Presentation 6: DROWNING Emergency Care CLS 243 Dr.Bushra Bilal

INTRODUCTION Drowning is death within 24 hours from suffocation by submersion in a liquid, normally fresh water or sea water. It occurs more frequently in males and the young Near drowning is survival for more than 24 hours (even if temporary) from suffocation by submersion.

TYPES OF DROWNING In wet drowning, the person has inhaled water which interferes with respiration and causes the circulatory system to collapse. In the less common instance of dry drowning, the airway closes up due to spasms caused by the presence of water

THREE PEAKS Toddlers Adolescents Elderly

PREDISPOSING FACTORS Poor swimming ability Exhaustion Panic Hypothermia Trauma Coma, seizures Alcohol/Drugs Hyperventilation Rapidly moving water

PATHOPHYSIOLOGY Central Nervous System Injury Pulmonary Injury 3 Major metabolic abnormalities Anoxia Acidosis Hypercapnia

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

END ORGAN DAMAGE Renal injury Hypoxia Myoglobinuria Hemoglobinuria Hematologic Hemolysis DIC

PREHOSPITAL CARE Resuscitation 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

DON’T FORGET Warm patient Hypothermia Monitor IV access Warm isotonic fluids

ED TREATMENT Continue EMS care Airway Oxygen Ventilation Warmed fluids Warming adjuncts Treat associated injuries

HOSPITAL MANAGEMENT Supportive Avoid ARDS Pneumonia rare Dopamine, epinephrine drips 48 hour window

PREVENTION Infants Parental vigilance Toddler Pool fencing Adolescent/Young Adult Control Alcohol/Drug Use Swimming lessons Elderly-Same as infant/toddler

PREVENTION Fences Self-locking gates Immersion alarms Keep pool full Decrease intoxicants around the pool! Proper protective gear survival suit Flotation device Cold water training Supervise patients with seizures

DROWNING CLAIMS >50,000 deaths/year