Near Drowning and Wet Drowning - Lecture Notes

NEAR DROWNING & WET DROWNING

Overview of Drowning

  • Drowning:
    • Definition: Suffocation and death as a result of submersion in liquid.
  • Near Drowning:
    • Definition: The victim survives a liquid submersion, at least temporarily (defined as survival for 24 hours post event).
  • Dry Drowning:
    • Mechanics: Glottis spasms, preventing fluid from entering the lungs.
  • Wet Drowning:
    • Mechanics: Glottis relaxes, allowing fluid to flood into the lungs, which can result in non-cardiogenic pulmonary edema.
    • Complications of Wet Drowning:
    • If the victim is submerged in unclean water, pneumonia may occur and in severe cases can lead to ARDS (Acute Respiratory Distress Syndrome).

Anatomic Alterations

  • Changes in the lungs due to drowning include:
    • Laryngospasm of Lungs: Spasm of the muscles involved in breathing, obstructing airflow.
    • Interstitial Edema: Fluid accumulates in the lung interstitium.
    • Decreased Surfactant: Leads to increased surface tension in the alveoli.
    • Frothy White and Pink Secretions: Indicative of pulmonary edema.
    • Atelectasis: Collapse or closure of a lung resulting in reduced or absent gas exchange.
    • Consolidation: Solidification of the lung tissue due to accumulation of fluid.
    • Bronchospasm: Constriction of the bronchial tubes, leading to difficulty in breathing.

Favorable Prognostic Factors in Cold-Water Near Drowning (Table 42-1)

  • Age: The younger the victim, the better the prognosis.
  • Submersion Time: The shorter the time submerged, the better the prognosis (60 minutes appears to be the upper limit in cold-water submersions).
  • Water Temperature: The colder the water, the better (optimal range is from 27° F to 70° F).
  • Water Quality: The cleaner the water, the better the prognosis.
  • Other Injuries: The absence of serious other injuries correlates with better outcomes.
  • Amount of Struggle: Less struggle prior to rescue improves prognosis.
  • Quality of Cardiopulmonary Resuscitation (CPR): High-quality CPR techniques significantly increase survival rates.
  • Suicidal Intent: Victims with suicidal intent have lower survival rates compared to those who drowned accidentally.

Clinical Manifestations of Drowning

  • Common clinical manifestations include:
    • Apnea: Absence of breathing.
    • Increased Heart Rate (HR), Respiratory Rate (RR), and Blood Pressure (BP): Common physiological responses to distress.
    • Cyanosis: A bluish discoloration of the skin resulting from hypoxia.
    • Cough and Sputum Production: Indicative of respiratory distress.
    • Pallor: Unhealthy pale appearance, often linked to shock or poor circulation.
    • Crackles: Abnormal lung sounds when auscultating, indicative of fluid presence in the lungs.

Pulmonary Function Tests (PFT) and Arterial Blood Gas (ABG) Analysis

  • Pulmonary Function Tests (PFTs): Indicate restrictive lung pattern due to drowning.
  • ABGs in Moderate and Advanced Stages of Wet Drowning: Often reveal acute ventilatory failure with hypoxemia.

Chest X-Ray (CXR)

  • Typical Findings:
    • Fluffy infiltrates on radiological exams.
    • Initial CXR may show varied findings from normal to pulmonary edema and atelectasis.
    • Deterioration of lung status may occur within the first 48 to 72 hours post incident.

Radiological Example

  • In reference to a radiograph taken after an episode of near drowning:
    • Observation: Pulmonary edema pattern noted on the image.

First Responder Protocols

  • Immediate Actions:
    • Remove the victim from the water.
    • Administer CPR if indicated.
    • Remove wet clothing and replace with warm, dry coverings.
  • Cold Water Submersion:
    • If submerged in cold water for less than 60 minutes, this does not necessarily indicate a poor prognosis.
    • Water as a medium: Water is an excellent conductor of body heat, cooling the body 25 times faster than air at the same temperature.
    • Body cooling reduces oxygen consumption, thus increasing the chances of survival.

Glasgow Coma Scale

  • Purpose: A test used to assess the level of consciousness post-near drowning.
  • Critical Value: A score of less than 8 indicates the necessity for intubation.

Management During Transport

  • Procedures:
    • Ensure high-quality CPR is maintained with a Fraction of Inspired Oxygen (FiO2) set to 1.0.
    • Conserve the patient’s body heat by monitoring rectal temperature.
    • Cover high heat loss areas (head, neck, axillae, groin) with warm, dry coverings.

Management at Hospital

  • Actions:
    • Perform Chest X-Ray (CXR).
    • Intubation and mechanical ventilation may be required, specifically with the need for Positive End-Expiratory Pressure (PEEP).
    • Use of inotropic agents and diuretics as necessary.
    • Warming the patient is essential to prevent hypothermia.