40 - near drowning

Question 1

what happens when aspirate fluid

Answer 1

• loss o surfactant causes atelectasis
• injury to membrane leading to edema
• leak of protein rich fluid into alveoli
• small airway obs
• bronchospasm
• chemical injury if stomach
  all result in hypoexmia

Question 2

what is main neuro insult

Answer 2

hypoxic encephalopathy

Question 3

what happens in sudden cardiac death

Answer 3

catecholamine surge

- otherwise the cardium remains relatively stable

Question 4

what is secondary drowning

Answer 4

onset of Sx, usually edema and infection kill later

Question 5

investigations

Answer 5

• CXRs
• blood gases
• baseline bloods

Question 6

mgmt

Answer 6

• ABCs
• O2
• c-spine protection
• IV access
• ## cardiac monitoring

Question 7

4 important features of brain resus

Answer 7

1. Oxy
2. avoid hypotension and fluid overload
3. correct sugar
4. aggressively treat seizures

Question 8

what does disposition depend on (4)

Answer 8

1. age extremes
2. significance of event
3. any Sx of pulm compromise
4. awareness that resp distress can occur any time

Question 9

4 groups for making dispo decision

Answer 9

1. 4 hours - those with no sig event
2. extended obs in er - asymptomatic after sig event
3. admit - those with hypoxemia or mild CNS sx
4. ICU - those that are critically ill or unconscious