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Drowning
- 1. Drowning David Slocum MD Albany Medical Center
- 2. Miracles Matthew Granger 14 month old 20-40 minutes
- 3. Vocabulary Drowning – death within 24 hours Near-drowning – survival past 24 hours
- 4. Who? Usually young, healthy individuals
- 5. 2006 Drowning U.S.A. – 5000 died Worldwide – over 100,000 died
- 6. Epidemiology 500,000 submersion events annually 2nd cause of death – children under 15 Injury ranges Transient Profound neurological deficit
- 9. Coastal Areas Swimming pools more likely
- 11. Young Adults Alcohol 40% adult drownings 75% boat drownings
- 12. Elderly
- 13. Complicating Factors Spinal cord injury Hypothermia Panicking Syncope Seizures
- 14. Pathophysiology Central Nervous System Injury Pulmonary Injury
- 15. Dry-drowning 10-20% of submersions Laryngospasm Hypoxia Loss of consciousness
- 16. Wet-drowning Aspiration of water Dilution of surfactant Diminished gas transfer Atelectasis Ventilation perfusion mismatch
- 17. Pulmonary Injury Contaminated foreign material Particulate matter Bacteria Vomitus Chemical irritants
- 18. Prognosis Submersion time Physiological scoring systems
- 19. Two extremes Fair cardiovascular and neurological function Minimal disability Unstable cardiovascular function and coma Poorly Hypoxic CNS injury
- 20. End Organ Damage Renal injury Hypoxia Myoglobinuria Hemoglobinuria Hematologic Hemolysis DIC
- 21. Treatment
- 22. Prehospital Care Resuscitation Time optimizes outcome Removal from water C-spine protection CPR ASAP
- 23. Airway Breathing High flow oxygen by facemask Not Breathing Bag valve mask Endotracheal tube Unconscious Protect from aspiration
- 24. Who to transport? Amnesia Loss or depressed consciousness Period of apnea Period of artificial respirations Even if asymptomatic
- 25. Don’t Forget Warm patient Hypothermia Monitor IV access Warm isotonic fluids
- 26. Summary Rapid, cautious rescue Spine precautions Cardiopulmonary resuscitation Supplemental Oxygen Transport
- 27. ED Treatment Continue EMS care Airway Oxygen Ventilation Warmed fluids Warming adjunts Treat associated injuries
- 28. GCS > 12 Oxygen to keep sat > 95% Observe 4-6 hours Pulmonary exam normal Saturation normal Discharge home No xray or labs needed
- 29. GCS > 12 Oxygen to keep sat > 95% Observe 4-6 hours Pulmonary exam abnormal Requires oxygen Deteriorates Admit to Monitored bed
- 30. GCS < 13 High flow oxygen Intubation for low PaO2 CXR, Labs Continuous cardiac monitoring Frequent reassessments
- 31. Seizure Dilutional hyponatremia Control seizures Correct electrolytes Residual disorder uncommon
- 32. ED Arrest Warm water drowning Recovery doubtful Consider early discontinuation of efforts Risk profound neurological handicaps
- 33. Hospital Management Supportive Avoid ARDS Pneumonia rare Dopamine, epinephrine drips 48 hour window
- 34. No benefit Mannitol Loop diuretics Hypertonic saline Fluid restriction Hyperventilation Controlled hypothermia Barbiturate coma
- 35. Prognosis No CPR Full recovery within 48 hours May develop ARDS Bystander CPR Steady recovery Steady decline ED CPR Very poor prognosis
- 36. Pediatric Warm Water Drowning 500 victims 100% received ED CPR 84% died 16% severe hypoxic encephalopathy
- 37. Diving Reflex Mammals Bradycardia Peripheral Vasoconstriction Greatest in cold water Preserves oxygen
- 38. ICE water submersion Asystole Children and Adults Complete Recovery Rare Resuscitate until normothermic
- 39. Prevention Infants Parental vigilance Toddler Pool fencing Adolescent/Young Adult Control Alcohol/Drug Use Swimming lessons Elderly Same as infant/toddler
Notes de l'éditeur
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