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Submersion Injuries Mandi Stone, MD Orlando Health Emergency Medicine • No disclosures Vocabulary Vocabulary • Drowning vs near-drowning? • Wet vs dry? • Primary vs secondary? Vocabulary • Drowning vs near-drowning? • Wet vs dry? • Primary vs secondary? Vocabulary • Drowning vs near-drowning? • Wet vs dry? • Primary vs secondary? • “A process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.” Epidemiology • Estimated 500,000 deaths per year, worldwide Pathophysiology Submersion Breathholding Air hunger Reflex gasping Aspiration Salt vs Fresh water? Salt vs Fresh water? • Surfactant washout • Atelectasis • VQ mismatch • Pulmonary edema • ARDS H+ O2 Management Pre-hospital ED Management •A •B •C •D •E ED Management • Cause of drowning? • Trauma • Seizure • Hypoglycemia • Arrhythmia • Suicide attempt • Abuse or neglect Immersion syndrome • Syncope secondary to cardiac dysrhythmia due to sudden contact with cold water • ASSOCIATED WITH CONGENITAL PROLONGED QT SYNDROME • Caused by V.fib/Asystole secondary to catecholamine release in response to quick temperature change CXR • Routine steroids or antibiotics NOT recommended Disposition • Symptomatic patients - admit for observation, supplemental O2 • Asymptomatic - observe for 4-8 hours Prevention • Fences around pools • Swimming lessons • Close monitoring of infants/children • Avoiding alcohol/drug use while swimming Thank you!