6 Drowning

Question 1

remarks on drowning

Answer 1

worldwide, leading cause of injury death among children <15 years of age

incidence has 3 peaks:
<5 y/o
15-24 y/o
elderly

Question 2

diving reflex

Answer 2

parasympathetic activation:

• bradycardia
• apnea
• peripheral vasoconstriction

however, in most cases, this is overwhelmed by the stimulation of the sympathetic nervous system, yielding no meaningful protectkon

Question 3

remarks on cold water submersion

Answer 3

cerebral protection most likely results from rapid CNS cooling before significant hypoxic damage occurs

Question 4

prehospital care for drowning: who should be transported to an ED for evaluation

Answer 4

all patients with Amnesia for the drowning event,
loss of or depressed Consciousness, or
an observed period of Apnea, as well as
those who require a period of artificial Ventilation

or based on figure 215-1: “Transport all patients”

Question 5

gcs level that can be observed and discharged after 4-6 hours if with normal pulmonary PE and SpO2 ≥95%?

Answer 5

GCS ≥13

Question 6

what to do if GCS <13

Answer 6

ABC
Dx:
- blood: CK, ABG, Troponin I
- urine: urinalysis, urine myoglobin, urine drug screen

Monitor
1. Volume status (e.g., UO)
2. Acid-base status
3. Temperature

Question 7

Remarks onn cervical injury in drowning

Answer 7

Cervical injury is rare without a history of diving or associated trauma. Because of this, routine cervical immobilization and CT of the brain are not necessary

Question 8

factors associated with poor resuscitation prognosis in near-drowning

Answer 8

need for bystander CPR at scene
CPR in the ED
asystole at scene or in ED after warming