They're still called drownings and the victims still have fluid in the lungs.
We had a technical director back in Telads Pty Ltd (WA) whose first answer to every problem report was "what changed?" It stuck.
Scuba diver dies after complaining of gear malfunction
- Thread starter CuzzA
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They're still called drownings and the victims still have fluid in the lungs.
We had a technical director back in Telads Pty Ltd (WA) whose first answer to every problem report was "what changed?" It stuck.
It’s been a few years, to say the least, but this is a little different from my experience. Rarely did I ever see anyone go from a “normal rhythm” to full asystole. Usually there is some type of arrhythmia between the two with cardioversion or defibrillation not unusual.
Question: It says there was a diver down that they waited for. Was that person on deco? Many boats have a recall signal in case of an emergency. Was there one on this boat?
-Had a two dive trip turn into one dive. Diver on dive one developed a leaky reg/mouth piece and got fluid in lung. Coming up from 60 he got a lot of discomfort at 30 ft. Hung there for a while with buddy and then came up to boat in rough shape. There was some bloody froth. Put on O2 and boat headed the 45 minutes back to shore. Tended to by DM who was also an emergency first aid instructor. Fellow taken to hospital and recovered.
Saw a DM CESA from 60 ft when his reg shut down when he went to unhook the anchor. It suddenly stopped at 60ft and stayed stopped. He had made an error when servicing it himself and put a part in upside down and only had one reg since he had loaned the other one to a diver on the boat. He appeared fine and was put on O2. Done diving for the day. Other DM had to do the anchor bit.
Suddenly getting water in the lungs/mouth could lead to panic.
Had a beginner instabuddy go onto my air (would have shot up otherwise). First ocean dive, first post cert, mouth piece came off, and her spare octo was in pocket and not where she was trained.
Stopped a fellow from panicing and drop his weight belt at 30 ft in the keys. His mask had flooded and he was reaching to drop the weights. Was able to calm him and lead to the surface slowly.. Another instabuddy.
Stuff happens.
-Had a two dive trip turn into one dive. Diver on dive one developed a leaky reg/mouth piece and got fluid in lung. Coming up from 60 he got a lot of discomfort at 30 ft. Hung there for a while with buddy and then came up to boat in rough shape. There was some bloody froth. Put on O2 and boat headed the 45 minutes back to shore. Tended to by DM who was also an emergency first aid instructor. Fellow taken to hospital and recovered.
Saw a DM CESA from 60 ft when his reg shut down when he went to unhook the anchor. It suddenly stopped at 60ft and stayed stopped. He had made an error when servicing it himself and put a part in upside down and only had one reg since he had loaned the other one to a diver on the boat. He appeared fine and was put on O2. Done diving for the day. Other DM had to do the anchor bit.
Suddenly getting water in the lungs/mouth could lead to panic.
Had a beginner instabuddy go onto my air (would have shot up otherwise). First ocean dive, first post cert, mouth piece came off, and her spare octo was in pocket and not where she was trained.
Stopped a fellow from panicing and drop his weight belt at 30 ft in the keys. His mask had flooded and he was reaching to drop the weights. Was able to calm him and lead to the surface slowly.. Another instabuddy.
Stuff happens.
OP
CuzzA
Wetwork for Hire
Due to the nature of spearfishing most people often dive solo for safety reasons. The report said it was their first dive of the day and her boyfriend was under for an additional 30 minutes after she surfaced two minutes into her dive. At a spot with a 35 ft. hard bottom where your average depth would likely be around 25 ft., he was not doing any deco.
Despite the IPE discussion and other medical speculation, the witness stated the doctor said, "bubbles entered and blocked her bloodstream." My take away from that statement is arterial gas embolism.
According to the US Navy Diver Manual, using an AED is the proper treatment. Unfortunately, immediate recompression appears to be the only hope for saving a diver who has experienced arterial gas embolism.
20-2 Arterial gas embolism, sometimes simply called gas embolism, is caused by entry of gas bubbles into the arterial circulation which then act as blood vessel obstructions called emboli. These emboli are frequently the result of pulmonary barotrauma caused by the expansion of gas taken into the lungs while breathing under pressure and held in the lungs during ascent. The gas might have been retained in the lungs by choice (voluntary breathholding) or by accident (blocked air passages). The gas could have become trapped in an obstructed portion of the lung that has been damaged from some previous disease or accident; or the diver, reacting with panic to a difficult situation, may breathhold without realizing it. If there is enough gas and if it expands sufficiently, the pressure will force gas through the alveolar walls into surrounding tissues and into the bloodstream. If the gas enters the arterial circulation, it will be dispersed to all organs of the body. The organs that are especially susceptible to arterial gas embolism and that are responsible for the life-threatening symptoms are the central nervous system (CNS) and heart. In all cases of arterial gas embolism, associated pneumothorax is possible and should not be overlooked.
20-2.1 Arterial Embolism Development. Arterial gas embolism may develop within minutes of surfacing, causing severe symptoms that must be diagnosed and treated quickly and correctly. Because the supply of blood to the central nervous system is almost always involved, unless treated promptly and properly by recompression, arterial gas embolism is likely to result in death or permanent brain damage.
20-2.2 Unconsciousness Caused by Arterial Gas Embolism. Gas embolism can strike during any dive where underwater breathing equipment is used, even a brief, shallow dive, or one made in a swimming pool. As a basic rule, any diver who has obtained a breath of compressed gas from any source at depth, whether from diving apparatus or from a diving bell, and who surfaces unconscious or loses consciousness within 10 minutes of reaching the surface, must be assumed to be suffering from arterial gas embolism. Recompression treatment shall be started immediately. A diver who surfaces unconscious and recovers when exposed to fresh air shall receive a neurological evaluation to rule out arterial gas embolism.
20-2.3 Neurological Symptoms of Arterial Gas Embolism. Divers surfacing with any obvious neurological symptoms (numbness, weakness, or difficulty in thinking) should be considered as suffering from an arterial gas embolism. Commence recompression treatment as soon as possible.
20-2.4 Additional Symptoms of Arterial Gas Embolism. Other factors to consider in diagnosing arterial gas embolism are:
The onset is usually sudden and dramatic, often occurring within seconds after arrival on the surface or even before reaching the surface. The signs and symptoms may include dizziness, paralysis or weakness in the extremities, large areas of abnormal sensation, blurred vision, or convulsions. During ascent, the diver may have noticed a sensation similar to that of a blow to the chest. The victim may become unconscious without warning and may even stop breathing.
If pain is the only symptom, arterial gas embolism is unlikely and decompression sickness or one of the other pulmonary overinflation syndromes should be considered.
Some symptoms may be masked by environmental factors or by other less significant symptoms. A chilled diver may not be concerned with numbness in an arm, which may actually be the sign of CNS involvement. Pain from any source may divert attention from other symptoms. The natural anxiety that accompanies an emergency situation, such as the failure of the diver's air supply, might mask a state of confusion caused by an arterial gas embolism to the brain. A diver who is coughing up blood (which could be confused with bloody froth) may be showing signs of ruptured lung tissue, or may have bitten the tongue or experienced a sinus or middle ear squeeze.
20-2.5 Neurological Examination Guidelines. Appendix 5A contains a set of guidelines for performing a neurological examination and an examination checklist to assist nonmedical personnel in evaluating decompression sickness cases.
20-2.6 Administering Advanced Cardiac Life Support (ACLS) in the Embolized Diver.
A diver suffering from an arterial gas embolism with absence of a pulse or respirations (cardiopulmonary arrest) requires Advanced Cardiac Life Support. Performing ACLS requires that special medical training and equipment be readily available. ACLS procedures include diagnosis of abnormal heart rhythms and correction with drugs or electrical countershock (cardioversion or defibrillation). Though patient monitoring and drug administration may be able to be performed at depth, electrical countershock must be performed on the surface.
If an ACLS-trained medical provider or a Basic Life Support-Defibrillation (BLS-D) provider with the necessary equipment can administer the potentially life-saving therapies within 10 minutes, the stricken diver should be kept at the surface until pulse and/or respirations are obtained. It must be realized that unless ACLS procedures—especially defibrillation—can be administered within 10 minutes, the diver will likely die, even though adequate CPR has been begun. If a Diving Medical Officer cannot be reached or is unavailable, the Diving Supervisor may elect to compress to 60 feet, continue Basic Life Support, and attempt to contact a Diving Medical Officer.
If ACLS becomes available within 20 minutes, the pulseless diver shall be brought to the surface at 30 fpm and defibulated on the surface. (Current data shows there is 0-percent recovery rate after 20 minutes of cardiac arrest with BLS.) If the pulseless diver does not regain vital signs with ACLS procedures, continue CPR until trained medical personnel terminate resuscitation efforts. Never recompress a pulseless diver who has failed to regain vital signs after defibrillation or ACLS. Resuscitation efforts shall continue until the diver recovers, the tenders are unable to continue CPR, or trained medical personnel terminate the effort. If the pulseless diver does regain vital signs, compress to 60 fsw and follow the appropriate treatment table.
20-2.1 Arterial Embolism Development. Arterial gas embolism may develop within minutes of surfacing, causing severe symptoms that must be diagnosed and treated quickly and correctly. Because the supply of blood to the central nervous system is almost always involved, unless treated promptly and properly by recompression, arterial gas embolism is likely to result in death or permanent brain damage.
20-2.2 Unconsciousness Caused by Arterial Gas Embolism. Gas embolism can strike during any dive where underwater breathing equipment is used, even a brief, shallow dive, or one made in a swimming pool. As a basic rule, any diver who has obtained a breath of compressed gas from any source at depth, whether from diving apparatus or from a diving bell, and who surfaces unconscious or loses consciousness within 10 minutes of reaching the surface, must be assumed to be suffering from arterial gas embolism. Recompression treatment shall be started immediately. A diver who surfaces unconscious and recovers when exposed to fresh air shall receive a neurological evaluation to rule out arterial gas embolism.
20-2.3 Neurological Symptoms of Arterial Gas Embolism. Divers surfacing with any obvious neurological symptoms (numbness, weakness, or difficulty in thinking) should be considered as suffering from an arterial gas embolism. Commence recompression treatment as soon as possible.
20-2.4 Additional Symptoms of Arterial Gas Embolism. Other factors to consider in diagnosing arterial gas embolism are:
The onset is usually sudden and dramatic, often occurring within seconds after arrival on the surface or even before reaching the surface. The signs and symptoms may include dizziness, paralysis or weakness in the extremities, large areas of abnormal sensation, blurred vision, or convulsions. During ascent, the diver may have noticed a sensation similar to that of a blow to the chest. The victim may become unconscious without warning and may even stop breathing.
If pain is the only symptom, arterial gas embolism is unlikely and decompression sickness or one of the other pulmonary overinflation syndromes should be considered.
Some symptoms may be masked by environmental factors or by other less significant symptoms. A chilled diver may not be concerned with numbness in an arm, which may actually be the sign of CNS involvement. Pain from any source may divert attention from other symptoms. The natural anxiety that accompanies an emergency situation, such as the failure of the diver's air supply, might mask a state of confusion caused by an arterial gas embolism to the brain. A diver who is coughing up blood (which could be confused with bloody froth) may be showing signs of ruptured lung tissue, or may have bitten the tongue or experienced a sinus or middle ear squeeze.
20-2.5 Neurological Examination Guidelines. Appendix 5A contains a set of guidelines for performing a neurological examination and an examination checklist to assist nonmedical personnel in evaluating decompression sickness cases.
20-2.6 Administering Advanced Cardiac Life Support (ACLS) in the Embolized Diver.
A diver suffering from an arterial gas embolism with absence of a pulse or respirations (cardiopulmonary arrest) requires Advanced Cardiac Life Support. Performing ACLS requires that special medical training and equipment be readily available. ACLS procedures include diagnosis of abnormal heart rhythms and correction with drugs or electrical countershock (cardioversion or defibrillation). Though patient monitoring and drug administration may be able to be performed at depth, electrical countershock must be performed on the surface.
If an ACLS-trained medical provider or a Basic Life Support-Defibrillation (BLS-D) provider with the necessary equipment can administer the potentially life-saving therapies within 10 minutes, the stricken diver should be kept at the surface until pulse and/or respirations are obtained. It must be realized that unless ACLS procedures—especially defibrillation—can be administered within 10 minutes, the diver will likely die, even though adequate CPR has been begun. If a Diving Medical Officer cannot be reached or is unavailable, the Diving Supervisor may elect to compress to 60 feet, continue Basic Life Support, and attempt to contact a Diving Medical Officer.
If ACLS becomes available within 20 minutes, the pulseless diver shall be brought to the surface at 30 fpm and defibulated on the surface. (Current data shows there is 0-percent recovery rate after 20 minutes of cardiac arrest with BLS.) If the pulseless diver does not regain vital signs with ACLS procedures, continue CPR until trained medical personnel terminate resuscitation efforts. Never recompress a pulseless diver who has failed to regain vital signs after defibrillation or ACLS. Resuscitation efforts shall continue until the diver recovers, the tenders are unable to continue CPR, or trained medical personnel terminate the effort. If the pulseless diver does regain vital signs, compress to 60 fsw and follow the appropriate treatment table.
SapphireMind
Contributor
I work in a different area than you most likely did
My codes tend to be more akin to drowning - lack of oxygen related. They don't go from normal to asystole, they go sinus>sinus brady>asystole. None of that is shockable. Again though, these are codes precipitated by a lack of oxygen/ventilation though, not a primary cardiac issue, and in patients that by and large have no preexisting conduction abnormalities. During BLS, it is always the correct decision to apply the AED pads and assess for need for defib, but arterial embolism, as you said, is unlikely to end with needing defib.
The only reason I make the distinction is because it is so commonly thought that AEDs are cure-alls and defib is useful for asystole, thanks to media. You should always apply the AED to check for arrhythmia, but do not be surprised when it says "no shock advised, continue CPR". No amount of defib will restore oxygen to a heart that is being starved, nor will it restart one. It is absolutely true that either recompression or immediate centesis to remove the air if you have a large enough collection in one place is the only fix. Embolisms have very poor survival in general.
I'm on a medical message board that has a running humor thread of all the medical mistakes and inaccuracies in TV/movies. Most commonly mentioned: defib for asystole.
My own personal favorite though is from the Wolverine: Origins movie, when they discussed a character being given a medication to slow her heartrate and "mimic death". And they picked a really fancy sounding drug - hydrochlorothiazide.
..
..
.....Which is a diuretic, meaning it makes you pee. Many of us found that very amusing.
The point I am trying to make is that the average bystander, hell even the knowledgable bystander, isn’t going to know the precipitating event or even the heart rhythm, so there is zero need to make a decision whether or not to apply an AED in an emergency. It is a no brainer. If it’s available put it on. It may or may not shock. Even if it does correct the rhythm it may not last. This is the reality of resuscitation, especially out of hospital.
So back to the original question, just because an AED was applied does not equate a cardiac event nor as pointed out that a shock was even delivered.
So back to the original question, just because an AED was applied does not equate a cardiac event nor as pointed out that a shock was even delivered.
OP
CuzzA
Wetwork for Hire
Right. I've seen several posts around the internet that were trying to imply that because an AED was used that the incident must have been a medical issue and not a diving related one.
I think there's a reason the pre-dive gear malfunction was reported by witnesses and law enforcement, because it probably played a significant role in her death. That seems to be the only piece of missing information that could really fill in the blanks of why she ended up on the surface. My speculation is a stuck inflator or free flowing reg. Neither should lead to the death of a diver, but IMO a stuck inflator would remove some of the personal responsibility from her (although she did do the dive knowing about the issue). If she panicked because of a free flow, sadly, that is all on her as there's no reason to panic in that situation.
johndiver999
Contributor
Is there good information that the inflator was sticking on before the dive and that she dove with it anyway ? Or
Is that speculation?
A stuck inflator would not be that unusual, especially if
It was the first time out after a long winter of storage.
Is that speculation?
A stuck inflator would not be that unusual, especially if
It was the first time out after a long winter of storage.
OP
CuzzA
Wetwork for Hire
My speculation is inflator or reg. If you put a gun to my head I'd say free flowing reg.
I know spear fisher people often dive solo. That has nothing to do with not having a call back signal. Noise travels very well underwater. Banging a ladder with something hard can be heard a long way off.
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