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Joe West wrote: > Greetings Everyone, > > I was involved (intimately) in a rescue off of Catalina > Island last weekend. I'm hoping that if I can provide enough detail; this > group can provide some clues as to what might have caused this incident. > Here's what happened: > The diver acts as if he does > not seem to quite understand what is expected, and is generally acting a > little confused. The instructor directs me to sit with this diver while > she finishes the skills on the last diver in the group. > As I position myself face to face with the diver, I notice that he is > breathing very quickly (almost constant flow from the regulator) and > shallow. He's opening and closing his eyes (mostly closed)). I reach in > and grab his left forearm with my right (a buddy breathing type grip) and > he holds on to me. We sit there for a couple of minutes, and then the > instructor directs us to ascend. I keep my grip on him and we start going > up. The ascent took 42 seconds (according to the computer profile of the > dive) and I had to dump air from the diver's BC because he wasn't > responding to my direction to dump the air from his BC. We were face to > face on the entire ascent, and his breathing was the same rapid shallow > breathing on the way up. These are pure guesses but I think the student diver was either: A: concentrating on not vomitting underwater. That eplains the breathing rate and depth, inability to communicate or do skills (testing or ascending). Also explains why he puked immediately at the surface. Why was he so nauseated? Could be purely behavioral, but probably had a medical problem emerging. B. diver was simply having a medical problem. > Once on the surface, the diver immediately threw up. After he finished > throwing up, I told him to relax and rest a few minutes and then we'd go > back to the boat. As he lay on his back, he started drifting with the > current. I told him to swim over to me, and he did not respond. I then > told him that I would tow him in. I swam over to him, and grabbed his > first stage and started towing him in. He threw up again, and then settled > back into the BC. I towed him like this for about a minute, and then > noticed that he was awfully quiet. I asked him if he was doing okay, and > there was no response. I stopped towing him and went to his side and > looked at him. His face and lips were blue. His eyes were open, but > clearly not seeing anything. After tearing off his mask (which was around > his neck) I checked for breathing. None. I gave him two quick packing > breaths, and then began rescue breathing (one breath every five seconds). All this points to medical problem during the dive. > After yelling to the boat that he was not breathing, I continued towing and > rescue breathing. It took about two minutes to get him to the dive platform. > Two nurses (divers also) happened to be on board and they checked for a > pulse... There was none. They began CPR. After approximately one minute, > the diver began breathing on his own. Probably one of three things happened here. Either he had a pulse and the nurses missed it and started CPR erroneously, or he was in ventricular fibrillation and the CPR compressions actually defibrilated his rythm (documented cases of this happening) or he was in arrest due to temporary hypovolemia, that is, his everyday too low (needs medication) blood preasure had gone to nil. Immersion in the water could have started this. Shock, the inadequate perfusion of tissues, will cause rapid shallow breathing, confusion, nausa, vomitting, passing out and death. Cyanosis (blue lips) is sometimes found, but cool clammy skin is the real differential sign. Was he pale at the surface, like white as a sheet? The supine position for CPR out of the water could have then brought his pulse and breathing back, as well as the CPR. (Note: the compressions to pump blood will not work if there is no blood to pump. But that is generally hard to tell for sure unless there is huge external bleeding. The rescue breathing will always get 02 into the lungs.) In any event I am not criticizing the rescue here, just trying adding my 0.02. > The Coast Guard arrived and took the diver to the Catalina Decompression > Chamber area. > By the time we got to the chamber, the diver was completely lucid and > responsive. Makes sense that with time his full circulation would be restored. > After a level 6 decompression, the diver was taken to USC medical center. > They could find no embolism, nor any other likely cause of the cardio > pulminary arrest. The diver was on low blood pressure medication which he > took the morning of the incident. > Also... They did find some signs of fluid in the lungs; but were unsure of > the cause (heart failure or inhalation of seawater). Low blood preasure can cause the serum part of the blood to seperate out and move into the lungs from the bloodstream. > So... > My question to the group is; What could possibly cause cardio-pulminary > arrest in a diver of somewhat advanced age, at these moderate depths? The fact that it happened while diving and not some other sport is interesting. The fact that he did have some fluid in the lungs (heart failure or shock) and is on low blood preasure meds means my money would be on hypovolemic shock due to immersion underwater, with the fluid entering his longs (exacerbating his shock = cyanosis, blue lips) and eventual cardiac arrest until the blood preasure was restored (out of the water, CPR, 02???) and eventual full recovery. Did you give 02 during CPR? Did the cyanosis go away first or did his skin color come back from pale to 'rosy' first? You guys did good. Tom -- The Guns and Armour of Scapa Flow Scotland 1998 Underwater Photographic Survey of Historic Wrecks http:www.gunsofscapa.demon.co.uk -- Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'. Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'.
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