SAN DIEGO - A man who was scuba diving died Sunday

[finnks]

I agree with where you're going with this but recent studies have shown that it's getting an AED on a person with a cardiac incident is what improves their chances of survival. CPR is good, but it's a band-aid compared to the potential gain from an AED.

Can you elaborate a bit? My understanding is that AEDs are only of use in a rather small window within rather specific fibrillation events - in diving environment the AED would only be of use to those specific heart attack events - and then only if applied within a very short period after the event starts. If I'm correct, the likelihood of recognizing the event, getting victim onto the boat and connecting AED up fast enough is vanishingly small. OTOH if someone suffers and recognizes a heart attack while on the boat, an AED could definitely be a life saver. Personally I experience far more physical and mental stress while on the boat than in the water - so hope that if I won't suffer a heart attack under water.

Definitely agree regarding efficacy of CPR. Would still use it if called upon, but don't hold out much hope that it will work.

 

[dytis-sm]

Definitely agree regarding efficacy of CPR. Would still use it if called upon, but don't hold out much hope that it will work.

From incident aboard the Truth a couple of months back, I gathered that CPR was instrumental in reviving a drowning victim after "free falling" from the surface to 80 ft and brought up to the boat unconscious. I am not sure if an AED was even used in that case. Maybe Bill from Power Scuba can comment on the benefits of CPR in that case.

Regardless this is a very sad incident and would like to send my condolences to the family.

 

[Power Scuba]

From incident aboard the Truth a couple of months back, I gathered that CPR was instrumental in reviving a drowning victim after "free falling" from the surface to 80 ft and brought up to the boat unconscious. I am not sure if an AED was even used in that case. Maybe Bill from Power Scuba can comment on the benefits of CPR in that case.

Regardless this is a very sad incident and would like to send my condolences to the family.

It was not on the Truth, dytis-sm. Diver was unresponsive and not breathing. CPR was initiated by myself very quickly and the diver was revived. There's a thread on it in this forum.

My personal belief is that it was the quick manner in which the unconcious diver was brought up from the bottom, onto the boat, and CPR initiated that enabled her recovery. My sources on the SD Lifeguards have told me to cherish the experience of bringing someone back... because it very rarely happens in drownings.

Bill

 

[boulderjohn]

You have less risk to have a medical emergency (be it a perceived one) underwater if you are fit. That's all I am saying. The diver looked healthy, so I would never had suspected a problem, and there have been fit people dying of heart attack or other fatal health problems, so obviously the issue is complex. But tech diving is strenuous, so I maintain that fitness should be part of the plan.

Jim Fixx wrote The Complete Book of Running. When he died at age 52 after a standard workout run, he was almost certainly more fit than anyone participating in this thread. Physical fitness promotes heart health, but it does not guarantee it. If you have badly clogged arteries, you can be in the best of possible fitness and still die almost instantly and without warning.

 

[Ken Kurtis]

Can you elaborate a bit? My understanding is that AEDs are only of use in a rather small window within rather specific fibrillation events - in diving environment the AED would only be of use to those specific heart attack events - and then only if applied within a very short period after the event starts.

Here's the salient point on an AED: It's going to do a more sophisticated analysis of what's going on cardiac-wise than simply checking for a pulse will do. (This doesn't mean people might not revive only with CPR.) The quicker you get the person on an AED, the sooner that info will be available to you. The AED will tell you if it's going to shock or not, &/or will tell you to continue CPR. My point is simply that you have a better chance with CPR and an AED than you do with CPR alone. There's definitely some controversy about an AED in a wet environment but again, the machine will decide if it's appropriate to shock or not based on the patient and the conditions.

I don't think there's a specific time limit as you mentioned but obviously sooner is better and after 6 minutes of no heartbeat, the assumption is that brain death will have set in. So if that's where you're going with the time limit concern yes, but it would apply to CPR as well.

 

[Sudzfd]

I am a paramedic. It is not either CPR OR AED. It is both.

The Aed is a good tool that will be effective at only resetting Ventricular Fibrillation or Ventricular Tachycardia. These rhythms do not last long before progressing into pulse less electrical activity or asystole. They are also not present in all cardiac arrest events.

Also the Aed is generally only effective after good quality CPR has been performed. The CPR primes the pump and the defibrillator starts the pump up. Without the CPR the heart may reset but push no blood (pulse less electrical activity) a fatal rhythm.

When I defibrillate manually I ensure good quality CPR up to the point of defibrillation and immediately resumed after for 1 minute before checking for a pulse.

The problem with diving emergencies is the time to CPR and Aed is very long. To get someone to the surface, to the boat and cut wetsuit off is quite a while.

Every 1 minute in cardiac arrest decreases survival probability 10%. So 7 mins in cardiac arrest gives 30% survival probability.

The best thing you can do is high quality CPR (push fast and hard at least 100 compressions per minute) minimize CPR interruptions and get the diver CPR/Aed as soon as possible.

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---------- Post added June 24th, 2014 at 11:40 PM ----------

Here's the salient point on an AED: It's going to do a more sophisticated analysis of what's going on cardiac-wise than simply checking for a pulse will do. (This doesn't mean people might not revive only with CPR.) The quicker you get the person on an AED, the sooner that info will be available to you. The AED will tell you if it's going to shock or not, &/or will tell you to continue CPR. My point is simply that you have a better chance with CPR and an AED than you do with CPR alone. There's definitely some controversy about an AED in a wet environment but again, the machine will decide if it's appropriate to shock or not based on the patient and the conditions.

I don't think there's a specific time limit as you mentioned but obviously sooner is better and after 6 minutes of no heartbeat, the assumption is that brain death will have set in. So if that's where you're going with the time limit concern yes, but it would apply to CPR as well.

------- Post added June 24th, 2014 at 11:38 PM ----------


Your 6 minute brain death number is quite incorrect. Especially in the case of quality CPR performance. Most CPR events I have worked last well over 30 mins and up to an hour. I have had return of spontaneous circulation after many minutes. The point of CPR is to keep the brain and vital organs oxygenated.


Also AED doesn't give you any info other than shock or no shock. While a good tool it takes time away from CPR and an over reliance on it can be fatal to the patient. If the Aed advises no shock it tells you nothing about the patients perfusion status. Also it will shock in wet conditions and it's important to dry the chest before applying the pads so the current goes into the chest rather than across the surface on the water.

 

[PhatD1ver]

I don't think its overstated at all. If you dont believe that, compare cardiac incident survival rates on land to those occurring underwater.

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And how is that in any way comparable? other than the fact that the same emergency puts you in a position where treatment is farther away... in reality, if the guy had a heart attack, he probably was due in open air.

I don't disagree people should watch their fitness, I'm doing all I can to drop my excess baggage, but to claim a direct relationship between underwater survival rates and above water is not accurate, as it is the environmental factors that make the difference.

Maybe an individual shouldn't be diving, and here's a piece of info... HEALTHY PEOPLE (or seemingly healthy) people have medical emergencies... and they will be in your stats too.. in fact, do you have a number to compare for the % of divers who were 'not fit' and those who were and survival rates underwater?

I weigh over 330# , I ran two miles this morning...am I fit? Will I have a cardiac incident underwater? I certainly am more pre-disposed to have one ANYWHERE.

---------- Post added June 25th, 2014 at 01:24 PM ----------

Out of curiosity, and not to take the topic off track, what's your weight and height? What's your average time running a mile and how often do you run? I know the types that claim fitness has nothing to do with diving.

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Oh, oh, wait, ME, pick ME!!! I want to answer..

I average 25 miles a month, the past month I have been remiss, but I ran today, and my time for a 2 mile run (my average run three times a week, with a 3 or 5 mile run on Saturday) was still 15:35 miles... I am not fast, but I get where I want to go...

I weighed 335.7 this morning (181cm or 6'0") , and I have slightly elevated ALT, normal blood chemistry for everything else including glucose, cholesterol and triglycerides...

I have about 14,000 PVCs/PACs a day, and can cause a spiking event by overexcercising... I do not take beta blockers... during ANY exercise event, I have to make sure I manage my exertion level to prevent a spike (this is an even where my HR suddenly jumps to about 180# (I'm 54) because my heart is overexcited (for ease of explanation)... above water, I wear a HR monitor to track my HR, underwater, so far no good device exists (the Finis HRM doesn't work at depth)... so, if I swim into the current, I swim in a very slow, strong motion (a lot like a whale).. and if I tire, I do what I'm trained to do.. I pause, rest, then continue... and if I were to not resolve it within 2-3 minutes, I abort the dive.... more important is that I know a dive with current isn't one I should plan on, unless it's a drift.

My doctor refers to me as the healthiest fat man he knows... he still encourages me to keep working on my weight, and feels that my current 'fitness' does not pose any more of a risk UNDER water than it does above water or at altitude.

So, 'what is that type'? then again, I'm not saying someone shouldn't be fit, but for someone like you, a casual observer with no information on the medical history or background of the diver, to start pontificating in absolutes is kind of out there.

its the use of 'essential' that is hanging everyone up, and I won't say fitness is "essential". But I will say paraphrasing what was stated above, that if you intend to dive, and don't know how your current medical status, and fitness regime will affect your ability to dive safely and surface without incident, then you are a danger to yourself and others.

There, are we all friends now?

 

[mathauck0814]

Perhaps a MOD could split out the medical discussion from comments regarding the incident? There's a lot here that friends or family of the victim could find and be confused by.

 

[Ken Kurtis]

Slightly off-topic, but I'd like to clear up any confusion or misinformation . . .

Your 6 minute brain death number is quite incorrect.

When you get a chance, please call the National Institute of Health (301/496-4000) and let them know that they're wrong too. "Time is very important when an unconscious person is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 - 6 minutes later." (CPR - adult: MedlinePlus Medical Encyclopedia)

Most CPR events I have worked last well over 30 mins and up to an hour. I have had return of spontaneous circulation after many minutes. The point of CPR is to keep the brain and vital organs oxygenated.

You either didn't read or didn't understand what I wrote. So let me try again.

I wasn't referring to how long CPR went on for. I was referring to how long it was before it STARTED. According to NIH (and others), if you don't START within 4-6 minutes of the person going unconscious and the heart stopping, permanent brain damage can begin to occur. This is wholly different from how long you go ONCE YOU'VE STARTED. Once you begin CPR, even if they're unconscious, you're hopefully getting blood moving again and I have no doubt that people come back after lengthy CPR sessions.

Also AED doesn't give you any info other than shock or no shock.

Which is exactly what I said. (And when not shocking, or after it shocks, the one I train on does say, "Continue CPR.")

While a good tool it takes time away from CPR and an over reliance on it can be fatal to the patient. If the Aed advises no shock it tells you nothing about the patients perfusion status.

I disagree with your dismissal of the potential value of the AED. Yes, you pause and stop CPR while the AED is analyzing. But it may determine that it will shock. You seem to be essentially saying the AED's value diminishes because it makes you stop CPR (which is admittedly valuable) briefly but then it may not shiock. And you seem to feel that if it's not going to shock, the CPR stoppage was detrimental. But you won't know if a shock is needed unless you let the AED do it's thing and in cases where it can and will shock, that will likely be more valuable than CPR alone.

 

[Tony387]

This really needs to be moved to another thread...there are several dealing with this topic, where physicians have weighed in.

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