Wk 12 PPT Near Drowning (2)

NEAR DROWNING

  • Focus on Chapter 42 of Des Jardins and Chapter 30 of Egan.

TERMINOLOGY (1 OF 2)

  • Drowning:

    • Definition: Respiratory impairment due to submersion or immersion in liquid, leading to suffocation and potential death.

    • Outcome: If the individual does not survive, it is termed fatal drowning.

  • Near Drowning:

    • Definition: Incidents with respiratory impairment from submersion but survival with medical intervention.

    • Outcome: Survivors may experience respiratory distress, hypoxia, or other complications.

TERMINOLOGY (2 OF 2)

  • Immersion:

    • Definition: Being partially or completely submerged in a liquid; does not necessarily lead to drowning.

    • Outcome: Can be accidental without breathing impairment.

  • Submersion:

    • Definition: Body is partially or completely under water, often leading to breathing difficulty.

    • Outcome: Can lead to drowning or near drowning.

STATISTICS AND EPIDEMIOLOGY

  • CDC reports over 4,500 drowning deaths annually from 2020 to 2022.

  • Children (1-4 years): Leading cause of death in this group due to drowning.

  • Black Individuals: 28% increase in drowning rates from 2019 to 2021; second-highest death rate in the U.S.

  • American Indian/Alaska Native Communities: Highest drowning rates, stable over time.

  • Approximately 40 million adults in the U.S. (15.4%) cannot swim; 54.7% have never taken swimming lessons.

EPIDEMIOLOGY

  • Age Distribution of Drowning Deaths:

    • First Peak: Children under 5; risk factors include lack of supervision and limited swimming skills.

    • Second Peak: Young adults aged 15-24; associated with water-related accidents, alcohol use, and risky behaviors.

THE DROWNING SEQUENCE

  • Steps: Initial immersion → Laryngospasm → Gasping/Respiratory struggle → Water inhalation → Loss of consciousness → Cardiac arrest and death.

TWO PATHOLOGICAL REFLEXES

  • 1. Reflex Laryngospasm:

    • Definition: Protective response where vocal cords close, blocking the airway upon water aspiration.

    • Consequences: Can cause respiratory distress, hypoxia, and airway obstruction if prolonged.

  • 2. Diver's Reflex:

    • Definition: Physiological response in mammals submerged in cold water, characterized by three responses:

      • Bradycardia: Reduced heart rate to conserve oxygen.

      • Peripheral Vasoconstriction: Blood flow directed to vital organs.

      • Blood Shift: Shunts blood to central body to maintain blood volume.

    • Protective Function: Helps conserve oxygen during submersion.

DRY DROWNING

  • Definition: Larynx closes off, preventing water from entering lungs; leads to suffocation due to airway obstruction.

  • Time Frame: Can occur shortly after event (minutes to hours).

  • Symptoms: Respiratory distress, coughing, chest tightness after the event.

WET DROWNING

  • Definition: Larynx relaxes, allowing water into lungs, leading to respiratory failure.

  • Symptoms: Difficulty breathing, foamy sputum, worsening respiratory distress.

KEY PATHOLOGIC PULMONARY CHANGES

  • Laryngospasm: Limits water entry initially but may allow damage if failure occurs.

  • Pulmonary Edema: Fluid accumulation in alveoli; varies with saltwater vs. freshwater drowning.

  • Surfactant Dysfunction: Caused by damage or washout leading to atelectasis.

  • Inflammatory Response: Increases fluid leakage, worsening gas exchange.

  • Hypoxia, Hypercapnia, and Acid-Base Imbalances: Complicate clinical picture; untreated can lead to respiratory failure.

PULMONARY CONCERNS

  • Alveolar flooding.

  • Surfactant washout leading to pulmonary edema.

  • Decreased lung compliance.

  • V/Q mismatch and intrapulmonary shunt.

  • Refractory hypoxemia and ARDS.

SALTWATER DROWNING

  • Osmotic Pressure: Saltwater higher in salinity than blood; causes water to be drawn into alveoli.

  • Pulmonary Edema: Fluid impairs oxygenation.

  • Electrolyte Imbalance: High salt content causes serious complications like arrhythmias.

FRESHWATER DROWNING

  • Osmotic Pressure: Freshwater lower in salinity; causes water influx into bloodstream.

  • Pulmonary Edema: Rapid dilution of blood leads to significant leakage and impaired oxygen transfer.

  • Hemodilution: Lowers blood's oxygen-carrying capacity, leading to potential hypovolemic complications.

PULMONARY EDEMA

  • Associated with pink, frothy sputum.

RECALL QUESTIONS

  • Reflex Laryngospasm affects airway: B) Involuntary closure of the vocal cords.

  • Diver's Reflex NOT associated: C) Increased blood flow to extremities.

PRE-HOSPITAL MANAGEMENT

  • Assessment and Immediate Actions:

    • Ensure scene safety, check responsiveness and breathing.

  • Airway Management:

    • Rescue breathing, CPR for cardiac arrest, intubation if no spontaneous ventilations. Monitor oxygen levels, provide supplemental oxygen.

  • Control Hypothermia: Remove wet clothing, cover with blankets, and ensure rapid transport.

HOSPITAL MANAGEMENT

  • Extension of rescue efforts; monitor for hypoxemia, hypercapnia, acidosis.

  • Administer Narcan if appropriate; use warming techniques (IV solutions, heated lavage).

RULE OF THUMB

  • Intubation: Consider if ALOC, apnea, or severe hypoxemia present.

  • CPR: Continue until core body temperature > 35°C. Metabolic processes depend on normal body temperature. Hypothermia complicates heart activity.

OTHER HOSPITAL MANAGEMENT CONSIDERATIONS

  • Conduct airway clearance and consider bronchoscopy; prone positioning assists in fluid clearance.

  • Use antibiotics for pneumonia prevention; may require diuretics, inotropic agents, and mechanical ventilation for ARDS.

PULMONARY EDEMA/ARDS

  • Drowning is a common cause of ARDS, involving pulmonary edema and poor compliance; employ protective lung strategies.

NEUROLOGIC INJURIES

  • Management aims to prevent ischemia, cerebral edema, and complications; monitor ICP and control seizures aggressively.

GLASGOW COMA SCALE

  • Eyes Open: 4-1 points, Verbal Response: 5-1 points, Motor Response: 6-1 points. Injury scoring: Minor (13-15), Moderate (9-12), Severe (3-8).

GENERAL PROGNOSIS - POOR OUTCOMES

  • Key factors for prognosis: Submersion time, water temperature, and initial cardiac rhythm play crucial roles in outcomes.

  • Higher GCS scores (above 5) are linked to better prognos.

FAVORABLE PROGNOSTIC FACTORS IN COLD-WATER NEAR DROWNING

  • Younger age, shorter submersion time, colder water temperature, cleaner water quality, minimal struggle, and good CPR technique improve survival chances.

SELF ASSESSMENT QUESTIONS

  • Continuous CPR until core temperature reaches 35°C serves to revive circulation and organ function.

  • Clinical manifestations in near-drowning victims: frothy, pink secretions, crackles, indicating severe pulmonary issues.