Reflective Essay

Reflective Essay

During a paramedic science foundation degree course introductory class, one of

the two senior lecturers present asked us (the students) if we could enlighten him
on what could be a common cause of carotid sinus stimulation in Gibraltar,
considering its geography. None of us supplied him with an answer, so the
lecturer answered for us; carotid stimulation due to tight neck seals in divers.
Having been a professional diver since 1987 and a diver medical technician since
2007, having worked for the ministry of defence and later for major oil companies
as a saturation diver , I am not only familiar with the condition, but, I also believe
having experienced the initial setting of this phenomena on a number of

occasions 1. Nevertheless, that night whiles considering a topic for my reflective

essay I thought I would glance through my diving courses and diving medical
technician notes and read over the subject. I was conscious that I may be veering
from our instructions; the reflective essay should be based on a particular subject
covered during the two day lessons, I believe that I could justify my brief change
of direction; it was mentioned during a lesson and it is a medical issue.
My notes included an article by Dr Sawatzky titled “An Unusual Cause of Fainting

2, given to me by the diving school, where he mentions carotid sinus stimulation
as a possible aetiology of fainting in divers. I then attempted to further research
the subject. I started by searching for the Australian study the lecturer had
mentioned and although I failed to find the study per se, I did find a mention to
this study in SUDDEN DEATH SYNDROME (Cardiac Death)
http://www.divingmedicine.info/divingmedicine/Welcome_files/Ch%2035.pdf
Finding the topic interesting it made me also reflect on other plausible causes of
carotid sinus stimulation which may affect divers and in particular those I may
have encountered and or had heard about during my diving career. A possible
cause came to mind. In fact, it seemed ridiculous that I had not made a
connection earlier, albeit having experienced signs and symptoms similar to that
experienced during the initial stages of carotid sinus stimulation 1

My argument/reflection is based on the AH3 deep sea diving hard helmet when
fitted with its own neck seal and its possible carotid sinus stimulation during
particular presentations. Before elucidating I will provide a basic overview of the
helmet:
The Dive Dynamic AH3 is a light weight hard helmet made of fibre glass Fig. 1.
Fig 1
When in operation medical air is allowed to free-flow into the helmet via an
umbilical which fits to the screw valve (on Fig. 1 the inlet-valve can be seen on
the left of the picture. It is the front most valve) at pressure higher than the
seawater pressure for a given depth. Excess air together with expiratory air flows
out through the exhaust valve seen far left on Fig.1
In particular circumstances, it is my opinion, that this system may provoke

carotid sinus stimulation.
• When used with its own neck seal a base plate together with the neck seal
sits over the primary suit neck seal. This may markedly augment the tight
neck seal theory 3
• Although excess air freely flows out of the helmet, through the exhaust
valve, the positive pressure exerted by the inward flow frequently exceeds
outflow (inflow is regulated subjectively by the diver depending on depth
and work load). This may cause
1. On a loosely fitted helmet harness, a pronounced positive buoyancy

(see fig. 2 which illustrates the harness configuration) this may result on
the helmet base exerting an upward pressure on the carotid fossa and
sub-maxillary area.
2. The positive pressure increases intra-helmet pressure and thus may

exert a back pressure against carotid arterial blood flow and in turn reduce
cerebral perfusion strictly speaking not related to carotid sinus stimulation,
but still I thought of it important under the general concept of cerebral
hypo-perfusion) .
Fig. 2
Cognitive function Cognitive performance during simulated deep-sea

diving
Robert H. Logie; Alan D. Baddeley
Ergonomics, 1366-5847, Volume 28, Issue 5, 1985, Pages 731 – 746
I would be very surprised to find that no studies have been done on this topic
given that there could be a possibility for at least one physiological system to be
challenged. I also presume that countless episode of carotid sinus stimulation in
commercial diving may have not been reported to the diving supervisor and/or
the supporting medical team (I say this by experience) and thus these
occurrences may be under reported. The inadequacy in revealing a possible
condition, albeit transient in most cases once the insult has been removed. 3
may be owing to the in-build machismo and the competiveness experienced in
the industry of a commercial diver.
Failing to find any specific information to support my speculation; I searched

diving manuals and effectuated a number of different web searches, I contacted
Divex Ltd in Aberdeen, United Kingdom and the Diving Diseases Research Centre
in Plymouth requesting their possible assistance on elucidating this matter.
Not being satisfied with my poor results I then thought that perhaps I should look
for other studies on deep sea divers which may be related as a product of poor
cerebral function. So I did a search on cognitive function and deep sea divers
and also on memory loss and deep sea divers and came across
Memory deficit caused by compressed air equivalent to 36 meters of seawater.

By Philp, R. B.; Fields, G. N.; Roberts, W. A.
Journal of Applied Psychology, Vol 74(3), Jun 1989, 443-446.
Abstract
Twenty-four students from a diving school undertook a hyperbaric chamber dive to a
pressure equal to 36 m of seawater. Tests of cognitive function and manual dexterity,
performed in the chamber during the 35-min bottom time and before, or after, the
dive included immediate and delayed free recall of words presented as 7 lists of 15
each, recognition of previously presented words, number identification, and a forceps
pickup of ball bearings. Delayed free recall and immediate free recall (primacy
region) were significantly impaired, whereas manual dexterity and recognition
memory were not. These are in keeping with previously reported findings but indicate
that significant impairment of memory may occur in experienced divers at operational
depths for air diving. Lack of effect on recognition memory suggests that cueing
strategies might be useful for debriefing divers. (PsycINFO Database Record (c)
2010 APA, all rights reserved)
Carotid Sinus Syndrome

Purks, William Kendrick M.D.
http://journals.lww.com/smajournalonline/Citation/1945/09000/Carotid_Sinus_Syn
drome.3.aspx
Southern Medical Journal:

September 1945 - Volume 38 - Issue 9 - ppg 578-584
Demontrate not
I thought I would look into memory loss. My first port of call was
basics of diving practise/medicine which I had been taught in basic diver training,
had had to release neck seal pressure more than once (by introducing my fingers
in the suit ahead of diving) before fallen victim to this condition as a diver and
had been trained to diagnose and treat as a medic. It only fall into place
❑ Carotid Sinus Syndrome.

The Carotid arteries, on each side of the neck, are the main arteries which
supply the brain
with blood, and these have a pressure sensing organ – the carotid sinus –
in their walls at
about the level of the larynx. External pressure on these carotid sinuses
causes the cardiac
control centre of the brain to mistakenly assume that the blood pressure
has suddenly risen.
This leads to a reflex slowing of the heart and reduced blood
pressure. This can cause
faintness or even loss of consciousness.
A similar effect is caused by pressure from the collar of a tight fitting
wetsuit or dry suit
neck seal, on the carotid sinus. The problem is especially likely in wet suits
without a front
zip fastener or having tight "crew necks".
In a series of 100 carefully documented diving deaths in Australia, only
one case was
thought to be due to this carotid sinus syndrome. In other cases however,
distressed divers
were seen to pull a constricting wetsuit away from the neck. This may
have been a response
to respiratory difficulty from cardiac causes, a tight neck opening in the
suit, or the carotid
sinus syndrome.
Hyperbaric
Sudden death syndrome (chapter 35)
Mentions vasovagal stim on divers
http://www.divingmedicine.info/divingmedicine/Welcome_files/Ch%2035.pdf

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What is carotid sinus stimulation and how can it affect divers?

What studies have been done on the effects of pressure on cognitive function in deep sea divers?

Reflective Essay

During a paramedic science foundation degree course introductory class, one of

occasions 1. Nevertheless, that night whiles considering a topic for my reflective

My notes included an article by Dr Sawatzky titled “An Unusual Cause of Fainting

experienced during the initial stages of carotid sinus stimulation 1

In particular circumstances, it is my opinion, that this system may provoke

1. On a loosely fitted helmet harness, a pronounced positive buoyancy

2. The positive pressure increases intra-helmet pressure and thus may

Cognitive function Cognitive performance during simulated deep-sea

Failing to find any specific information to support my speculation; I searched

Memory deficit caused by compressed air equivalent to 36 meters of seawater.

Carotid Sinus Syndrome

Southern Medical Journal:

❑ Carotid Sinus Syndrome.

Sudden death syndrome (chapter 35)

Mentions vasovagal stim on divers

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