Drowning

Define drowning

• A type of suffocation induced by submersion of mouth and nose in liquid

• Person prevented from inhaling air due to liquid occluding the entrance of the airway

Define submersion and immersion

• Submersion

  • Airway being occluded by liquid

  • Remainder of body does not necessarily have o be below the surface of liquid

• Immersion

  • Covered in liquid medium (head may be above water)

  • Does not necessarily imply the entire body has to be submerged.

What can drowning cause?

• Asphyxia And Subsequent hypoxia

What are exacerbating factors for drowning?

Intoxication and drugs

Age extremes

Describe the pathophysiology of submersion

• Conscious pat try to hold breath

• Then will swallow water to avoid inhaling it

• Urge to breathe takes over → water enters lungs

  • Causes laryngospasm (cough) and involuntary closure of larynx

  • This means some patients who have been retrieved may have no water in lungs as laryngospasm has stopped water interring lungs

What factors can influence survival in submersion?

• Cold water (<6*) slowing metabolic processes and oxygen demand (some cases survival over 90 mins)

• Intoxication also slowing metabolic processes

What is the relationship between aspirated water and surfactant?

• Alveoli have pulmonary surfactant

• Aspirated water will wash away this surfactant

• Loss of surfactant increased work of breathing

• Higher ventilation pressure may be needed

What elements of primary survey do we need to consider for drownings?

• D - safety first, PPE and SBAR (can you safely extract patient)

• R - Shout to patient if in water

• A - see if submerged or immersed

• B - rate? O2?

• C - HR - auscultate it unsure

• D - Temp important

• E - Escalate for support

What Dynamic Risk Assessment should we consider for drownings?

• Keep safe distance (3m)

• Number of patients (rescuers may be patients)

• Age (under 12 may be difficult to keep head above water)

• Size (body habitus)

• Time of immersion/submersion

• Air pockets? (E.g. in boat or car)

• Approx temperature of water

SBAR this

Explain the archemides principle or ‘secondary drowning’

• Conscious patients who have been treading water for a long time are under hydrostatic pressure, body maintaining BP in relation to this and concentrating warm blood in core

• If rapidly removed from water, and kept vertically, rapid drop in BP, Leading to Fluid leak into alveoli from capillaries (resp distress, haemoptysis)

• Should take pat out horizontally if immersed in water for long time, to stop BP drop

Describe management for a patient who is spontaneously breathing post-drowning

• Consider C-spine

• addressing hypoxaemia with oxygen

• Consider BVM

• Monitor A and B closely

  • Measure RR

    • SpO2 might not read

• Prepare suction

• Remove wet clothing

• Address hypothermia (tympanic reading unreliable so assume hypothermia)

• Commence resus on children

• Refer to submerged person tool on JRCALC

• Always convey

Describe different management for a patient who is not breathing post-drowning

• 5 initial rescue breaths from BVM before ILS