Red Book - Drowning Flashcards
Define drowning
Respiratroy impairment following submersion or immersion in a liquid medium
Near drowning: survivors of drowning
Dry drowning: used to describe drowning victims without aspiration, died prior to submersion
WE DONT USE THESE TWO
Classification of drowning
1 - No evidence of aspiration
2 - Aspiration with adequate ventilation
3 - Aspriation with inadequate ventilation
4 - Absent vent and circ
Process of drownign
Immersion —> panic —> breath holding —> laryngospasm —> aspiration —> swallow water
Leads to Hypoxia, hypercapnia and acidosis
Muscles relax and respiration stimulated
ASPIRATION —> direct alveolar injury. —> pulmonary oedema
—-> surfactant washout —> atelectasis
—> bronchospasm
V/Q mismatch
Reduced compliance
ARDS
Pathophysiological changes by system
CVS
CVS —>
Diving reflex —> CN V1 from cold water —> brady and apnoea
Catecholamine surge —> vasoconstriction, arrhytias, oedema Hypoexamia and hypothermia —> brady, pulmonary hypertension, failure
Pathophysiosology by system
Neuro
Hypoxic brain injury
Leading cause of mortality
Within 5 minutes
Hypothermia is NOT protective
Confusion/disorientated —> Cerebral oedema —> seizures —> coma —> death
Pathophysiology by system
Metabolic/Infection
Metabolic
Hypothermia
No difference if salt or fresh water
Infection
Contamination in 50%
Oro-pharynx aspiration —> strep. Staph
Aerobic gram negative —> pseudomonas, aeromonas, leptospiridia Fungal —> aspergillus. (Immunocomp)
Risk factors for drowning
Age -young children - baths/pools, cant swim, no fence etc
Young adults - risk taking
Male 2-4x more than F
Intoxication
Jobs/hobbies
Scuba
Fishing/farming
Medical: IHD, Epilepsy, stroke, DM, depression
Poor water conditions
Current, rip tides, waves
Management of drowning
Initial
Get person out the water!
No need for spinal precautions unless a dive in shallow water.
If arrested ALS plus
5 rescue breaths at the start
Compressions after that
Needs breaths AS WELL AS compressions
Management of drowning in hospital
ATLS approach
Secure ETT if needed
Examine for signs of aspiration
Record GCS at the scene
Treat life threatening injuries
Oxygenate
LPV strategy
NO STEROIDS
Bronch for debris
Cardiac output
prompy fluid resus often hypovolaemic
Inotropes
Neuroprotection
No evidence of ICP monitoring or barbituates
?temp to 34C
No prophylactic abx BUT
if water is grossly contaminated
develops pneumonia
ECMO in drowning, evidence?
Cardiac arest with ROSC prior to ECLS —> 34%
Overall survival 51%
V-V ecmo has better survival than V-A
Indictors of poor prognosis
Sumberged by >5-10 minutes
No resus attempted for >10 minutes after rescue
>25 mins resus
GCS <5
Unreactive pupils in hospital
Pulseless and apnoeic in hospital
pH<7.10
