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EMERGENCY MED > Submersion Injuries > Flashcards

Submersion Injuries Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

“a process resulting in primary respiratory impairment from submersion or immersion in a liquid medium”

A

Drowning

Fatal and nonfatal

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2
Q

“survival after aspiration of liquid into the lungs”. Symptom onset can be immediate or delayed as long as 72 hours

A

Wet non-fatal drowning

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3
Q

“survival after a period of asphyxia secondary to reflex laryngospasm”

A

Dry non-fatal drowning

Much better prognosis than wet drowning

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4
Q

1st peak age group distribution of deaths due to drowning

A

1-5 yrs (tubs, buckets, pools - 20% neglect/abuse)

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5
Q

2nd peak age group distribution of deaths due to drowning

A

Males 15-25 years, high ETOH involvement

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6
Q

Shallow water blackout - 3 steps

A
  1. Hyperventilation before submersion (leads to low CO2 levels in blood)
  2. O2 drops, but CO2 levels are still abnormally low so brain does not trigger to come up for air. Swimmer loses consciousness.
  3. Drowning - one swimmer loses consciousness, breath intake is triggered and lungs fill with water
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7
Q

Pulmonary pathophys of drowning

A

Once wet or dry drowning occurs, leads to

  1. decreased lung compliance
  2. Ventilation - Perfusion Mismatch
  3. Intrapulmonary shunting

(4. Diffuse hypoxemia / ischemia)

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8
Q

Main cause of morbidity (long term damage) from drowning

A

Cerebral hypoxia

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9
Q

Neurologic end effects of hypoxemia due to drowning

A
  • Neuronal damage
  • Cerebral edema
  • Elevated ICP
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10
Q

Pulmonary end effects of drowning

A
  • Fluid aspiration washes out surfactant > leads to non cardiac pulmonary edema and ARDS
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11
Q

What component of drowning can lead to ARDS

A

Fluid aspiration washing out surfactant

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12
Q

Cardiovascular end effect of drowning

A

Hypothermia / hypoxia leads to&raquo_space;

Arrhythmias

  • Sinus tachy
  • Sinus brady
  • A fib
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13
Q

Acid-base imbalance caused by drowning?

A

Metabolic and/or respiratory acidosis is common

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14
Q

Renal end effects of drowning?

A

Rare - but can have acute tubular necrosis / acute renal failure

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15
Q

Hematologic end effects of drowning?

A

Rare - but coagulopathies and/or hemolysis can occur

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16
Q

Pre-hospital care for drowning (4 steps)

A
  1. Immediate CPR, starting with ventilation and 2 rescue breaths
  2. Administer high-flow O2 via face mask to spontaneously breathing patients
  3. Intubate apneic patients
  4. Initiate rewarming of hypothermic patients
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17
Q

Is C-spine immobilization recommended in pre-hospital care for drowning?

A

Only if :

  • pt has clinical signs of cervical injury
  • concerning mechanism (shallow dive)
  • altered mental status (i.e. intoxication)
18
Q

Should one attempt maneuvers / positions to remove water from lungs?

A

No.

19
Q

ED management of drowning

A
  1. Continue resuscitative efforts
  2. Continue high-flow O2 to maintain 94% O2sat
  3. CPAP/BiPAP to improve oxygenation and correct Ventilation/Perfusion mismatch
  4. Trauma evaluation (focued PE / neuro?)
  5. Remove wet clothing
  6. Rewarming for hypothermic patients
  7. Check blood glucose
  8. Consider whether there is opioid intoxication / naloxone needed
  9. Monitor (cardiac, O2, end tidal CO2, frequent vitals/neuro checks)
20
Q

In patients who are not hypothermic, how long until resuscitative efforts are associated with poor neurologic outcomes

A

> 30 mins

21
Q

What can be used to correct ventilation/perfusion mismatch?

A

CPAP/BiPAP

22
Q

What must be monitored for patients on CPAP/BiPAP

A

Hypotension secondary to increased intrathoracic pressure

decreased preload due to decreased blood return because of the increased intrathoracic pressure

23
Q

Indications for intubation

A
  1. Inability to protect airway / neurologic deterioration
  2. PaO2 < 60mmHg or O2sat < 90% on high flow O2
  3. PaCO2 > 50mmHg
24
Q

What should be placed along with intubation to prevent gastric distention

A

Place orogastric tube

25
Q

How should a drowning patient be monitored once ED workup has been done?

A
  1. Cardiac telemetry
  2. Continuous O2 /end-tidal CO2
  3. Frequent vitals and neuro checks
26
Q

Diagnostic tests indicated for ED workup of drowning

A

Cardiac:
EKG
CXR
CMET

Heme:
CBC
PT/PTT

Pulm:
ABG/VBG

Other:
ETOH / drug screen

  • Cardiac enzymes as needed*
  • Imaging studies as indicated by trauma eval*
27
Q

Four pulmonary problems to consider in continued treatment of drowning

A
  1. Bronchospasm
  2. Pneumonia
  3. Mechanical ventilation
  4. ARDS
28
Q

Tx for bronchospasm

A

Inhaled beta agonists

29
Q

High suspicion organisms for post-drowning pneumonia

A 
Pseudomonas
Proteus
Pseudallescheria boydii (fungus from contaminated waters)
30
Q

Potentially helpful treatment for ARDS due to drowning

A

Surfactant treatments

31
Q

Why be cautious in use of diuretics for hypervolemic patients (in drowning management)

A

Volume depletion > decreased cardiac output > decreased cerebral perfusion

32
Q

How long do you observe / monitor asymptomatic drowning patients

A

minimum 8 hours

33
Q

What must be repeated before discharging asymptomatic patients after 8 hours of observation

A

CXR and vitals / physical exam

34
Q

Submersion of more than ____ mins indicates poor prognosis

A

5 mins

35
Q

Delay of BLS of more than ____ mins indicates poor prognosis

A

10 mins

36
Q

Age of ____ indicates poor prognosis

A

> 14 yrs

37
Q

Glasgow coma scale of ___ indicates poor prognosis

A

< 5

38
Q

Arterial blood pH of ____ on arrival indicates poor prognosis

A

< 7.1 on arrival

39
Q

Decorticate rigidity, forearms/elbows are ____ and legs are ____

A

flexed, internally rotated

Damage to cervical spinal tract or cerebral hemisphere

40
Q

Decerebrate regidity, forearms / elbows are ___

A

extended

Damage to midbrain or pons

EMERGENCY MED (10 decks)

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