Drowning And Submersion Injury Flashcards
What is the most important step to reduce impact of drowning injury? Hmm?
PREVENTION!!
Drowning is one of the leading causes of childhood morbidity and mortality in the world. Prevention is the most important step to reducing the impact of drowning injury, followed by early initiation of cardiopulmonary resuscitation (CPR) at the scene.
CH 91 p606 nelson 21st ed
Most common drowning deaths in children below 1 year old
BATHTUB!
Next: Large 5 gallon household bucket!
Most (71%) drowning deaths in children younger than 1 yr occur in the bathtub, when an infant is left alone or with an older sibling. Infant tub seats or rings may exacerbate the risk by giving caregivers a false sense of security that the child is safe in the tub. The next major risk to children <1 yr is the large (5-gallon) household bucket, implicated in 16% of infant drowning deaths. These buckets are approximately 30 cm (1 ft) tall and designed not to tip over when half-full. The average 9 mo old child tends to be top-heavy and thus can easily fall headfirst into a half-full bucket, become stuck, and drown within minutes.
Ch 91 p606 Nelson 21st ed
COmmon factor of drowning deaths in children 1-4 year old in US
residential SWIMMING POOLS
Rural areas: farm injury related deaths (ditch river irrigation ponds etc)
Drowning rates are consistently highest in 1-4 yr old children, likely because of their curious but unaware nature, coupled with the rapid progression of their physical capabilities. From 1999 to 2015, U.S. rates are highest in the southern regions, in some areas as high as 3.8 per 100,000. A common factor in many of these deaths is a lapse in adult supervision, often reportedly <5 min. Most U.S. drownings occur in residential swimming pools. Usually, the child is in the child’s own home, and the caregiver does not expect the child to be near the pool. In rural areas, children 1-4 yr old often drown in irrigation ditches or nearby ponds and rivers. The circumstances are similar to those noted previously, in a body of water that is near the house. Drowning is one of the leading causes of farm injury–related deaths in children.
P 606 ch 91 nelsons 21s ed
COmmon cause of drowning deaths in school age kids
NATURAL WATERWAYS (lakes ponds rivers canals) (10-19 y/o)
School-age children are at increased risk of drowning in natural bodies of water such as lakes, ponds, rivers, and canals. Although swimming pools account for most nonfatal drownings across all ages, natural waterways account for a higher death rate in children 10-19 yr old. Unlike for preschool children, swimming or boating activities are important factors in drowning injuries in school-age children. P 608 ch91 nelsons 21st ed
Most common Cause of drowning deaths among adolescents
DANGEROUS UNDERWATER BREATH HOLDING BEHAVIORS (DUBBS)
Adolescent drowning incidents are 2nd most common age group.
-90% drown in open water
- males more fatally drowned than females
- DUBBS are often performed by experienced healthy swimmers or fitness enthusiasts (hypoxic training) or when (Schnupid) teenagers hold breath-holding contests during horseplay. DUBBs have been primarily reported in regulated swimming facilities. Behaviors include intentional hyperventilation before submersion, static apnea, and extended periods of underwater distance swimming or breathhold intervals. Swimmers are found motionless and submerged; resuscitation is often unsuccessful.
NOTE: THIS IS ASKED IN MOCK EXAM: teenager felt unconscious while diving in a shallow pool
Other pa: drugs, alcohol, intentional (abuse, suicide)
Highest rates of drowning incidents per age
1-4 years old, males
Pathophysiology of drowning
- they drown silently, dont signal distress or call for help
Vocalization is precluded by efforts to achieve maximal lung volume to keep the head above the water or by aspiration leading to laryngospasm. Young children can struggle for only 10-20 sec and adolescents for 30-60 sec before final submersion. A swimmer in distress is vertical in the water, pumping the arms up and down. This splashing or efforts to breathe are often misconstrued by nearby persons as merely playing in the water, until the victim sinks
True or false
Most pediatric drowning victims should be observe for at least 24 hours even if asymptomatic on presentation at ER
FALSE!
- Most pediatric drowning victims should be observed for at least 6-8 hr, even if they are asymptomatic on presentation to the ED. At a minimum, serial monitoring of vital signs (respiratory rate, heart rate, blood pressure, and temperature) and oxygenation by pulse oximetry, repeated pulmonary examination, and neurologic assessment should be performed in all drowning victims.
Golden period of observation on critical drowning victims at the PICU
24-72hrs
If no substantial improvement beyond this period and whose coma cannot be otherwise explained should be seriously considered for limitation or withdrawal of support.
