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Drowning Ane

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    DROWNING

    EZYAN ZAMZUARY

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    DEFINITION

    Drowning syndromes: range btwminimal aspiration of water withgood survival to severe pulmonary

    injury with death

    Drowning: a process ehwreby airbreathing animals succumb on

    submersion in a liquid

    Near drowning: submersion withtemporary survival

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    pathophysiology

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    DROWNING can be primaryevent but can also happens

    secendory to: Seizure

    Head/spine trauma

    Cardiac arrythmias

    Hypothermia

    Alcohol/drug ingestion Syncope

    Apnea

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    Classification of victim

    Asymptomatic

    Symptomatic

    Altered vital signs, anxious appearance,tahypnnea, hypoxia, methabolicacidosis, Altered level of consciousness,neurologic deficit, cough, whizzing,

    hypothermia, vomiting, diarhhoea Cardiopulmonary arrest

    Apnea, asystole, VT/fibrillation,

    bradycardia

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    Pre-hospital care

    Carefull Immediate rescue from water

    Assessment of ABCs

    Cervical spine control/protection

    Initiate CPR if necessary

    breathing

    High flow O2 via facemask

    Non breathing

    PPV

    Fail to recover spontaneousrepiratory effort or remain

    unconscious

    Endotracheal

    Intubation

    HOSPITAL

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    Hospital careGCS 13

    SPO2>95

    GCS < 13

    SPO295% Intubation and PPV as

    needed

    monitor Oxygen saturation Oxygen saturationAcid-base statusTemperaturevolume status

    OBSERVE 4-6 H ICU

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    Secondary survey

    Head to toe examination

    Look for possible cause of incident

    Altered sensorium after recussitation Head injury

    Cervical spine injury

    Epilepsy Cardiac dysrhythmias

    Diving injuries

    Serial GCS assessment

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    management

    Correction of .

    hypoxia

    Volume depletion and acidosis Hypothermia

    others

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    hypoxia

    Maintain spo2 > 95%

    O2 supplement for all patient

    ET intubation Altered level of consciousness and

    inability to protect airway or handle

    secretion Respiratory failure

    High alveolar arterial gradient: PaO2 of60-80mmHg or less on 15L oxygen nonrebreathing mask

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    volume depletion andacidosis

    Volume depletion is common,secondary to PE andintracompartmental fluid shift,

    regardless of the type of fluidaspirated

    Rapid volume expansion using isotonic

    crystalloid(20mls/kg) or colloid Most acidosis is restored after

    correction of volume depletion and

    oxyfenation

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    hypothermia

    All wet clothing should be removedand patient dried

    Provide adequate insulation(wrap ptin clean and dry blanket)

    External warming if necessary

    All fluids given should be warmed

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    others

    Nasogastric tube placement removal of swallowed water anddebris

    Bronchoscopy may be needed ifsuspected to have foreign material,such as debris or vomitus plugs in

    the airway

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    COMPLICATION

    PULMONARY

    Pulmonary hypertension

    Postobstructive pulmonary edema Pneumonia

    Chemical pneumonitis

    CNS

    Primary CNS injury

    Secondary CNS injury

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    COMPLICATION

    CARDIOVASCULAR

    Hypovolemia d/t fluid losses frincrease capillary permeability

    Myocardial dysfunction

    Primary arythmias

    INFECTION

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    OUTCOME

    Uncomplicated

    Asymptomatic/mildly symptomatic

    Observed 4-6hours

    Secondary drowning

    Respiratory deterioration after intial stablepresentation

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    Complicated

    Not requiring CPR

    Complete recovery within 48 hours isexpected

    some with significant aspiration maydevelop severe ARDS

    Bystander CPR(at scene) guardedprognosis

    Paeds: 20% die in hospital; 5% severeHIE

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    CPR in ED poor prognosis

    Sustain significant anoxic or ischemicinsult to the brain/ vital organs

    Complete neurologic recovery is rare

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    REFERENCE

    Near drowning, guide to theessentials in emergency medicine;shirly ooi 2004

    tintinelli

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    THANK YOU

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