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8/3/2019 Drowning Ane
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5/5/12
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
SPO2<95
Cervical spine clear Clear
Ancillary test Only as indicated ABGFBC, BUSE, glucose,
PT/APTT, CK, urinemyoglobine, urine drugscreenCXRECG
Respiratory support O2 Keep SPO2>95% Intubation and PPV as
needed
monitor Oxygen saturation Oxygen saturationAcid-base status Temperaturevolume 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 of 60-80mmHg 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 if suspected 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) guarded
prognosis
–
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