MEDSURG-DROWNING

Page 1

  • Title: BROWNING Quintana, Cris Jerico D. Dela Cruz, Jobelyn

Page 2

LESSON OUTLINE

  • Overview of the concept

  • Clinical manifestations

  • Risk Factors

  • Laboratory and Diagnostic Tests

  • Managements

  • Common Complications

  • Pharmacology

  • Nursing Interventions

  • Nutrition and Diet Therapy

Page 3

OVERVIEW

  • Nonfat drowning: Survival for at least 24 hours after submersion causing respiratory arrest.

  • Common consequence: Hypoxemia.

  • At-risk groups: Highest risk in children under 5 and adults over 85 years.

  • Global statistics: Approximately 320,000 drownings annually, accounting for 7% of global unintentional injury mortality (WHO, 2020).

Page 4

CLINICAL MANIFESTATIONS

  • Hypoxia: Insufficient oxygen in the body.

  • Acidosis: Build-up of acid in the body fluids.

  • Hypothermia: Subnormal body temperature.

  • Loss of Consciousness: May occur due to severe hypoxia or other complications.

Page 5

RISK FACTORS

  • Alcohol ingestion

  • Inability to swim

  • Diving injuries

  • Hypothermia

  • Exhaustion

  • Common drowning locations: Pools, lakes, and bathtubs.

  • Suicide by drowning is rare in pools, typically not involving alcohol.

Page 6

LABORATORY AND DIAGNOSTIC TESTS

  • Arterial Blood Gas (ABG): Monitors oxygen, carbon dioxide, bicarbonate levels, and pH.

  • ECG Monitoring: To check for arrhythmias that often occur post-drowning.

  • Complete Metabolic Panel: Assesses serum electrolytes, renal, and hepatic function.

  • Chest X-ray: To identify complications such as ARDS, pneumonia, or pleural effusions.

  • Intracranial Pressure Assessments

  • Vital Signs Monitoring

Page 7

PREVENTION

  • Avoid rip currents offshore; 85% of shore drownings involve them.

  • Surround pools with fencing and self-latching gates; provide swimming lessons.

  • Supervision: Most effective prevention near water.

  • When boating, use personal flotation devices (PFDs) even for swimmers.

  • Nearly 50% of nonfatal drownings lead to hospital admissions for management.

Page 8

MANAGEMENT

  • Maintain airway, ventilation, and stabilize circulation.

  • If there's a history of loss of consciousness or head/neck trauma, consider spinal injury.

  • Cardiopulmonary Instability: Provide adequate oxygen, consider intubation, and 100% oxygen ventilation. Administer cardiac massage if needed.

  • Insert a nasogastric tube to remove ingested water.

  • Obtain chest X-ray, ABGs, and establish IV access.

  • Monitor urinary output with a Foley catheter; fluids may include lactated Ringer’s or normal saline.

Page 9

CONTINUED MANAGEMENT

  • Avoid diuretics for pulmonary edema; instead, consider plasma volume expanders for poor peripheral perfusion.

  • If hypoxemia persists despite ventilation, apply positive end-expiratory pressure as needed.

  • Metabolic Acidosis: Administer IV bicarbonate if pH < 7.1.

  • Hypothermia Treatment: Dry patient, remove wet clothing, and use warming methods if core temperature drops.

  • Hospitalization Criteria: Apnea, cyanosis, CPR, loss of consciousness, hypoxemia, acidosis, abnormal chest x-ray, or physical exam.

  • General Measures: High dose broad-spectrum antibiotics may be required if aspiration is suspected.

Page 10

COMMON COMPLICATIONS

  • Major complications include hypoxia and acidosis; emergency intervention is critical.

  • Pathophysiologic changes and pulmonary injury depend on fluid type (fresh/salt water) and volume aspirated.

  • Freshwater leads to surfactant loss and lung expansion difficulties.

  • Saltwater causes pulmonary edema due to osmotic effects.

  • ARDS can result from submersion, leading to hypoxia, hypercapnia, and respiratory/metabolic acidosis.

Page 11

PHARMACOLOGY

  • Hypotension and impaired tissue perfusion post-nonfatal drowning can be treated with intravascular volume expanders and inotropic agents.

  • Intravascular Volume Expanders: e.g., Albumin.

  • Inotropic Agents: e.g., Dobutamine, Dopamine.

Page 12

DRUG NAME: Dobutamine

  • Classification: Inotropic agent.

  • Mechanism of Action: Stimulates beta-1 receptors, enhancing myocardial contractility and stroke volume.

  • Indication: Short-term inotropic support in cardiac decompensation.

  • Contraindications: Acute myocardial infarction, unstable angina, severe hypertension, arrhythmias.

  • Side Effects: Increased heart rate, blood pressure, possible IV site reactions, monitor for adverse reactions and vitals.

Page 13

DRUG NAME: Albumin

  • Classification: Plasma volume expander.

  • Mechanism of Action: Provides colloidal oncotic pressure, mobilizing fluid to intravascular space.

  • Indication: Temporary albumin replacement in low plasma protein conditions.

  • Contraindications: Allergic reactions, severe anemia, CHF.

  • Side Effects: Headache, pulmonary edema, fluid overload; monitor vital signs and for signs of overload.

Page 14

NURSING INTERVENTIONS

  • Assess for loss of consciousness.

  • Maintain adequate cerebral perfusion and oxygenation to mitigate organ damage.

  • Cardiopulmonary resuscitation (CPR) greatly influences survival; provide oxygen as ordered.

  • Regularly monitor ABGs, temperature, ECG for arrhythmias.

Page 15

NUTRITION AND DIET THERAPY

  • No special diet post-drowning recovery.

  • Intravenous nutrition may be provided during hospitalization.

Page 16

REFERENCES

  • Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, Volume 2.

  • Critical Care Medicine, 2nd Edition.

Page 17

  • Thank you!