View
10
Download
0
Category
Preview:
Citation preview
Not all drowning is fatalJonathon Webber
The drowning problem
A snapshot
• Drowning claims the life of one person every 1.5s
• Where lifeguard services operate, <6% of persons rescued require
medical attention and only 0.5% require CPR
• Where bystanders are involved, almost 30% of persons rescued
require CPR
• Epidemiologic data lacks reports for >94% of non-fatal incidents
• The highest burden of drowning is in low/middle-income countries
Drowning in New Zealand
Drowning hospitalisations
Possible explanations
• Increased awareness amongst parents/caregivers to seek
medical attention
• Lower threshold for ambulance staff to transport to hospital
• Consequence of fatal drownings declining
• Something else??
Framework
Drowning Chain of Survival
https://1drv.ms/f/s!AiPJvRcAPrGjsBZgEQTbz1v_yUCg
Back to basics
Drowning definitions
Drowning is the process of experiencing respiratory impairment from
submersion/immersion in liquid
• Drowning outcomes are fatal or non-fatal
• Non-fatal drowning is then further classified as with or without
morbidity (injury)
• Obsolete terms include: near, dry, wet, delayed and secondary
drowning
WHO draft position statement
https://www.who.int/violence_injury_prevention/drowning/non-fatal-drowning/en/
Types of respiratory impairment
Respiration was impaired due to submersion/immersion in liquid, and
immediately after the drowning process stopped the person was:
1. Breathing, experiencing involuntary distressed coughing, and was
fully alert (Mild – 1)
2. Having difficulty breathing and/or was disoriented but conscious
(Moderate – 2)
3. Not breathing and/or had become unconscious (Severe – 3)
Case study one
A survey respondent indicates that their child was in distress in the water and
had difficulty breathing immediately after they were pulled out of the water.
The respondent states that their child has more difficulty completing daily
activities such as school work than prior to the drowning incident.
Case one is a non-fatal drowning. The correct categorisation of case one is
having had moderate respiratory impairment at the moment that the
drowning process stopped, and some morbidity at the time of measurement.
Category: 2B
Case study two
The respondent indicates that they experienced distress in the water and
were told they were not breathing and were unconscious immediately after
the drowning process stopped. At the time of measurement, the respondent
indicated that their functional capacity was the same as prior to the incident.
Case two is a non-fatal drowning. The correct categorization of case two is
having had severe respiratory impairment at the time the drowning process
stopped, and no morbidity at the time of measurement.
Category: 3A
Red flags
Further advice
If you notice behaviour changes up to 4 hours after a child has
left the water, seek medical help immediately
• There have been no recorded cases of normal, healthy
children who suddenly die because they went swimming
days earlier
• Symptoms that appear unexpectedly, much later, are likely
unrelated to the drowning episode and should be
evaluated as such
First aid management
Considerations
• Patients often froth. Do not
suction; apply the mask and
leave the froth to go in and out
with the oxygen
• Be prepared for vomiting
• Most post-drowning "collapse" is
due to physical exhaustion
• Hypothermia occurs in summer
Dead heroes cant save lives
Bystander rescue
• In many case reports it is the person in distress that survives, and the rescuer
that fatally drowns
• Avoid entering the water if possible. Only enter the water with some form
of flotation
• Always use non-contact tows. Remember, you are a source of buoyancy to a
drowning victim
• In most cases, providing flotation to the patient will interrupt or stop the
drowning process
Drowning resuscitation
General principles
• Start CPR on any person located within
60min of being reported missing*
• Prompt initiation of rescue breathing
and basic life support is more
important than defibrillation
• Regurgitation occurs in >40% of cases;
be prepared for it
• Submersion time is the most powerful
predictor of outcome
Drowning resuscitation
Initial assessment
• Assess patients in a supine position
• Perform CPR for ~1min and then attach an AED if resources
are limited
• If regurgitation occurs, quickly roll the patient onto their side
and allow the water to drain out. Resume CPR without delay
• Chest compression-only CPR is not recommended
Conclusions
Take home messages
• The drowning toll is heading in the right direction, but we can do better
• Seek medical help immediately for any non-fatal drowning patient
displaying any of the warning signs: www.NotOutOfTheWater.com
• People who have drowned and showed minimal symptoms after leaving
the water either get better or worse within 2-4hrs
• Chest compression-only CPR does not address hypoxia
• The prevention of drowning will always be a better cure than
resuscitation from it
www.surflifesaving.org.nz
Recommended