Environment

Question 1

Drowning definitions

Answer 1

Submersion - entire body including airway under water

Immersion - covered in water

Question 2

Drowning causes

Answer 2

Alcohol 25-50%
Seizures
Syncope
Dementia
Cardiac
Trauma
Deliberate -nai in children
Second most common cause accidental death kids

Water <10 if rapid may confer some benefit
No difference salt vs fresh for electrolytes.
Fresh has more bugs gram -ve, staph, algae, fungi

Question 3

Drowning assessment

Answer 3

Immersion/submersion
Time in, time removed, temp, type
Precipitating event
Other injuries
Airway
Oxygenation/ventilation
Cardiac rhythm
Temp
Electrolytes

Conn and Modell 2 hours post
A-awake
B-conscious but obtunded
C-comatose 1-flexion to pain, 2-extension to pain, 3-flaccid

Question 4

Drowning treatment

Answer 4

Support abc, reward, prevent secondary brain injury

Awake - supportive, 6 hours observation at least, if o2 required needs longer/admit

O2, CPAP, intubation, salbutamol if spasm
IVF (care re oedema)
Rewarm
Abx if gross contamination/pool kids

Question 5

Drowning prognosis

Answer 5

Submersion <6 mins 85% good outcome, > 10 mins poor

GCS < 5 poor but good if improving first 2-6 hours

First breath <15-30 mins < 10% poor
First breath > 60-120 50-80% poor

Orlowski scale (<3 90% recovery, >3 5% recovery)
Age < 3
Submersion > 5 mins
No resus attempt first 10 mins
Coma on arrival to ED
pH < 7.1

Question 6

When to stop CPR in drowning

Answer 6

Blood frozen
K > 11
Asystole after 1 hour CPR (warmed)
Water temp > 6 and immersion for > 30 mins
Water temp < 6 and immersion for > 90 mins
Submersion > 10 mins without hypothermia