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