Diving Accident, Self-Responsibility and Balance

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Thea,

Whatever happened to you, you need to get checked out by a physician. This could have been pulmonary edema or any one of a number of other things. By your own report you are a 49-year-old, sedentary, overweight smoker, which sets you up for a number of health-related problems. Please get evaluated by a diving physician before you dive again. If you PM me your exact location in Missouri I can point you at the nearest facility.

Best regards,
DDM
 
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.

Looking at the video again it appears there is another diver with you at 25 seconds into the video. It also seems that after your initial thrashing around at the start you are relatively calm while you are being towed back. I am guessing you did not have a full on melt down until after you reached the boat and started thinking about what could have gone wrong.
 
I'm a doctor an I have seen sats of 85, 45, 25, etc...

Doctormike have you seen such sats on a otherwise healthy, but hyperventilating adult patient? If so I will retract my opinion.

Yes, pulse oxymetry can be inaccurate. If her O2 sats were 85% 40 minutes after the incident my bets are on a significant medical issue that led to anxiety rather than the reverse.

I'm absolutely with DDM on a full medical evaluation before further diving.
 
Doctormike have you seen such sats on a otherwise healthy, but hyperventilating adult patient? If so I will retract my opinion.

Yes, pulse oxymetry can be inaccurate. If her O2 sats were 85% 40 minutes after the incident my bets are on a significant medical issue that led to anxiety rather than the reverse.

I'm absolutely with DDM on a full medical evaluation before further diving.

Sure! I mean, I don't treat adults, so maybe you can dismiss my post on those grounds, but I think that I have been around pulse oximiters enough to at least have an opinion.

My point is not that a sat of 85% isn't clinically significant, if that is what you are getting at. My point was that a pulse oximiter is a fairly flaky device under the best of circumstances (intubated and sedated patient in an ICU), not to mention when applied in a clinic on a tropical island to a terrified, possibly disoriented and moving diver fresh out of the ocean. So all I am saying is that you shouldn't treat that "85" like it's a biopsy result or a blood gas or a mass on a CT scan. You and I have no idea what the actual clinical situation was during the incident, or what her baseline sat was, or if she wasn't hyperventilating but was just tachypneic with very shallow excursions and paradoxically reduced RMVs and atelectasis or aspiration or any number of other things, etc... etc...

And if her "significant medical issue" resolved instantly with O2 (which is what she seems to be saying), then I'm wondering what it was. DCS symptoms go away fairly quickly with O2, but I doubt that was what was going on, do you agree?

I am simply taking issue with the people who say "Hey, she had a sat of 85, it's gotta be EIB, and if she had only gotten the O2 mask on correctly then she would have been fine".
 
I used to suffer from EIB or 'exercise induced asthma' as it used to be known. Fortunately for me, my last experience was over 20 years ago. It was a 'typical' attack as described in earlier weblinks. I was out of condition, went for a run on a cold winter night and pushed myself harder than I should have, thinking it would help to get myself fit again. Deep breathing of cold air is generally considered a trigger along with the exertion.

As both the new and old names indicate, the brochospasm leads to air trapping and a wheeze on exhalation; but perhaps more importantly for this thread, included in the trigger for this is also the exertion or exercise.

We all have memories of important events early in our dive careers and I remember one told to me by an Instructor in the Caribbean when he saw me flailing about in the surge. He was the most chilled out West Indian gentleman you could imagine and his wise words to me in those early days have stayed with me over the years. He said (you have to read this with a chilled West Indian accent), "Hey, don' fight the ocean, man...." <pause & wide smile> "she bigger dan u!"

Some positive points I noted:
1. You had enough awareness to signal for help and got attention

2. You had enough awareness to drop your weight belt

[don't underestimate the significance of above two, those who are truly close to death are those not signalling and not thinking]

3. You are your own harshest critic and are probably beating up on yourself harder than anyone else.

4. You are turning this around to being a positive experience that you, and many others reading this, can learn from. Keep it that way and don't allow it to disintegrate into anything negative.

Take care and hope the medical checks out OK. I'm with DDM - even though EIB might appear most plausible, there are observations here which make pulmonary oedema a consideration.
 
Not to beat a dead horse. Very good points drmike. Nothing says the OP's original post is accurate in the details - but I have no reason to doubt it and used that as my starting point.

The vast majority of the posts imply that panic WAS the cause of her problem. When I read the original post my first thought was a medical issue, but it took about 4 pages before any posts considered this. Panic should be a diagnosis of exclusion, not the first (and therefore often the last) considered.

If it does turn out to be medical, then all you posters that wrote the incident off simply as a panic episode for a diver who clearly had a very traumatic experience and was looking for constructive support should consider whether their posts hurt or helped in the overall scheme of things. I am not pointing my finger at any one poster, nor am I including all the thread's posts either. If the shoe fits, then wear it.

Whether or not this turns out to be immersion pulmonary edema or exercise induced bronchospasm or something much more common it does suggest that what looks like panic isn't always so. How many times has panic been cited when there was something less known going on.
 
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Not to beat a dead horse. Very good points drmike.

The vast majority of the posts imply that panic WAS the cause of her problem. When I read the original post my first thought was a medical issue, but it took about 4 pages before any posts considered this. Panic should be a diagnosis of exclusion.

If it does turn out to be medical, then all you posters that jumped on panic for a clearly emotionally distressed diver should be ashamed

This is just "the chicken & the egg" argument, it does not matter which one came first, IF there was a medical issue at all and nothing in her original statement suggests that. I still think it was the panic that placed her at greater risk at that time.
 
'Panic' and 'medical issue' are not mutually exclusive. Remaining calm with or without a medical issue is always helpful.


Sent from my iPhone using Tapatalk
 
The margin between "healthy" saturation levels (95-98%) and respiratory failure (usually 85-90%) is narrow."


Wrong. 80% and below is when impairment and organ failure occurs.

If the DM's had stood back and let me "wear myself out", I would be dead right now. I was not fighting or flailing, I was very still, limp actually, in the water.

No. The video CLEARLY shows that you were thrashing hard. That camera was waving around very, very fast.

I am not sure why so many are determined to call this a panic attack, it wasn't. It was an acute medical emergency that I had never experienced before.

No...it wasn't. This is increasingly becoming your line; as you seek to deny what happened and find a medical excuse. You are not qualified to diagnose yourself. You displayed EVERY indication of a panicked diver, however.

Lots of DM's smoke, I do not think they should be left to die in the ocean, as they would if they were left to "wear themselves out".
Who said anything about leaving anyone to die??? But, if you take Rescue training, you'll know that one of the courses of action for a panicked diver at the surface IS to let themselves wear themself out, THEN rescue them.

The ONLY other thing anyone could have done was smacking the right mask on in the right position with enough O2 to get a distressed diver back to the shore. When things go well for so long, it is an easy thing to over look. And SUCH an easy way to save a life.

No. Oxygen is a placebo in a panic attack like this. Attacking the dive crew for a quick fumble and then you sucking down their O2 is not helpful.

Except have adequate O2 on board and someone who knew how to hook it up. BUT, they did get it hooked up and had enough to almost get me back to shore. Thank you.
They had adequate O2! They did hook it up right! You're just over-complaining and sucked up all the O2.

The other possibility is that the crew remembered that O2 will do nothing for you in a panic attack and turned it off and restowed it. You know, in case they had a real emergency that needed it.

I am surprised a bit at how some folks here do not really advocate for diving buddies. We did not have dive buddies on this trip, we just followed the DM.

And there's your first point of failure on this dive. You violated your training by not having a buddy, and you were not trained and equipped for solo diving. 'Following the DM' is NOT a valid dive plan.

My bottom line on this incident, I would encourage DM's etc., to check their ER O2 set up, and make sure the DM's know how to use it. A non-diver on the boat said it took the DM several tries to hook up the mask, then they had to switch that mask out for another one, and they were unsure what position the mask should be in on my face. A quick refresher on occasion can really make a difference.

That non-diver didn't know what he was seeing; he was too busy worrying about his wife- YOU. The DMs did everything right. A quick mistake does not mean they failed or had trouble.

You're reduced yourself to self diagnosis of EIB and blaming the DMs. Not quite the 'self-responsibility' that the thread is titled with.





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
And you're clearly not a Doctor. I consulted with one; my sister. She said that 85% is really low, but that the person could still function. It is NOT a 'significantly impaired level.', nor was she in a 'world of medical hurt'.

Remember, the clinic did NOTHING to treat her except let her hoover up some of their O2, and calm down. Oxygen is nothing more than a placebo in Panic cases. She self-diagnosed herself with EIB, probably after reading the internet that night.

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.
Exactly. I learned this same lesson from a SF medic in Afghanistan. Don't automatically trust a pulse-ox. They're usually good and reliable; but a variety of things can throw them off. Cold will make them read lower (vasioconstriction), and alcohol or heat will read higher (vasiodilation).

My sister told me that a panic can also trigger vasioconstriction. Panic was clearly present here.

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.
Agreed. As well; there was no 12 minutes until she was 'rescued'. I quit the video after about 5 minutes. She was on the boat then for at least a minute. She weren't that far from the boat, and the current wasn't that strong.

Thea; You panicked. It happens. Find the cause, get some additional training, quit smoking, get checked out and dive again.
 
richkeller, I hate phone keyboards and should never post from them. As you were writing your response to my post I was cleaning it up to be clearer and more tactful.

I don't think it really is a "chicken and the egg" issue. Not being able to breath will often lead to panic, but panic doesn't usually lead to continued respiratory distress that improved with oxygen, turned her feet blue, and reportedly dropped her blood oxygen saturation to 85%. But be that as it may. If panic caused the medical issue then training to prevent panic is most helpful. OTOH if the medical issue preceded and 'causes' panic then preventing the medical issue is better. In this case we don't know if there was either panic, a medical issue, or both. Someone in respiratory distress can look like they are panicking.

Also I found plenty in the original post to think it might have been medical. So much so that after quickly scanning the first 4 pages felt it important to PM the OP and suggest she get a medical evaluation in case it was a medical event that set off this traumatic experience.
 
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