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Presentation 6: DROWNING
Emergency Care CLS 243 Dr.Bushra Bilal
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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.
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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
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THREE PEAKS Toddlers Adolescents Elderly
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PREDISPOSING FACTORS Poor swimming ability Exhaustion Panic
Hypothermia Trauma Coma, seizures Alcohol/Drugs Hyperventilation Rapidly moving water
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PATHOPHYSIOLOGY Central Nervous System Injury Pulmonary Injury
3 Major metabolic abnormalities Anoxia Acidosis Hypercapnia
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DRY-DROWNING 10-20% of submersions Laryngospasm Hypoxia
Loss of consciousness
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WET-DROWNING Aspiration of water Dilution of surfactant
Diminished gas transfer Atelectasis Ventilation perfusion mismatch
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END ORGAN DAMAGE Renal injury Hypoxia Myoglobinuria Hemoglobinuria
Hematologic Hemolysis DIC
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PREHOSPITAL CARE Resuscitation Removal from water C-spine protection
CPR ASAP
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AIRWAY Breathing -High flow oxygen by facemask Not Breathing
Bag valve mask Endotracheal tube Unconscious Protect from aspiration
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DON’T FORGET Warm patient Hypothermia Monitor IV access
Warm isotonic fluids
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ED TREATMENT Continue EMS care Airway Oxygen Ventilation Warmed fluids
Warming adjuncts Treat associated injuries
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HOSPITAL MANAGEMENT Supportive Avoid ARDS Pneumonia rare
Dopamine, epinephrine drips 48 hour window
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PREVENTION Infants Parental vigilance Toddler Pool fencing
Adolescent/Young Adult Control Alcohol/Drug Use Swimming lessons Elderly-Same as infant/toddler
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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
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DROWNING CLAIMS >50,000 deaths/year
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