Drowning

Question 1

What is near drowning?

Answer 1

Patient is recused before point of death. Or temporary survival.

Question 2

What are the two types of near drowning?

Answer 2

Submersion.

Immersion.

Question 3

Describe submersion

Answer 3

Head below water. Main problems asphyxia and hypoxia

Question 4

Describe immersion

Answer 4

Head above water main problems hypothermia and cardiovascular instability

Question 5

What is dry drowning?

Answer 5

When unconsciousness deepens patients continue to breathe. Water is diverted to stomach due to reflexes of trachea and epiglottis.

Question 6

What is fresh water drowning?

Answer 6

A high volume of fresh water entering the lungs interferes with the process of external respiration. Haemodilution is created by rapid absorption of water into the blood which distorts the PH volume of the blood. Cardiac arrest occurrs 2-4mins after rescue

Question 7

Describe salt water drowning

Answer 7

Salt water entering lungs is more solute than blood. Water is drawn into alveoli from blood stream increasing volume of fluid into the lungs. This increases viscosity of blood and causes sluggish circulation and slows heart rate. Leaving to cardiac arrest in 12 mins after rescue

Question 8

Describe secondary drowning

Answer 8

Occurs within 4 hours of near drowning but can occur up to 24 hrs after immersion. Rapid absorption of water that entered the body will take place from the stomach into the bloodstream causing distortion of PH balance. In salt water secondary drowning may occur from residual water in the lungs drawing fluid from bloodstream causing pulmonary oedema or shocked lung syndrome.

Question 9

What are the 4 complications of drowning?

Answer 9

Hypothermia.
Alcohol.
Mammalian diving reflex.
Prolonged immersion (prolonged immersion collapse)

Question 10

How is alcohol a complication of drowning?

Answer 10

Alcohol may speed hypothermia, slowing reactions and increasing risk of vomiting

Question 11

How is hypothermia a complication of drowning?

Answer 11

Must be considered in all cases of near drowning. Signs are dilated pupils, imperceptible pulse and resps. Can mimic cardiac arrest

Question 12

Describe mammalian diving reflex

Answer 12

Need total shutdown of resp, circulatory and nervous system to the point of suspended animation and apparent death. Victims have been known to make a complete recovery after 38mins submerged and 16subsequent hours of resus

Question 13

What is prolonged immersion collapse?

Answer 13

Most victims from prolonged immersion float vertically. Water exerts pressure on the legs and massages veins causing adequate venous return. When rescued this pressure is lost and gravity prevents blood returning to heart leading to syncope or death

Question 14

How would you manage drowning?

6

Answer 14

Open airway.
Assist ventilations if o2 30. Expansion is inadequate. (Ventilation could be difficult due to inhaled water affecting ling compliance).
CPR where required supplement with high flow o2 or EAR where possible in water.
Check pulse in at least 2 different places especially in hypothermia.
Lifting prolonged immersion patients horizontally to reduce risk of post immersion collapse. Place patient in head down feet raised position.
Consider spinal injuries if in pool or shallow water.

Question 15

What should you not do in drownings? 3

Answer 15

Apply direct heat to hypothermic.
Tilt patient to aid water drainage as it will drain from stomach to pharynx.
Perform abdo thrusts as it will displace water from abdo into lungs.

Question 16

What are the 5 types of drowning?

Answer 16

Near drowning.
Dry drowning.
Fresh water drowning.
Salt water drowning.
Secondary drowning.