without further problems. (about IWR, the book recommends breathing 100% o2 and and having yourself checked by a physician as the others wrote above.)

thank you very much for sharing though, this was a good lesson for me.
 
This really is not really a case of in-water recompression. She never showed any signs of DCS. It is more of what would be called "Omitted Decompression."

Although staying on the surface with O2 is generally recommended, a number of agencies say that if you miss some deco and can get back in the water quickly, you can return to the water and complete the omitted stops. For example, Here is an excerpt from TDI's Decompression Procedures manual (p. 34). It is quoting U.S. Navy procedures.

The most common course of action for short time misses will be to put the diver on oxygen and monitor their condition. Further diving should be curtailed by the diver for 24 to 48 hours minimum.

If the diver and the conditions allow, the U.S. Navy has an alternative emergency technique.

If a diver ascends from 20 FSW or shallower, feels well and can return to the water in 1 minute, descend to the required stop depth and continue with the planned decompression. The minute is added to the stop time.

If the diver ascends from 20 FSW or shallower and is not able to return to water in 1 minute but remains free of symptoms, the diver can return to the stop and multiply the stop times by 1.5.

In this case, I would say that using O2 would have been better, but returning to the water was OK. I believe, though, that the amount of time spent in this case was excessive, especially at 30 feet. I would have spent less time total, and I would have spent all of it at the shallower depth.
 
@Jandee: What dive computer were you using? I ask because I'm curious whether a more conservative algorithm (Suunto, Mares, etc.) was being used.

As you know, the effects of nitrogen narcosis should be mitigated by moving to a shallower depth. If this did not help, then I think a strong argument can be made for scopolamine being a contributing factor. In my personal experience, anticholinergic anti-motionsickness meds (like scopolamine) have a "cognitive blunting" effect. It's kind of difficult to describe, but I just know that I'm not as "sharp" as I could be. YMMV since meds (even at comparable dosage) can affect people differently. Based on your story, I'd recommend that you steer clear of both oral and transdermal scopolamine on future dive trips.

Thanks for sharing your story.

In case anyone is interested about the related topic of IWR, here's the link to a nice paper published by the South Pacific Underwater Medicine Society in 2000 entitled: On-site recompression treatment is acceptable for DCI.
 
@Jandee: What dive computer were you using? I ask because I'm curious whether a more conservative algorithm (Suunto, Mares, etc.) was being used.

Another point is that with many computers, if you get back in the water within a reasonable amount of time (like 10 minutes), it will continue with your decompression schedule from your dive.

I was on a dive a couple of years ago when something along these lines happened. We were a group doing a DM-led drift dive in Colzumel. After we had been on the surface a few minutes and the boat was beginning to pick us up, one of the divers said that she had gone into deco and her computer had not cleared. The DM took her back down to finish her deco. No problem.
 
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