Drowning

Question 1

Which groups are at highest risk of drowning?

Answer 1

• children from impoverished families
• Males
• ppl using Alcohol, sedatives
• epileptics
• ppl with Long QT syndrome (swimming can trigger arrhythmias)
• ppl who engage in dangerous underwater breath-holding behaviors (DUBBs)

Question 2

risk of dying from drowning is __

Answer 2

1:4 (dying:non-fatal)
So like 20% chance you’ll die

Question 3

what part of drowning really kills you?

Answer 3

Hypoxia

Question 4

generalized tissue hypoxia may cause _____ acidosis

Answer 4

metabolic

Question 5

What is dry drowning?

Answer 5

Immediate hypoxia results from aspiration of fluid or gastric contents, acute reflex laryngospasm (previously called dry drowning), or both

Question 6

How does drowning affect body systems?

Answer 6

Pulmonary: atelectasis. Alveolar collapse leads to poor ventilation causing shunting of blood. Hypoxemia

Neurologic: Ischemia of brain, leads to neurological damage Can have cerebral edema and high ICP

Cardiovascular: Bradyarrhythmias, tachycardia, A-fib

Renal: Acute tubular necrosis from hypoxemia. Hemoglbinuria, myoglobinuria.

Question 7

do people pulled out of cold water have a better or worse prognosis?

Answer 7

better! the cold slows everything down and is neuroprotective!

Question 8

Ultimately, if this organ fails -> DEAD

Answer 8

BRAIN

Question 9

Is it okay to discharge a pt who drowned 2 hrs ago and now appears stable with no respiratory symp?

Answer 9

no, they need to be monitored for several more hours bc resp symp can sometimes be up to 6hrs late

Question 10

do asymp patients need to be sent to the hospital?

Answer 10

yes, they should be monitored for several hours to watch for possible late respiratory symptoms

Question 11

factors that incr chance of survival w/o permanent injury

Answer 11

• Rapid institution of resuscitation (most important)
• Brief duration of submersion
• Cold water temperature
• Young age
• Absence of underlying medical conditions, secondary trauma, and aspiration of particulate matter or chemicals

Question 12

Trmnt checklist

Answer 12

1. Resuscitate
2. rmv wet clothes & warm em up
3. correct O2 and CO2 levels (goal: SpO2 >94%)
4. Intensive resp support
5. trmnt to correct cardiac arrest, hypoxia, hypoventilation, hypothermia, etc
6. Monitor circulation
7. Elevate head to decr ICP
8. Prophylactic ABX for Pneumonia if dirty water

ICP = intracranial pressure

Question 13

Should you try to remove water from the lungs when resuscitating on scene

Answer 13

no, that wastes time, delays ventilation and increase the risk of vomitting

Question 14

does the neck need to be mobilized even if there is no known injurying event?

Answer 14

yes everyone who drowns get a C-neck

Question 15

what can you give to reduce bronchospasm and wheezing?

Answer 15

Nebulized Beta-2 agonists

Question 16

Giving pts with significant lung compliance issues __________ may help, although no large clinical trials have addressed this

Answer 16

surfactant

Question 17

Special populations at risk for drowning

Answer 17

• Debilitated ppl
• elderly
• Seizure DO
• drug use
• Long QT
• FMH of unexplained drowning

Question 18

pts with FMH of unexplained drowning or seizure disorders should be evaluated for ______

Answer 18

Long QT syndrome