Submersion Injuries Flashcards
Define Drowning.
A process resulting in primary respiratory impairment from submersion or immersion in a liquid medium
Is death always the result of drowning?
No, there is a such a thing as non fatal drowning
Define non fatal drowning.
Survival, at least temporarily, after suffocation by submersion in a liquid medium
Define wet non fatal drowning. When is sx onset?
Survival after aspiration of liquid into the lungs.
Sx onset can be immediate or delayed as long as 72 hours.
Define dry non-fatal drowning. Is prognosis better or worse than wet drowning?
Survival after a period of asphyxia secondary to reflex laryngospasm.
Much better prognosis than wet drowning.
Should we use the following terms?
near-drowning, secondary/delayed drowning, shallow water blackout, and dry drowning
no, they are outdated and their are more accurate terms and descriptions now
Drowning ranks overall ____ for unintentional death, ___ for children under 4 years old
5th and 1st
___% of deaths from drowning are children <14 years old
20%
There is a (unimodal/bimodal/trimodal) age distribution for drowning deaths. What is/are the peak(s) and where do those drownings most commonly occur?
Bimodal
1st peak 1-5 y/o (pools, tubs, buckets) w/ ~7% due to neglect or abuse
2nd peak males 15-25 years old (rivers, lakes, oceans) w/ high incidence of ETOH involvement
Why are non-fatal drowning incidents difficult to track?
Many do not present to ED, at least 5x more than fatal
> 50% adult drowning deaths are due to ingestion of what substance?
Alcoholllllll
Why does hypothermia lead to increased chance of drowning and death?
Hypothermia accelerates exhaustion and can cause cardiac arrhythmia
Why should you never hyperventilate prior to going under water?
Hyperventilation artificially lowers CO2 levels, and as you are holding your breath O2 is metabolized and CO2 levels increase further. Body becomes starved of O2, and under normal circumstances, the increase in CO2 would trigger a breath, but bc the CO2 levels were so low upon submersion, there is not enough to initiate a breath, so you go unconscious. Once you lose consciousness, your body reacts and forces a breath, causing the lungs to fill with water. Without immediate rescue, death is almost certain.
What three physiological results come from drowning?
Decreased lung compliance, ventilation-perfusion mismatch and intrapulmonary shunting
What neurologic results of hypoxemia occur after drowning?
Neuronal damage, cerebral edema, and elevated intracranial pressure.
What is the main cause of morbidity in drowning pts?
Cerebral hypoxia, additionally, ~20% of non-fatal drowning victims sustain neurologic damage with long term effects
What pulmonary effects occur after drowning?
Fluid aspiration washes out surfactant causing non-cardiogenic pulmonary edema and ARDS
What cardiovascular effects of hypoxemia occur after drowning?
Arrhythmias (hypothermia/hypoxia from submersion can cause sinus tachy and sinus brady, and AFib)
What acid-base effects of hypoxemia occur after drowning?
Metabolic and/or respiratory ACIDOSIS fairly common
What renal effects of hypoxemia occur after drowning?
Rarely acute tubular necrosis can occur leading to acute renal failure
What hematologic effects of hypoxemia occur after drowning?
Rarely hemolysis and coagulopathy can occur
How does CPR on a drowning victim differ from typical CPR protocol?
Ventilation first with 2 rescue breaths (differs from typical cardiac arrest patient)
Is C-Spine immobilization recommended for drowning pts?
No
Should the Heimlich maneuver be performed to remove water from the patient’s lungs after drowning?
No
EMS should administer high flow oxygen by facemask to ____ ____patients, intubate____ patients, and initiate re-warming of ____ patients, post-drowning.
Spontaneously breathing
Apneic
Hypothermic
In hypothermic patients, continue resuscitation and rewarming efforts until core temperature reaches ___F
95 F
Continue high-flow O2 to maintain O2 saturation >___%
> 94%
If you are utilizing CPAP/BiPAP to improve oxygenation and improve ventilation/perfusion mismatch, what should you be monitoring the patient for?
Hypotension secondary to increased intrathoracic pressure
Inability to protect airway/neurologic deterioration, having a PaO2 <60 mmHg or O2 saturation <90 on high-flow O2, or having a PaCO2 >50 mmHg are all indications for what procedure?
Intubation!
If intubated, you should also place a____ tube to counteract what?
Orogastric; gastric distension
If opioid intoxication is suspected, what should you consider empirically administering?
Naloxone
Should you obtain an Accucheck blood glucose on drowning pts?
Yes
How do you tx a drowning pt w/ bronchospasm?
Inhaled beta agonists
If a drowning pt develops PNA, what organisms to you suspect as potential culprits?
Pseudomonas, Proteus, Pseudallescheria boydii … GUILTY!
What type of tx may be helpful in a drowning pt with ARDS?
Surfactant treatments
Explain the hemodynamics of a hypothermic drowning pt who presents with cold diuresis.
Vasoconstriction, which results in blood being shunted to the pt’s core, which results in central volume receptors sensing fluid overload, which leads to decreased ADH production, which leads to diuresis and hypovolemia, which leads to hypotension and shock
What is the most common fungal infection in non-fatal drowning victims?
Pseudallescheria boydii
If a drowning pt does not have a c spine injury, what should be done to help avoid cerebral edema?
Elevated head of the bed by 30 degrees
If a drowning pt is hypervolemic, what should be administered cautiously?
Diuretics
What comorbidity should be tightly controlled in drowning patients?
Sz
T/F As part of ongoing tx, you should administer neuromuscular blocking agents (i.e. succinylcholine) to drowning pts
FALSE, do not do this
Asymptomatic drowning pts should be observed on a monitor for a minimum of ___ hours
8
T/F Symptomatic drowning patients should be admitted to monitored setting until sx are resolved
True
Factors that indicate a poor outcome/prognosis for drowning pts include: Submersion >\_\_\_ minutes (most important) Delay to BLS >\_\_\_minutes Duration of resuscitation >\_\_\_ minutes Age >\_\_\_ y/o Glasgow coma scale
Submersion >5 minutes (most important) Delay to BLS >10minutes Duration of resuscitation >25 minutes Age >14 years (kids bounce back, older pts do not) Glasgow coma scale <5 Continued apnea and need for CPR in ED Arterial blood pH <7.1 on arrival to ED
What should you do if you are caught in a rip current?
Swim parallel to shore.Once free of the current, swim diagonally toward shore.
If drowning occurs in contaminated (not pool) water, and the pt is not responding to abx, what should be considered?
Fungal infection
