Aquatic

Question 1

What is the morbidity and mortality of drowning in children?

Answer 1

No1 cause of death in kids aged 1-4
3rd leading cause of trauma related death over all age groups under 18

Question 2

What is the definition of drowing?

Answer 2

Respiratory impairment due to submersion or immersion in liquid

Question 3

What is the difference between immersion and submersion?

Answer 3

Submersion is the whole body is under a liquid medium
Immersion is when only part of the body is under a liquid medium (ie just the face)

Question 4

What % of drownings do not aspirate and what does lack of aspiration usually mean?

Answer 4

<1% don’t aspirate (dry drowning)
Lack of aspiration can suggest death or obstruction/severe apnoea prior to submersion

Question 5

What is the most common traumatic injury associated with drowing?

Answer 5

C-spine injury
Particularly associated with diving

Question 6

What are Boyles law and Henrys Law in relation to diving injuries?

Answer 6

Question 7

What are the poor prognostic factors for drowning?

Answer 7

• Immersion/submersion >5mins
• arterial pH <7.1 on arrival
• > 10mins to effective BLS
• > 25mins of CPR
• Ongoing need for CPR by ED arrival
• GCS <5
• Age >14
• Persistent apnoea
• Rectal temp <30C
• Persistent asystole

Question 8

What are the principals of managing a drowing?

Answer 8

ALS if arrested
Dry and keep warm
Intubation if severe hypoxia or neurological compromise (lung protective strategies)
NG/OG placement for stomach decompression (passive ingestion of fluid whilst unconscious)
IV warmed fluids for hypotension
Consider other occult trauma (EFAST, c-spine)
ABx not routinely indicated

Question 9

What are the different rates of warming with different methods?

Answer 9

Warm blankets: 0-2C/hr
IV fluids: no loss if warmed
Warm air: 1.5C/hr
Peritoneal lavage: 3C/hr
Thoracic lavage: 3-6C/hr
Carrdiopulmonary bypass: 9-18C/hr

Question 10

What is the Moddell and Conn classification used for post drowning?

Answer 10

Assesses likelyhood (%) of neurologically intact recovery for those presenting to ED within 1hr of drowning, uses GCS to score this

A- GCS 14-15 = 100%
B- GCS 8-13 = 100%
C- GCS 6-7 = 90%
C1- GCS 5 = 90%
C2- GCS 4 = 90%
C3- GCS 3 = <20%
C4- Arrested = <20%

Simplified
GCS 8-15 = 100%
GCS 4-7 = 90%
GCS 3 or arrested = <20%

Question 11

When can a child be discharged from ED post a drowning episode?

Answer 11

• Observed for 8hrs post drowning
• Asymptomatic
• Normal resp exam
• Sats >95% RA
• Education about water safety provided
• No ongoing safety concerns
• Referral to social work made if deemed appropriate

Question 12

What are the typical toxidromes of australian marine envenomation?

Answer 12

Blue ringed octopus
- Na+ channel blocker neurotoxin (Tetradotoxin)
- Rapid descending symmetrical paralysis
- +/- GI symptoms

Question 13

What are the important aspects of a diving history?

Answer 13

Question 14

What are the important symptoms/signs with diving injury and how should they be further assessed?

Answer 14

• Chest pain (PTx, air embolism)
• Focal deficits (stroke)
• Seizures
• Mottled skin/rash (air under skin)