Drowning
- 1. DrowningDrowning David Slocum MDDavid Slocum MD Albany Medical CenterAlbany Medical Center
- 2. MiraclesMiracles Matthew GrangerMatthew Granger 14 month old14 month old 20-40 minutes20-40 minutes
- 3. VocabularyVocabulary Drowning death within 24 hoursDrowning death within 24 hours Near-drowning survival past 24 hoursNear-drowning survival past 24 hours
- 4. Who?Who? Usually young, healthy individualsUsually young, healthy individuals
- 5. 2006 Drowning2006 Drowning U.S.A. 5000 diedU.S.A. 5000 died Worldwide over 100,000 diedWorldwide over 100,000 died
- 6. EpidemiologyEpidemiology 500,000 submersion events annually500,000 submersion events annually 2nd cause of death children under 152nd cause of death children under 15 Injury rangesInjury ranges TransientTransient Profound neurological deficitProfound neurological deficit
- 9. Coastal AreasCoastal Areas Swimming pools more likelySwimming pools more likely
- 11. Young AdultsYoung Adults AlcoholAlcohol 40% adult drownings40% adult drownings 75% boat drownings75% boat drownings
- 12. ElderlyElderly
- 13. Complicating FactorsComplicating Factors Spinal cord injurySpinal cord injury HypothermiaHypothermia PanickingPanicking SyncopeSyncope SeizuresSeizures
- 14. PathophysiologyPathophysiology Central Nervous System InjuryCentral Nervous System Injury Pulmonary InjuryPulmonary Injury
- 15. Dry-drowningDry-drowning 10-20% of submersions10-20% of submersions LaryngospasmLaryngospasm HypoxiaHypoxia Loss of consciousnessLoss of consciousness
- 16. Wet-drowningWet-drowning Aspiration of waterAspiration of water Dilution of surfactantDilution of surfactant Diminished gas transferDiminished gas transfer AtelectasisAtelectasis Ventilation perfusion mismatchVentilation perfusion mismatch
- 17. Pulmonary InjuryPulmonary Injury Contaminated foreign materialContaminated foreign material Particulate matterParticulate matter BacteriaBacteria VomitusVomitus Chemical irritantsChemical irritants
- 18. PrognosisPrognosis Submersion timeSubmersion time Physiological scoring systemsPhysiological scoring systems
- 19. Two extremesTwo extremes Fair cardiovascular and neurologicalFair cardiovascular and neurological functionfunction Minimal disabilityMinimal disability Unstable cardiovascular function andUnstable cardiovascular function and comacoma PoorlyPoorly Hypoxic CNS injuryHypoxic CNS injury
- 20. End Organ DamageEnd Organ Damage Renal injuryRenal injury HypoxiaHypoxia MyoglobinuriaMyoglobinuria HemoglobinuriaHemoglobinuria HematologicHematologic HemolysisHemolysis DICDIC
- 22. Prehospital CarePrehospital Care ResuscitationResuscitation Time optimizes outcomeTime optimizes outcome Removal from waterRemoval from water C-spine protectionC-spine protection CPR ASAPCPR ASAP
- 23. AirwayAirway BreathingBreathing High flow oxygen by facemaskHigh flow oxygen by facemask Not BreathingNot Breathing Bag valve maskBag valve mask Endotracheal tubeEndotracheal tube UnconsciousUnconscious Protect from aspirationProtect from aspiration
- 24. Who to transport?Who to transport? AmnesiaAmnesia Loss or depressed consciousnessLoss or depressed consciousness Period of apneaPeriod of apnea Period of artificial respirationsPeriod of artificial respirations Even if asymptomaticEven if asymptomatic
- 25. Dont ForgetDont Forget Warm patientWarm patient HypothermiaHypothermia MonitorMonitor IV accessIV access Warm isotonic fluidsWarm isotonic fluids
- 26. SummarySummary Rapid, cautious rescueRapid, cautious rescue Spine precautionsSpine precautions Cardiopulmonary resuscitationCardiopulmonary resuscitation Supplemental OxygenSupplemental Oxygen TransportTransport
- 27. ED TreatmentED Treatment Continue EMS careContinue EMS care AirwayAirway OxygenOxygen VentilationVentilation Warmed fluidsWarmed fluids Warming adjuntsWarming adjunts Treat associated injuriesTreat associated injuries
- 28. GCS > 12GCS > 12 Oxygen to keep sat > 95%Oxygen to keep sat > 95% Observe 4-6 hoursObserve 4-6 hours Pulmonary exam normalPulmonary exam normal Saturation normalSaturation normal Discharge homeDischarge home No xray or labs neededNo xray or labs needed
- 29. GCS > 12GCS > 12 Oxygen to keep sat > 95%Oxygen to keep sat > 95% Observe 4-6 hoursObserve 4-6 hours Pulmonary exam abnormalPulmonary exam abnormal Requires oxygenRequires oxygen DeterioratesDeteriorates Admit to Monitored bedAdmit to Monitored bed
- 30. GCS < 13GCS < 13 High flow oxygenHigh flow oxygen Intubation for low PaO2Intubation for low PaO2 CXR, LabsCXR, Labs Continuous cardiac monitoringContinuous cardiac monitoring Frequent reassessmentsFrequent reassessments
- 31. SeizureSeizure Dilutional hyponatremiaDilutional hyponatremia Control seizuresControl seizures Correct electrolytesCorrect electrolytes Residual disorder uncommonResidual disorder uncommon
- 32. ED ArrestED Arrest Warm water drowningWarm water drowning Recovery doubtfulRecovery doubtful Consider early discontinuation of effortsConsider early discontinuation of efforts Risk profound neurological handicapsRisk profound neurological handicaps
- 33. Hospital ManagementHospital Management SupportiveSupportive Avoid ARDSAvoid ARDS Pneumonia rarePneumonia rare Dopamine, epinephrine dripsDopamine, epinephrine drips 48 hour window48 hour window
- 34. No benefitNo benefit MannitolMannitol Loop diureticsLoop diuretics Hypertonic salineHypertonic saline Fluid restrictionFluid restriction HyperventilationHyperventilation Controlled hypothermiaControlled hypothermia Barbiturate comaBarbiturate coma
- 35. PrognosisPrognosis No CPRNo CPR Full recovery within 48 hoursFull recovery within 48 hours May develop ARDSMay develop ARDS Bystander CPRBystander CPR Steady recoverySteady recovery Steady declineSteady decline ED CPRED CPR Very poor prognosisVery poor prognosis
- 36. Pediatric Warm Water DrowningPediatric Warm Water Drowning 500 victims500 victims 100% received ED CPR100% received ED CPR 84% died84% died 16% severe hypoxic encephalopathy16% severe hypoxic encephalopathy
- 37. Diving ReflexDiving Reflex MammalsMammals BradycardiaBradycardia Peripheral VasoconstrictionPeripheral Vasoconstriction Greatest in cold waterGreatest in cold water Preserves oxygenPreserves oxygen
- 38. ICE water submersionICE water submersion AsystoleAsystole Children and AdultsChildren and Adults Complete RecoveryComplete Recovery RareRare Resuscitate until normothermicResuscitate until normothermic
- 39. PreventionPrevention InfantsInfants Parental vigilanceParental vigilance ToddlerToddler Pool fencingPool fencing Adolescent/Young AdultAdolescent/Young Adult Control Alcohol/Drug UseControl Alcohol/Drug Use Swimming lessonsSwimming lessons ElderlyElderly Same as infant/toddlerSame as infant/toddler