1. Near Drowning R. Hernandez

2. Near Drowning Suffocation and death as a result of submersion in liquid. – Near drowning: Liquid submersion survival – Dry drowning: Glottis spasm – Wet drowning Glottis relaxes – Water floods tracheobronchial tree / alveoli

3. Pulmonary pathologic and structure changes Laryngospasm and bronchial constriction Interstitial edema Decreased pulmonary surfactant Increased surface tension of alveolar fluid Atelectasis Pulmonary edema

5. Drowning or Near Drowning Sequence Panic and violent struggle Period of calmness and apnea Swallowing of large amounts of fluid, followed by vomiting Gasping inspirations and aspirations Convulsions Coma Death

6. Favorable Prognostic Factors Cold Water Drowning Age Submersion time Water temperature Water Quality Other injuries Amount of struggle CPR Suicidal attempt

7. Near Wet Drowning Tachypnea or apnea Tachycardia, hypertensive Cyanosis Frothy pink sputum Crackles / decrease aeration Acute ventilatory failure with hypoxemia Neurologic Status – Dilated pupils – Pain response

8. X-Ray Fluffy infiltrates Opacities of atelectasis Hypovolemia Hypervolemia

9. Treatment Normalize Temperature Hyperoxia – Pa02 > 100 torr – PEEP Hyperventilation – pH> 7.45 – PaC02 25-30 torr