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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