Submersion Injuries Flashcards
“a process resulting in primary respiratory impairment from submersion or immersion in a liquid medium”
Drowning
Fatal and nonfatal
“survival after aspiration of liquid into the lungs”. Symptom onset can be immediate or delayed as long as 72 hours
Wet non-fatal drowning
“survival after a period of asphyxia secondary to reflex laryngospasm”
Dry non-fatal drowning
Much better prognosis than wet drowning
1st peak age group distribution of deaths due to drowning
1-5 yrs (tubs, buckets, pools - 20% neglect/abuse)
2nd peak age group distribution of deaths due to drowning
Males 15-25 years, high ETOH involvement
Shallow water blackout - 3 steps
- Hyperventilation before submersion (leads to low CO2 levels in blood)
- O2 drops, but CO2 levels are still abnormally low so brain does not trigger to come up for air. Swimmer loses consciousness.
- Drowning - one swimmer loses consciousness, breath intake is triggered and lungs fill with water
Pulmonary pathophys of drowning
Once wet or dry drowning occurs, leads to
- decreased lung compliance
- Ventilation - Perfusion Mismatch
- Intrapulmonary shunting
(4. Diffuse hypoxemia / ischemia)
Main cause of morbidity (long term damage) from drowning
Cerebral hypoxia
Neurologic end effects of hypoxemia due to drowning
- Neuronal damage
- Cerebral edema
- Elevated ICP
Pulmonary end effects of drowning
- Fluid aspiration washes out surfactant > leads to non cardiac pulmonary edema and ARDS
What component of drowning can lead to ARDS
Fluid aspiration washing out surfactant
Cardiovascular end effect of drowning
Hypothermia / hypoxia leads to»_space;
Arrhythmias
- Sinus tachy
- Sinus brady
- A fib
Acid-base imbalance caused by drowning?
Metabolic and/or respiratory acidosis is common
Renal end effects of drowning?
Rare - but can have acute tubular necrosis / acute renal failure
Hematologic end effects of drowning?
Rare - but coagulopathies and/or hemolysis can occur
Pre-hospital care for drowning (4 steps)
- Immediate CPR, starting with ventilation and 2 rescue breaths
- Administer high-flow O2 via face mask to spontaneously breathing patients
- Intubate apneic patients
- Initiate rewarming of hypothermic patients
Is C-spine immobilization recommended in pre-hospital care for drowning?
Only if :
- pt has clinical signs of cervical injury
- concerning mechanism (shallow dive)
- altered mental status (i.e. intoxication)
Should one attempt maneuvers / positions to remove water from lungs?
No.
ED management of drowning
- Continue resuscitative efforts
- Continue high-flow O2 to maintain 94% O2sat
- CPAP/BiPAP to improve oxygenation and correct Ventilation/Perfusion mismatch
- Trauma evaluation (focued PE / neuro?)
- Remove wet clothing
- Rewarming for hypothermic patients
- Check blood glucose
- Consider whether there is opioid intoxication / naloxone needed
- Monitor (cardiac, O2, end tidal CO2, frequent vitals/neuro checks)
In patients who are not hypothermic, how long until resuscitative efforts are associated with poor neurologic outcomes
> 30 mins
What can be used to correct ventilation/perfusion mismatch?
CPAP/BiPAP
What must be monitored for patients on CPAP/BiPAP
Hypotension secondary to increased intrathoracic pressure
decreased preload due to decreased blood return because of the increased intrathoracic pressure
Indications for intubation
- Inability to protect airway / neurologic deterioration
- PaO2 < 60mmHg or O2sat < 90% on high flow O2
- PaCO2 > 50mmHg
What should be placed along with intubation to prevent gastric distention
Place orogastric tube
