1. Other Important Topics
PART XIII
Other Important Topics

2. Chapter 42 Near Drowning PC FWS RBCPC
FWS
RBC
Figure Near wet drowning. Cross-sectional, microscopic view of the alveolar-capillary unit. Illustration shows fluid moving from a pulmonary capillary to an alveolus. PC, Pulmonary capillary; FWS, frothy white secretions; RBC, red blood cell; TI, type I alveolar cell; IE, interstitial edema.

3. Anatomic Alterations of the Lungs
Largyngospasm and bronchial constriction
Interstitial edema, including engorgement of the perivascular and peribronchial spaces, alveolar walls, and interstitial spaces
Decreased pulmonary surfactant
Increased surface tension of the alveolar fluid
Alveolar shrinkage and atelectasis
Frothy, white secretions throughout the tracheobronchial tree

4. Etiology 6000 to 8000 people drown each year in the United States
Children under the age of 5 account for 40%
20% occur in persons between 5 and 20 years of age
About 8000 victims of near drownings are hospitalized annually

5. Box 42-1.

6. Table 42-1.

7. Table 42-1., cont.

8. Overview of the Cardiopulmonary Clinical Manifestations Associated with NEAR WET DROWNING
The following clinical manifestations result from the pathophysiologic mechanisms caused (or activated) by Atelectasis (see Figure 9-7), Alveolar Consolidation (see Figure 9-8), and Increased Alveolar-Capillary Membrane Thickness (see Figure 9-9), and Bronchospasm (see Figure 9-10)—the major anatomic alterations of the lungs associated with near wet drowning (see Figure 42-1).

9. Figure 9-7. Atelectasis Clinical Scenario.
Figure 9-7. Atelectasis Clinical Scenario.

10. Figure 9-8. Alveolar Consolidation Clinical Scenario.

11. Figure 9-9. Increased Alveolar-Capillary Membrane Thickness Clinical Scenario.

12. Figure 9-10. Bronchospasm Clinical Scenario (e.g., asthma).
Figure Bronchospasm Clinical Scenario (e.g., asthma).

13. Clinical Data Obtained at the Patient’s Bedside
Vital Signs
Increased respiratory rate
Increased heart rate, cardiac output, blood pressure

14. Clinical Data Obtained at the Patient’s Bedside
Cyanosis
Cough and sputum production
Frothy, pink, stable bubbles
Chest Assessment Findings
Crackles and rhonchi

15. Clinical Data Obtained from Laboratory Tests and Special Procedures

16. Pulmonary Function Study: Expiratory Maneuver Findings
FVC FEVT FEF25%-75% FEF
 N or  N or  N
PEFR MVV FEF50% FEV1%
N N or  N N or 

17. Pulmonary Function Study: Lung Volume and Capacity Findings
VT RV FRC TLC
N or    
VC IC ERV RV/TLC%    N

18. Arterial Blood Gases Early and Advanced Stages of Near Drowning
Acute Ventilatory Failure with Hypoxemia
pH* PaCO HCO3-* PaO2
   (lactic acid) 
* When tissue hypoxia is severe enough to produce lactic acid, the pH and HCO3- values will be lower than expected for a particular PaCO2 level.

19. Oxygenation Indices QS/QT DO2 VO2 C(a-v)O2   Normal Normal
O2ER SvO  

20. Radiologic Findings Chest radiograph Fluffy infiltrates
Pneumothorax and pneumomediastinum

21. Figure This radiograph of a young man, taken just after an episode of near drowning, shows a pulmonary edema pattern. (From Armstrong P et al: Imaging of diseases of the chest, ed 2, St Louis, 1995, Mosby.)

22. General Management of Near Wet Drowning
The first responder
Management during transport
Management at the hospital

23. Classroom Discussion Case Study: Near Drowning