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This is posted to the list in the event anyone else besides Steve and I want to examine the nitty gritty medical stuff. Otherwise it might be pretty boring. Truckie57@ao*.co* wrote: > In a message dated 10/27/98 3:08:48 PM, you wrote: > > <<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.>> > > Just a note here...Hypovolemia is low blood (intravascular) volume not low > B/P, that would be hypotension and that is not always caused by low fluid > volume, could possibly have been some type of vasodilation. With his history > of hypotension he may very well have bottomed out and then may have suffered > some type of Pulseless Electrical Activity (PEA). True. I was using the term 'hypovolemia' since I do believe he was in PEA, and thus at his heart he was low on volume. This is due to peripheral vasodilation. Just like if he had been administered a nitrate. So 'hypotension' is a better choice. > <<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.>> > > I agree, sounds like it may have been a shock state > > <<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.)>> > > With this guy having blue lips and face, with no breathing on the surface it > sounds like it was cardiac arrest. I really doubt that just my putting him > into a supine position would bring back spontaneous pulses. Sounds more like > the CPR. If we go with PEA due to hypotension, then there is very little to no volume in the central circulation and at the heart, so therefor chest compressions offer no effect, at least not at first (but obviously should be done.) That is why I think putting him in the supine position, as well as getting him out of the water, is what started to reverse this incident. As blood volume began to shunt back to the central circulation then the CPR could help some. But if he was truly in PEA due to hypotension, then the pulses would spontaneously resume too, and CPR would be (and was) stopped. That is my thoughts behind the positioning. Plus, my experience is that people who go into arrest quickly do not get noticably cyanotic.They get a light ashy grey color. People with severe ventilatory problems (really tight asthmatics, COPD'ers, and somtimes acute pulmonary edema) will go blue. So I'm not sure the cyanosis nails the full arrest part. Either way, whatever happened to this guy (it would be nice for his full diagnosis to be posted) he should stay on dry land :-) 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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