Orlando Health Emergency Medicine Submersion Injuries Mandi Stone, MD Orlando Health Emergency Medicine

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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!