Solve the Diving First Aid Scenario!

[divemed06]

Ok folks...here's a diving first aid scenario for ya...
You're out doing a nice easy shore dive with your buddy. It's gonna be a wreck dive (no penetration) at a site that you're both familiar with. It's a bit out of the way (it took you 2 hours to get there by car). There's nothing around the dive site besides the dirt road that brought you there. Before doing the dive, you both make sure everything is ready to go. Current is about 1 knot, visibility about 25 feet and the water is a toasty 40F so you're both diving dry. After completing an uneventful dive for about 40 min at 45 feet you and your buddy start heading out of the water. You have to climb over a few slippery rocks to get to the dirt road where you're car is parked. You climb out of the water but your buddy decides to sit at the bottom of the hill on the rocks to have a little rest and enjoy the sun for a few moments. So, you climb to the road and start taking your gear off. It's been about 10 minutes and your almost ready to leave. You proceed to go and ask your buddy to get out of the water and pack-up. As you approach the little hill you see you're buddy laying on his back (tank and all) in an awkward position. His fins are at the base of the hill near the water and his mask is downstream. You rush down the hill and tap him on the shoulder... he doesn't respond...

What's you're next step? (You don't have a cell phone and there are no houses around...no one is around!)
In what sequence would you do things?
What is your main concern?


.... after about 4 minutes, your buddy starts convulsing.... What could be a probale cause for this? Name at least 2 things...

Have fun! :bogey:

 

[H2Andy]

What's you're next step? (You don't have a cell phone and there are no houses around...no one is around!)
In what sequence would you do things?
What is your main concern?

my immediate thought is "hypothermia" but i have NEVER
done any diving dry in cold water, so i may be missing the nuances.

just to be safe, i would check his airway, make sure he is
breathing, make sure he has a heartbeat.

assuming yes to all those, get him in the car (zero possibility
of spine or neck injury), give him oxygen if i have any, or the highest nitrox i have, and provide standard care for
hypothermia immediately. then drive to the nearest phone and contact emergency services.

once he starts convulsing, however, i would do the same
except put him on his side to make sure he does not aspirate
vomit, leave the o2 on, and keep rushing to the nearest phone.

sadly, there's nothing else i can do for him with my level of medical knowledge.

(i have never heard of an O2 toxicity seizure happening after
reaching the surface; the dive profile is awful conservative
for DCS -- but i guess it could happen).

 

[jonnythan]

Check for pulse and breathing, then act accordingly in standard first aid procedure with the knowledge that this is very likely a DCS scenario. If I had oxygen available and he were breathing, I'd administer that as I called 911.

I'm not really sure what would cause convulsing 15 minutes after egress, especially after unconsciousness set in 4 minutes before. Some sort of CNS hit?

 

[Snowbear]

[(zero possibility of spine or neck injury)

You sure about that?

You have to climb over a few slippery rocks to get to the dirt road where you're car is parked. You climb out of the water but your buddy decides to sit at the bottom

 

[H2Andy]

oh darn it!!!

 

[jonnythan]

You sure about that?

Good point that I even missed. Of course I probably would have thought about it had I just done that walk.. but even still, I wouldn't start moving someone til I were absolutely sure they had no such injury. There's no reason to drag my buddy up the rocks and into my car, you wait for the professionals to come.

 

[H2Andy]

no one is coming. the scenario makes it clear you don't have a cell phone and there are no houses to which you can shout or run to.

you're pretty much screwed:

if you don't move him, he deteriorates.

if you move him, you risk making his injuries worse.

in this scenario, with no likelihood of anybody happening upon
the scene (remote) and no cell phone, i would risk the move.

 

[divemed06]

You sure about that?

Snowbear is a wise one! Not bad H2A and Johny...but DCS wouldn't be my first instinct...although you might be correct..here's a little tip...always try to find the MOI (mechanism of injury)...ie. Why is he laying on his back?
DCS...maybe
Slip and fall.... seems to fit the scenario

Can anyone name/state the priorities in dealing with this type of scenario (well, any type of First Aid Scenario for that matter)?

P.S.: There's never an absolute right in these sort of things...but there are certain standards that we should try to follow. Good luck.

 

[archman]

According to my P.O.S. medic training, after doing the ABC's and placing in a recovery position, I'd be obliged to ditch "said dude" and run off for help. I would have to leave a note explaining care and condition of patient, and where/when I took off to to get help.

Sure would be nice just to chuck him in the back of my pickup truck though. I miss the old ways...

 

[Snowbear]

...after about 4 minutes, your buddy starts convulsing.... What could be a probale cause for this? Name at least 2 things...

Head injury, DCS, AGE, epilepsy, diabetes, stroke, cardiac arrest, pulmonary embolism, drugs, hypotension, hypoxia, hyperthermia. (I left out OxTox on purpose )