Transcript Drowning - Adirondack Area Network

Drowning
David Slocum MD
Albany Medical Center
Miracles
Matthew Granger
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14 month old
20-40 minutes
Vocabulary
Drowning – death within 24 hours
Near-drowning – survival past 24 hours
Who?
Usually young, healthy individuals
2006 Drowning
U.S.A. – 5000 died
Worldwide – over 100,000 died
Epidemiology
500,000 submersion events annually
2nd cause of death – children under 15
Injury ranges
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Transient
Profound neurological deficit
Three Peaks
Toddlers
Adolescents
Elderly
Toddlers
Toilets
Bathtubs
Buckets
Coastal Areas
Swimming pools more likely
Adolescents
Stupidity
Young Adults
Alcohol
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40% adult drownings
75% boat drownings
Elderly
Complicating Factors
Spinal cord injury
Hypothermia
Panicking
Syncope
Seizures
Pathophysiology
Central Nervous System Injury
Pulmonary Injury
Dry-drowning
10-20% of submersions
Laryngospasm
Hypoxia
Loss of consciousness
Wet-drowning
Aspiration of water
Dilution of surfactant
Diminished gas transfer
Atelectasis
Ventilation perfusion mismatch
Pulmonary Injury
Contaminated foreign material
Particulate matter
Bacteria
Vomitus
Chemical irritants
Prognosis
Submersion time
Physiological scoring systems
Two extremes
Fair cardiovascular and neurological
function
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Minimal disability
Unstable cardiovascular function and
coma
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Poorly
Hypoxic CNS injury
End Organ Damage
Renal injury
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Hypoxia
Myoglobinuria
Hemoglobinuria
Hematologic
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Hemolysis
DIC
Treatment
Prehospital Care
Resuscitation
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Time optimizes outcome
Removal from water
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C-spine protection
CPR ASAP
Airway
Breathing
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High flow oxygen by facemask
Not Breathing
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Bag valve mask
Endotracheal tube
Unconscious
Protect from aspiration
Who to transport?
Amnesia
Loss or depressed consciousness
Period of apnea
Period of artificial respirations
Even if asymptomatic
Don’t Forget
Warm patient
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Hypothermia
Monitor
IV access
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Warm isotonic fluids
Summary
Rapid, cautious rescue
Spine precautions
Cardiopulmonary resuscitation
Supplemental Oxygen
Transport
ED Treatment
Continue EMS care
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Airway
Oxygen
Ventilation
Warmed fluids
Warming adjunts
Treat associated injuries
GCS > 12
Oxygen to keep sat > 95%
Observe 4-6 hours
Pulmonary exam normal
Saturation normal
Discharge home
No xray or labs needed
GCS > 12
Oxygen to keep sat > 95%
Observe 4-6 hours
Pulmonary exam abnormal
Requires oxygen
Deteriorates
Admit to Monitored bed
GCS < 13
High flow oxygen
Intubation for low PaO2
CXR, Labs
Continuous cardiac monitoring
Frequent reassessments
Seizure
Dilutional hyponatremia
Control seizures
Correct electrolytes
Residual disorder uncommon
ED Arrest
Warm water drowning
Recovery doubtful
Consider early discontinuation of efforts
Risk profound neurological handicaps
Hospital Management
Supportive
Avoid ARDS
Pneumonia rare
Dopamine, epinephrine drips
48 hour window
No benefit
Mannitol
Loop diuretics
Hypertonic saline
Fluid restriction
Hyperventilation
Controlled hypothermia
Barbiturate coma
Prognosis
No CPR
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Full recovery within 48 hours
May develop ARDS
Bystander CPR
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Steady recovery
Steady decline
ED CPR
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Very poor prognosis
Pediatric Warm Water Drowning
500 victims
100% received ED CPR
84% died
16% severe hypoxic encephalopathy
Diving Reflex
Mammals
Bradycardia
Peripheral Vasoconstriction
Greatest in cold water
Preserves oxygen
ICE water submersion
Asystole
Children and Adults
Complete Recovery
Rare
Resuscitate until normothermic
Prevention
Infants
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Parental vigilance
Toddler
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Pool fencing
Adolescent/Young Adult
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Control Alcohol/Drug Use
Swimming lessons
Elderly
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Same as infant/toddler