Submersion injury 8.9

Question 1

Shallow water blackout

Answer 1

hyperventilation–>decreased CO2 upon submersion–>O2 metabolized to CO2 but its not high enough to trigger breath–>swimmer loses consciousness

Question 2

Pre-hospital care

Answer 2

Immediate CPR, ventilation first with 2 rescue breaths. NO maneuvers to remove water, high flow oxygen and intubate apneic patients

Question 3

ED care

Answer 3

resuscitative efforts in hypothermic patients until 35C, in non-hypothermic resuscitative efforts no more than 30 mins. high flow O2, inhaled beta-adrenergic agonists, CPAP/BiPAP, rewarming, glucose, opioid intoxication–>naloxone, monitor cardiac telemetry, continous and end tidal CO2, vital signs, neuro checks

Question 4

ED indications for Orogastric intubation

Answer 4

inability to protect airway/neurologic deterioration, PaO2 50mmHg

Question 5

ED diagnostic tests

Answer 5

ECG, chest radiograph, Serum electrolytes, BUN/Cr, EtOH/drug screen, CBC, PT/PTT, ABG/VBG, cardiac markers as indicated, imaging studies as indicated

Question 6

Pulmonary drowning complications

Answer 6

bronchospasm, pneumonia, ARDS

Question 7

Neurologic considerations

Answer 7

elevate head of bed, cautious use of diuretics if hypervolemic, tight seizure control with non-sedating anti-convulsants, avoid neuromuscular blocking agents, tight glycemic control, avoid hyperthermia,

Question 8

Asymptomatic patients

Answer 8

observe for 8hrs, if all vitals, clinical state and CXR are normal may discharge

Question 9

Poor Prognosis

Answer 9

submersion > 5mins, delay to BLS >10 mins, duration of resuscitation >25 mins, age >14 yrs, Glasgow coma Scale