Blue lips, warning sign

[cdavis]

I'd always assumed that blue lips on surfacing, which turn back to pink quickly when breathing resumes, is a good warning sign for anoxia brought on by staying down too long. See that and figure BO is not far away.

Is this warning sign affected by Bohr shift, ie, if a diver hyperventilates and drives his co2 way down, will his lips not turn blue before BO? Bohr shift means there will be more o2 retained in the haemaglobin, unavailable to keep you conscious, so blood will be less blue. Is that effect enough to affect lip color? More practically, will mild hyperventilation affect lip color, making this warning sign not reliable?

Anybody got any experience with this?

Thanks

Connor

 

[DivingDane]

not really got much experience wi did have a guy at training last night have a surface blackout after a big static, he has a tendancy to hyperventilate a bit (regardless of how many times we tell him not to) and he still came up very blue. (mindyou he had a pretty good black out thats for sure, was out of it for a little over 20sec. came to ok did his surface protocol and was waiting for his white card when he realised i was holding him clear of the water! hahahaha i think he has learnt his lesson about hyperventilating now i hope.

DD

 

[efattah]

Hyperventilating will affect the appearance of blue lips. Lips will not be as blue.

Keep in mind that blue lips are not a very good indicator. For example if you have low blood pressure, and stand up quickly, you may black out, but your lips will still be perfectly pink.

 

[trux]

Interesting question. Yes, you are right that CO2 and pH (beside other factors) will influence the safe threshold and whether the central cyanosis (blue lips) occur sooner or later before BO level. However the CO2 is not the only factor. Normally, the central cyanosis occurs at about 5 g of deoxigenated hemoglobin per 100 ml blood (normal person has about 15 g per 100 ml).

At normal persons it would correspond to the arterial saturation (SaO2) of about 85%. However, at anemic persons you would paradoxically get the blue lips at much lower saturation - at an anemic person with 9 g per 100 ml it would be at SaO2 of 73% (hence much deeper in hypoxemia).

And oppositely, at a person that has unusually high hemoglobin level, the cyanosis would occur sooner - hence still far above any dangerous level of hypoxemia.

Then there are also other factors, like vasoconstriction (I mean facial skin vasoconstriction in this case - periphery vasoconstriction may cause sever cyanosis on extremities), and cold temperature - both will amplify the blue-lips effect. Then natural predisposition, skin thickness and color, ambient light, and some other aspects.

From this point of view, having blue lips may be sign of a pretty deep hypoxemia, but as well it can occur quite a long time before the person holding her breath closes to her limits. So you need to know the person you spot very well, and as you wrote also watch her well during the breath-up, to be able evaluating the cyanosis.

Source: Cyanosis: Overview - eMedicine Pulmonology

 

[Mullins]

Just from what I have seen in the few divers I regularly train with, cyanosis varies greatly between individuals but seems very regular for each individual. E.g. my girlfriend's lips seem to change colour in direct relation to her level of hypoxia, and blue/grey means she is hypoxic. My lips (so they tell me) go quite blue after even moderate dynamics, e.g. 60% of max. My other training partner's lips hardly change, even on 80% dynamics (she hardly ever does max swims. Needs to harden up...)

 

[trux]

Yes, Dave, that makes sense - as I wrote, the individual predispostions, the level of hemoglobin in blood, and also consistent breath-up habitutes will result in relatively consistent cyanosis. Another factor that should be kept on mind is the temperature.

 

[BennyB]

What about ears and backs of necks? I rarely get to see someone's lips during a static/dynamic (not until they surface) so it's not an effective test for me. After I know a partner for a while I can kind of gauge what level they're at by the colour of their ears and their neck, and to some extent the veins that pop out (on some people), but it's very unscientific and only used as a rough guide.

Cheers,
Ben

 

[trux]

What I did not mention is splenic contraction and the release of additional hemoglobin - that will influence the cyanosis too, so in a series of the first few breath-holds you start getting blue earlier and earlier (untill the hemoglobin is fully released from the spleen)

 

[trux]

Veins popping up are due to increased blood pressure because of vasoconstriction and contractions. If you see the cyanosis on the neck or ears, then it can be used in the same way as on the lips, though it is much easier to see it on the lips, because they are supplied by blood directly from arterial branches connected to the carotids, and because the skin on lips is quite thin.

 

[chrismar]

Cyanosis is very variable in my experience too. My lips and face tend to go blue quite quickly, especially on high-CO2 swims. I can look blue from a 30% dynamic, if the dive reflex is strong enough. Near my limit, I go black and blue in my ears, neck, face & lips. One buddy (you know who you are!) gets some stunning colour changes in his ears. A very handy indicator of where he is in his dive.

None of the people I train with hyperventilate or 'purge', so that might contribute to them coming up looking reasonably blue after most dives.

 

[nostres]

I do 120-135m best dynamics depending on current shape. But no matter what shape I am in I always get blue lips after 75-80m, so says my buddy

 

[trux]

So I think we can conclude that if you are physiologically and technically good freediver (high hemoglobin, strong splenic contraction, strong vasoconstriction, low or no hyperventilation), you can easily get blue very early in the breath-hold without coming too close to the BO threshold. In contrary, if you are physically and technically unfit (low hemoglobin, weak diving reflex, high hyperventilation) you may blackout without no cyanosis whatsever.

 

[TimoP]

Seeing blue lips seems to depend very much on who you are looking at, even among the best freedivers...

I'm a buddy for a good freediver, and he has blue lips only when he has done 180-200+ m DYN, 140+ m DNF , 60+ m CWT or 7:15+ STA. In dynamics diving time is then over 3:15 min. These are performances with no-warm-ups. He doesn't hyperventilate, but packs quite a lot for maxs. I've never noticed that he has had blue ears or neck. His lips seems to get dark blue near his limits just before he would get samba. He rarely gets samba and "never" BOs, because he gets so clear "last warnings" before samba or BO.

In his case blue lips after a long or deep dive always mean - as far as I have noticed -that he has been near his limits.
When I ask him "Was it thigt at the end?",
His answer is "Maybe a little", if he has blue lips.
If he has some blue color in his face too, his answer is "It was too tight, I should have stopped just a little earlier or be more relaxed".
If he has no blue in his lips, his answer is "No, it was quite easy", even if 150+ m DYN, 125+ DNF or 7:00+ STA.
I always look his lips and face when he comes to surface, and so I know his answer before he tells me.
But if he does some warm ups or CO2 swimming, it can be different with the blue color. But with no-warm-up-max dives it has been so accurate sign with him.

-----------------------
Some more about seeing blue lips, a little OT :

Because we have here in Northern Europe often cold water in lakes even in summertime, it's very common to see at a beach children with blue lips when they have played or swimmed a long time in a lake. A long time means here about 20 mins, if water is under 22 C. They have no wetsuits, or hypoxia, you can be sure Then they go, if possible, to a 60-100 C degree sauna, and their skin and lips get very, very red again .

If you go here in winter time to ice swimming into the hole in the ice in a lake or sea, wearing only a swimming suit and neopren shoes (this is with a hot sauna a very common and healthy hobby here!) ,you normally don't get blue lips if your are "the normal" 5-15 seconds in a 0 C degree water. If you are longer, you maybe get, probly it depends on person... I have tested only that normal 5-15 seconds there, cause I´m not adapted enough to ice COLD water - without a 5 mm wetsuit, I mean .

Maybe some of THEM have blue lips:
(Notice: People have no hurry to go inside, because they enjoy some fresh air (which is below the freezing point). There is a machine making air bubbles underwater to keep the hole unfrozen.)



But you rarely see here in wintertime children or adults with blue lips, when they are normally outside with clothes even at -20- -35 C degrees, because their body is warm, though their face may be very cold. In fact your ears get white (or red!) if their get cold when you are in very cold air. I've never seen blue ears, neck or face in winter, it would sound a very dangerous situation:blackeye in these circumstances, I think. Cold and sometimes a little blue hands are common, when it's cold, but I varies very much. But nowadays it's not often very cold here anymore, -2 - + 2 C is now most usual in wintertime. We have really notice the climate change already here in the North...
Lakes and the sea have an ice covering ONLY from Dec/Jan to Apr/May, not anymore over half an year. And that's very strange, indeed

 

[cdavis]

Thanks to all for your extensive information. TimoP's experience is closer to mine, but there is obviously much more variation than I had realized. Given the comments, I'm going to assume that minor hyperventilation isn't going to change the onset of blue lips by any significant amount.

To turn the question around, given a physiologically fit and reasonably competent freediver, if there is no sign of blue lips or similar symptom, can we assume that the diver is not close to his limit?

Connor

 

[TimoP]

What I wrote earlier about blue lips, for me blue lips means they are a quite dark blue, not just a little grey-blueish. That's because here in the North you see often light white-grey-bluish lips for other reasons and don't pay much attention to it.

With a little bluish lips your are maybe not near your limits, but it's hard to me to say, because the variation is so large.

To turn the question around, given a physiologically fit and reasonably competent freediver, if there is no sign of blue lips or similar symptom, can we assume that the diver is not close to his limit?

It would be interesting to hear, what about Black Out situations, have BO-freedivers always blue lips or not ?
Because (sadly) BO:s are so common in competitions, somebody certainly have some information about this...

 

[trux]

As explained in the links I posted above, the color depends on several factors, and is quite individual. The most important factor is the volume of deoxigenated hemoglobin. The blue color starts at about 5 g Hb per 100 ml of blood. Hence you will likely find hypoxic and blacked out persons without blue lips (though they will likely start getting blue if the BO continues), as well as you will find people with strong cyanosis long time before they reach their limits.

 

[TimoP]

Just from what I have seen in the few divers I regularly train with, cyanosis varies greatly between individuals but seems very regular for each individual.

Trux: From this point of view, having blue lips may be sign of a pretty deep hypoxemia, but as well it can occur quite a long time before the person holding her breath closes to her limits. So you need to know the person you spot very well, and as you wrote also watch her well during the breath-up, to be able evaluating the cyanosis.

This, with the facts in Trux's link
Cyanosis: Overview - eMedicine Pulmonology
seems to be the conclution. So, you must remember who's lips you are looking at. Blue lips don't necesserily mean, that the freediver has been near her or his limits, and lips without blue color don't necesserily mean that everything (with O2) is ok.

This is valuable information for safety freedivers and other spotters.

 

[cdavis]

Well, I my spotter answered part of my "blue lips" question for me. He got up to and a little past his limit (got very wuzzy and light headed) after a long dive but his lips never got blue. He isn't anemic or anything like that, good healthy young and strong. Today he was using more hook breath technique and got a just a little light headed after a slightly longer dive (3:04, a pb for him). Again, nice pink lips.

 

[nostres]

Yesterday I did 110m DYN with red lips. Far from blue and should have push further, maybe a lot depends on a day because usually I'll get blue lips around 80m. After all my lips turned blue from staying 3 hours in chilly pool

 

[Mr. X]

I don't know about blue lips in a diving context but I have come across it several times on dry land. Once a choking infant, required an ambulance (police arrived first, in 1-2 minutes, ambulance in 3-4 minutes). Once an adult having a severe, acute reaction to Ibuprofin - several ambulances attended, and a fire engine! The first ambulance crew looked very frightened - they thought they were going to loose the patient & had to force air into her lungs. One of fire engine crew was apparently the highest qualified & most experienced medic & administered a shot (adrenaline?) with an epi-pen. Have also seen in a couple of older men with diagnosed heart conditions - one always looks tinged blue these days, almost 80 but he still dug his own Land Rover out of the snow recently. Also seen it with an asthmatic when their breath readings are falling too low.

I guess I associate it with lack of oxygen in the blood (&/or possibly cold) either acute or chronic. A bad sign & something to be remedied quickly if possible (but not always possible).

I took first aid training decades ago, thinking I would never use it. How wrong I was. Would recommend everybody take a course -- nothing worse than watching a loved one (or stranger) pass away in front of you unnecessarily (a British woman surgeon recently described in her autobiography how she lost her first "patient" as a med. student in a pub after collecting her skeleton -- a man collapsed and she did nothing other than order somebody to call an ambulance because she didn't know even basic first aid, several months training later she realised only she could have saved the man that day). I recently took short courses organised by a friend (a qualified PADI SCUBA instructor & first aid trainer) to learn about using an epi-pen & automatic defibrillator, although both are designed such that they can be safely used by the untrained - just follow the instructions (some of the defibrillators even give spoken instructions -- very easy to use). The epi-pen you can just apply to the thigh muscle - it'll go through jeans if necessary, no need to remove anything.