CH 25 Submersion Incidents: Drowning and Diving Emergencies

Vocabulary and key clinical metrics from Prehospital Emergency Care Chapter 25 regarding submersion incidents.

Drowning

An incident in which someone is submerged or immersed in a liquid that results in a primary respiratory impairment by preventing the patient from breathing air.

80%

The approximate percentage of drowning incidents that occur in males.

Bathtub

The most common location of drowning for children and for people with seizure disorders.

Prognostic predictors for survival

Survival chances are greatest with 2 or fewer of: age $3$ years or older, submerged $\le 5$ minutes, resuscitation delayed $\le 10$ minutes, no coma at ED, and arterial blood $pH \ge 7.10$.

Pathophysiology of drowning

Submersion results in aspiration of water or laryngeal spasms, leading to hypoxia, acidosis, brain damage, and death.

Surfactant

A substance that maintains surface tension in the alveoli to keep them from collapsing; it is washed out by water in the lungs during drowning.

Acute respiratory distress syndrome (ARDS)

A condition that results when surfactant is washed out and the alveoli collapse.

Mammalian diving reflex

A reflex activated by cold water drowning that drastically decreases the metabolic rate, potentially allowing for resuscitation after prolonged submersion.

Reach, throw, row, go

The safety strategy sequence used for rescuing a patient who is close to shore.

10 feet

The distance from the edge of the water within which a rescuer must wear a Personal Flotation Device (PFD).

Drowning patient categories

The four classifications for patients: Asymptomatic, Symptomatic, Cardiac arrest, and Obviously dead.

Target SpO2

Oxygen saturation should be maintained at a level of $95\%$ or greater.

72 hours

The duration after a drowning incident during which complications can still arise, necessitating transport even for asymptomatic patients.

93.2°F (34°C)

The core body temperature threshold; patients below this temperature are actively rewarmed, while those above are passively rewarmed.

Reassessment intervals

Repeat primary and secondary assessments every $5$ minutes for unstable patients and every $15$ minutes for stable patients.