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

2. No disclosures

3. Vocabulary

4. Vocabulary Drowning vs near-drowning? Wet vs dry?
Primary vs secondary?

5. Vocabulary Drowning vs near-drowning? Wet vs dry?
Primary vs secondary?

6. Vocabulary Drowning vs near-drowning? Wet vs dry?
Primary vs secondary?

8. “A process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.”

9. Epidemiology
Estimated 500,000 deaths per year, worldwide

13. Pathophysiology

14. Submersion
Breathholding
Air hunger
Reflex gasping
Aspiration

15. Salt vs Fresh water?

16. Salt vs Fresh water?

17. Surfactant washout
Atelectasis
VQ mismatch
Pulmonary edema
ARDS

18. H+ O2

19. Management

20. Pre-hospital

23. ED Management A B C D E

25. ED Management Cause of drowning? Trauma Seizure Hypoglycemia
Arrhythmia
Suicide attempt
Abuse or neglect

26. 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

27. CXR

28. Routine steroids or antibiotics NOT recommended

29. Disposition
Symptomatic patients - admit for observation, supplemental O2
Asymptomatic - observe for 4-8 hours

30. Prevention Fences around pools Swimming lessons
Close monitoring of infants/children
Avoiding alcohol/drug use while swimming

31. Thank you!