Old Serra'kis

Blackfathom Deeps

Moonshrine Ruins

Work through the Twilight's Hammer groups and find Lorgus Jett before leaving the ruins. Horde groups should clear the water around the Fathom Stone before collecting the Fathom Core and fighting its Baron Aquanis summon; check for the Strange Water Globe afterwards. Take the underwater detour to Old Serra'kis before returning to the ritual chamber, with enough breath to fight and swim back.

Old Serra'kis

Elite Beast

Old Serra'kis turns the underwater detour into a fight where the group must keep enough breath to stay within healing range.

Tank
Keep Old Serra'kis close enough to the surface that the group can take air without swimming out of the healer's reach.
Healer
Watch your breath while healing the swimmers below you, and account for players surfacing before they leave your healing range.
Damage
Surface before your breath runs out, then return to the tank's Old Serra'kis position rather than continuing farther through the flooded passage.

Loot