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>In a first aid class tonight we touched on seizures. The emphasis >was on epileptic seizures occurring on dry land, but at some point >the discussion turned to seizures that might occur underwater among >individuals who either didn't know they were at risk or who screwed >up and were breathing too high a PO2 and toxed. Basically everybody >agreed the biggest risk here is drowning and not the seizure itself, >but in response to questions about the proper response things were >less clear -- initially most people said they thought the buddy >should bring the victim to the surface as soon as they recognize >what's happening, but one guy raised the issue of lung expansion >injuries that could occur if the victim's airway was closed. He >said he'd asked DAN about it at some point, and they recommended >waiting until the seizures subsided before surfacing. > >So, what's the right answer? Is a seizure victim's airway likely >to close? If so, does it stay blocked throughout the entire seizure >or is it just intermittent? Is it best to wait, immediately ascend >slowly, or immediately ascend quickly? > >I'm guessing it would be intermittent and that an immediate slow >ascent is the proper response, but I'd really rather know than >guess! References or an explanation would be most appreciated. Todd, I'm in general agreement with your approach. I've not been able to come up with an "official" answer since every circumstance is a little different (the PADI and the BSAC rescue course manuals lump the seizing diver under "unconscious divers at depth") so let's look at a "practical" course of action. First, just for the record, a seizure is the simultaneous, uncontrolled electrical discharge of the brain. The net effect is lose of consciousness and uncontrolled, uncoordinated autonomic system activities (that's what makes seizures dangerous above or below sea level). Now if you figure that if you leave a diver in such a state under water they will almost *definitely* drown versus getting them to the surface where they *might* have an overexpansion injury, DCI or AGE (air gas embolus)... Secondly, once you have a drowned, dead diver, there's not much you can do for them. If you have a live (though injured) diver on the surface you have options. Even with an overexpansion injury, you can get them to a hospital to be placed on respirator support. Not a great state of affairs, but it sure beats the former state of affairs! Third, not every seizure is of the "grand mal" sort (with active, uncontrolled flailing) some are of the "petite mal" type where the victim just goes limp and loses consciousness. I'm not sure I could tell the difference (especially underwater) between that type of seizure state and say passive panic or just loss of consciousness from hypoxia. So it would be tough (for me at least) to judge an "end point" in order to decide *when* to start bringing them up. So, until better info or experience comes along, I'd handle it just like you...just get the guy to the surface in an expeditious fashion. I'd send him up as outlined in my rescue training (if his regulator is in his mouth...support it in his mouth in case they start breathing spontaneously. If it's already out, don't bother, just bring them up. As the residual air in their lungs expands it will push much of the water out of the respiratory tract). As their dive buddy and medical provider (official or otherwise) you do what you have to do. Get them to the surface *without* hurting yourself! Accompany them if you can, but if necessary, send them to the surface alone if otherwise it means *you* get injured. (there is no logic to creating *TWO* victims in extremus when you started out with just one!) A bent *live* victim on the surface... we can treat...a dead one below surface limits your options. My $0.02 (YMMV) Robb Wolov ======================================== CDR R.B. Wolov, MC, (FS), USNR Department of Orthopedic Pathology Armed Forces Institute of Pathology 14th & Alaska Aves. NW Washington, DC 20306-6000 wolov@hi*.co* (preferred) wolov@em*.af*.os*.mi*
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