Near Drowning

Question 1

Hypoxic Injury (tissue oxygen deficiency)

Answer 1

drowning, near drowning, inhalation of foreign object, hanging/strangulation, suffocation/asphyxiation, apnea

Question 2

Epidemiology

Answer 2

US accounts for 10% of deaths
M > F in all age groups
Boys 0-4 greatest rate of drowning followed by boys 15-19 y/o

Question 3

Drowning

Answer 3

death within 24 hrs of a submersion incident

Question 4

Near Drowning

Answer 4

survival for at least 24 hrs following submersion incident

Question 5

Pathophysiology

Answer 5

Submersion causes panic and struggle to get to the surface resulting in aspiration in attempts to breath or laryngospasm

Hypoxemia and decreased delivery of oxygen to vital tissues occurs

Sustain hypoxemia can result in neuronal injury, circulatory collapse, myocardial damage, dysfunction of multiple organ systems, further ischemic brain damage

Question 6

Dry Drowning

Answer 6

Laryngospasm (spasm of vocal cords,inability to speak or breath) without aspiration

Question 7

Wet Drowning

Answer 7

aspiration of water

Question 8

Progression of injury

Answer 8

First few minutes: brain deprived of oxygen (hypoxic)

Cardiovascular system fails, cerebral blood flow decreases —>ischemic injury occurs

Question 9

Areas with greatest susceptibility to ischemic damage

Answer 9

vascular end zones in hippocampus, insular cortex, and basal ganglia

More severe hypoxia-ischemia =more extensive and global cortical damage

Question 10

Prognosis

Answer 10

Depends on amount of CNS damage
1/3 of children have significant neurological damage like HIE

Prognosis is difficult to determine in first few hours after the incident

Poor outcome: prolonged resuscitation, fixed and dilated pupils, and GCS of 3