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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).

<<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.

<<In any event I am not criticizing the rescue here, just trying adding my
0.02.>>

Same here, Good job by all.

Steve Grasso
--
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