Diving Accident, Self-Responsibility and Balance

[Wookie]

So, DM's, if I get on your boat for a dive, and ask you show me your ER O2 set up, are you going to get all cranky with me?

If ever a boat crew member or DM gets cranky with you for asking to see the safety equipment, if a shop gets cranky with you asking to see the air test certificates, if anyone ever gets upset that you want to check and see with your own eyes what equipment they have, you turn and walk away.

I'd be so happy if anyone ever cared enough about their own safety to inventory my O2 cylinders, check the expiration date of the AED batteries and pads, or ask for an air test, they would be my new favorite customer forever (until a newer favorite customer came along ). Most expect the boat to be equipped with certain equipment, and of course a liveaboard should have more than a day boat, just because of the distance from shore and the difficulty of evacuation. Unfortunately, when you assume that the boat has up to date safety and medical equipment, well, you know what happens when you assume.

 

[Darnold9999]

Incorrect. Hyperventilation causes reduced CO2, not increased. Lowered pCO2 is the trigger to breathe more rapidly, hence the feeling of not getting enough air.

Sorry but I didn't say that Hyperventilation was happening here. From the narrative she was a smoker over exerting herself trying to fight surge and current while breathing through her reg. Pretty much a recipie for a CO2 overload as far as I am aware. But I have been wrong before.

 

[gianaameri]

The lady turned blue.

That should rule out hyperventilation, CO2, CO, and panic.

It points to low O2 in the tissues.

 

[doctormike]

The captain and the DM should have known how to operate their own O2 system and had it setup and ready to go before you got back on the boat. The O2 reg has the first and second stage built into the same piece, and the IP can be set on the reg. It sounds like it was set too high causing the tank to run low faster then it should have. Once they ran out of O2 the only other option that might have been available would be to have you breath off a nitrox tank if there were any onboard.

Even if the mask was not fitting perfectly the oxygen you were getting should have been enough to get the CO level in your system down. I would guess that at this point you were hyperventilating from the panic alone.

Based on the OP description (the mask "stuck on her face", etc..) it sounds like it was a non-rebreather facemask, not a regulator. But I agree with you about the other stuff...

 

[DandyDon]

I did not surface on purpose, I just couldn't get hold of the reef to drag myself over it into deeper water on the other side.

Uh, pardon me for interrupting the discussion, but where in the world did you get that idea? No one is ever supposed to touch a reef on any dive. What you think is dead just has smaller life than you can see. You might have been under weighted, but whatever - don't use the reef as crutch.

 

[Wannabedivebum]

I may be wrong as im not a pulmonologist or resp tech, but hyperventilation will cause a decrease of arterial CO2 , but an increase in CO2 in the lungs. this leads to increased hyperventilation due to respiratory alkalosis and hypercapnia. However, when you add a possible diagnosis of COPD (OP is a chronic smoker) it is theorized that the urge to breathe is reversed from the levels of Co2 to what is known as the hypoxic drive. However there are conflicting studies on this and some medical professionals disagree with it entirely. COPD also complicates alveolar respiration, adding a degree of ineffectiveness to gas exchange as well as other complications above my pay grade. Your decreased O2 sats could be explained by what is called a shunt as well, a thing called a PFO or Patent formamen ovale. Basically a whole in your heart that can allow de-oxygenated blood from your body into your left atrium to be pumped back into your body. It will also increase your risk of stroke, PE and DCS considerably. Apparently up to 20% of north-americans are undiagnosed with a PFO. However this is all keyboard medicine at this point and I recommend a conversation with your GP to root out the exact cause of your distressing event.

 

[doctormike]

However this is all keyboard medicine

I'll have you know that I am chairman of the department of keyboard medicine at a renowned New York medical school, as well as the director of googling for the hospital.

 

[raftingtigger]

You keep repeating this, over and over. Are you a doctor? Have a DOCTOR (not WebMD) diagnosed you with this?

Oxygen played no role in this. This is proven by your evident survival and well-being despite a lengthy period without it. Your "sweet, delicious" reaction to it is called the placebo effect.

This has every sign of a panic attack; not something medical; I feel you're trying to dodge the true cause of this near-accident by blaming this on something you found on the internet rather than what truly happened. You hit the surface, saw how far away the boat was and panicked because your mind thought you'd drift away and never be found. It's ok, it happens. It's not something to try to deny.

You've found something that allows you to dodge the true cause because you feel it may reflect poorly on you. Until you accept that this was a classic panic reaction, you're trying to find something other than yourself as the cause of this accident.

TC are you a doctor? In the OP's original post she states her O2 was 85. I'm going to assume that was a O2 Saturation of 85% which is a significantly impaired level. I have NEVER seen such an O2 level in a hyperventilating patient (panic). If this O2 level was at 85 she was in a world of medical hurt - which leads to psychological issues. and yes I am a medical provider

 

[Rich Keller]

P2190161 - YouTube

Tony, this is the 10 minute video I talked about. It comes on apparently around the time I surfaced. Listening to it, I think I was already physically wasted by the time I popped up.

The top of the reef is about 6 feet below me. I did not surface on purpose, I just couldn't get hold of the reef to drag myself over it into deeper water on the other side. Thank you again for helping me clarify this chain of events. It took a toll.

It is hard to be sure from the video but you were not 2'-3' seas, looked like 1' or less to me. The current on the wreck did not look too bad either. The DM with your seemed to be in control and doing the right thing. After seeing this I am much more certain that this was just a panic attack.

 

[doctormike]

TC are you a doctor? In the OP's original post she states her O2 was 85. I'm going to assume that was a O2 Saturation of 85% which is a significantly impaired level. I have NEVER seen such an O2 level in a hyperventilating patient (panic). If this O2 level was at 85 she was in a world of medical hurt - which leads to psychological issues. and yes I am a medical provider

I'm a doctor an I have seen sats of 85, 45, 25, etc... And that's on pulse oximiters in an ICU in a hospital in New York that are pretty well maintained. Not sure about how well they are working in the Bahamas, but let's give them the benefit of the doubt.

It is so easy to get inaccurate tracings, especially as the sats go down. Believe me, as a pediatric airway surgeon, I hear that dropping pulse oximeter tone in my dreams. But I also know that we know very little about the details of this event, and as my father used to say - the devil is in the details. If she had a persistent reading of 85 for a length of time with a good pulse tracing, yes, that might indicate any number of things (COPD from smoking, bronchospasm, pulmonary edema, shunt, barotrauma, pneumonia, pulmonary embolism, etc..). Again, I'm not diagnosing anything.

But just remember that as far as I know we are not talking about a blood gas, here, so unless you have information that the rest of us don't have, I wouldn't make a diagnosis based on this one number from a pulse oximiter, without any clinical context or real data.