Respiratory: Immersion and drowning Flashcards
A high % of drowning deaths involve who?
Men and children
Many of the swimmers are ** swimmers and die within ** metres of safety
Competent
10
Define drowning.
Process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.
Person is prevented from breathing air due to liquid at the entrance of the airway.
Does drowning infer the patient is dead?
No.
Drowning does not infer the patient is dead.
Define immersion.
Being covered in a liquid medium.
Doesn’t mean the water has entered airways.
What are the problems associated with immersion?
Problems: hypothermia and cardiovascular collapse from hydrostatic pressure on lower limbs
Define submersion.
The entire body including the airway being under the liquid medium.
What are the problems associated with submersion?
Problems:
Asphyxia
Hypoxia
Hypercapnia
What exacerbation factors could there be with drowning?
Intoxication of alcohol or drugs.
A medical condition
Mental health
Injuries
Pathophysiology (progress) of drowning? (4)
Patient initially tries to hold their breath.
May develop laryngospasm as water irritates the vocal chords.
May aspirate large quantities of water.
Both result in rapid hypoxia and hypercapnia.
What is hypercapnia?
High CO2 levels.
What happens if rescue is not made in drowning?
The patient will aspirate water into the lungs exacerbating hypoxia
Bradycardia will ensue followed by cardiac arrest.
What happens in 10-15% of patients where the laryngospasm is so intense?
None of the liquid medium enters the lungs known as dry drowning.
What happens when rescue in drowning is made if the patient is pulled out vertically?
If the patient is raised vertically from the water their blood pressure will fall ‘after drop’
This may lead to cardio vascular collapse.
What must we always attempt to ensure when pulling a patient out of water?
Always attempt to maintain the patient flat and avoid vertical removal from the water.
What is the Rescue procedure? (3)
Carry out a dynamic risk assessment
Assess Number of patients
Drag out of water.
What do you do if neck or back trauma is suspected?
Wait until patient has been rescued before applying immobilisation.
Limit neck extension and flexion.
What are the 5 main types of drowning?
Near Dry Fresh water Salt water Secondary
Describe near drowning.
A patient who has been rescued before the point of deathly if there is temporary survival.
Describe dry drowning.
Stimulation of the reflex action of the larynx and epiglottis causing them to seal off the trachea diverts the water to the stomachs.
How does the patient drown with dry drowning?
Due to acute hypoxia the patient will have died of asphyxiation long before water enters the lung.
What % of drowning incidents are the type ‘dry drowning’?
10%
Describe fresh drowning and what happens when fresh water enters the lungs. (5)
Fresh water entering the lungs;
Interferes with the normal process of respiration.
Removes the surfactant lining of the alveoli.
Prevents gaseous exchange
Creates dilution of the blood
May cause cardiac arrest.
What is the surfactant lining of the alveoli?
The grease lining which keeps the alveoli inflated.
How long after rescue in fresh water drowning can the patient go into cardiac arrest?
2-4minutes
What happens if a sufficient amount of salt water enters the lungs?
Causes water to be drawn into the alveoli from the bloodstream.
Why does water get drawn into he alveoli from the blood stream I. Salt water drowning?
Because salt sucks the water out of the blood
How long after rescue may you still go into cardiac arrest from salt water drowning?
12 minutes
How long after rescue from primary drowning could you go into secondary drowning?
Up to 24 hours later
What continues to be absorbed into the bloodstream causing a distortion of Ph levels with secondary drowning?
Water
What are the common problems with secondary drowning?
ARDS (Acute Respiratory Distress Syndrome Cerebral oedema Renal failure Infection Disturbance of - Electrolytes Acid base balance Lung function
Complications of drowning
Alcohol
Hypothermia
Prolonged immersion
Mammalian diving reflex
What is mammalian divine reflex?
suddenly immersed head first into icy cold water, everything shuts down - suspended animation
The following systems shut down:
Respiratory systems
Circulatory systems
Nervous systems
How is alcohol a complication of drowning?
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List the management of drowning. (11)
Assess ABCDE Airway Ventilation Oxygen Heart rate Concomitant injuries ECG Pain Position Transfer to further care Discontinuation of resuscitation efforts.
When administering Oxygen due to drowning, what saturation % do we aim for in adults?
94-98%
Define secondary drowning
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What are the problems with secondary drowning?
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How is hypothermia a complication of drowning?
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How is prolonged immersion s complication of drowning?
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What must we not do if a patient is a victim of a sub-Aqua accident?
We must not tamper with any valves on any part of the equipment.
We must always consider he possibility of decompression sickness. Why?
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How many deaths by drowning in 2009 in England and Wales?
205
How would we prevent further heat loss for the patient?
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What do we never do when dealing with a drowning victim?
Give up
What should we do if we suspect a c-spine injury on a drowning patient?
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What can drowning, immersion and hypothermia mimic?
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