DROWNING

By dr. pirah korai

CMC LARKANA

OUTLINES•Definition•Epidemiology•Types•Key risk factors•Pathophysiology•Difference b/w fresh water and sea water drowning•Rescue and initial resusitation•Hospital management•complications•Medico-legal aspect•Prevention

 “Drowning is the process of experiencing respiratory

impairment from submersion/immersion in

liquid.”

WHO                                                              

                                                              

3rd leading cause of death in the world

0.7% of all deaths worldwide — or more than 500,000 deaths each year, are due to unintentional drowning.

 For every person who dies from drowning, another four persons receive care in the emergency department for nonfatal drowning

EPIDEMIOLOGY

1) Non-fatal Drowning

2) Fatal Drowning

TYPES

Loadshedding

INFLATION

CORRUPTION

UNEMPLOYMENT

Any submersion or immersion incident without evidence of respiratory

impairment should be considered a water rescue and not a drowning.

Terms such as “near drowning,” “dry or wet drowning,” “secondary

drowning,” “active and passive drowning,” and “delayed onset of

respiratory distress” should be avoided.

WHO Guidelines 2002

Male

age of less than 14 years

alcohol use

low income & poor education

Rural residency

aquatic exposure

risky behavior

lack of supervision

KEY RISK FACTORs

•The victim struggles to keep his or her head above the water

•After the head submerges or drops below the water surface, breath holding occurs

•When water enters the upper airways, it causes the larynx to go into spasm

•Most often the spasm relaxes, allowing water through the larynx into the bronchial tree and the lungs.

PATHOPHYSIOLOGY

•Approximately 10% to 20% of drowning victims have persistent laryngeal spasm and no fluid is found in their lungs on autopsy.

•The brain stops functioning within just a few minutes without oxygen, and permanent damage occurs if there is no oxygen for more than six minutes.

•The heart muscle needs oxygen to function and deadly, irregular heart rhythms may occur with oxygen deprivation

DROWNING IN

FRESH WATER v/S

SALT WATER

RESCUE AND IN-WATER RESUSCITATIONLess than 6% of all rescued persons need medical

attention and just 0.5% need CPR.

For a person who is unconscious, in-water resuscitation with ventilation alone is indicated.

Immobilization of the spine in the water is indicated only in cases in which head or neck injury is strongly suspected

 Rescuers should try to maintain the rescued person in a vertical position while keeping the airway open.

INITIAL RESUSCITATION ON LAND

If the rescued person is breathing then adopt recovery position (Lateral Decubitus)

If he is unconscious then place him supine, with trunK and head at same level

Do CPR follow the traditional ABC sequence.

5 initial rescue breaths followed by 30 chest compressions & continue with 5 rescue breaths & 30 compressions until the signs of life reappear or

advanced life support becomes available

(EUROPEAN RESUSITATION COUNCIL RECOMMENDATIONS)

HOSPITALMANAGEMENT

DrowningSigns and Symptoms

Abdominal distention Bluish skin of the face,

especially around the lips

Chest pain Cold skin and pale

appearance Confusion Cough with pink, frothy

sputum

Irritability Lethargy No breathing Restlessness Shallow or gasping

respirations Unconsciousness Vomiting

ICU MANAGEMENT

GENERAL MEASURES

•Normalize Glucose

•Maintain pO2 within normal range

•Induce Hypothermia with core temperature maintained b/w 32 to 34 for 24 hours.

RESPIRATORY SYSTEM:

•Guidelines of ARDs be followed:-Bronchodilators-Glucocorticoids-Extracorporeal membrane oxygenation-Artificial surfactant-Inhaled Nitric oxide-Partial liquid ventilation with perfluorocarbons-not to use prophylactic antibiotics

CIRCULATORY SYSTEM:

-Inotropic agents-vasopressors-while diuretics and water restriction not recommended

• Cardiac (cardiac arrest, bradycardia, myocardial infarction).

• Pulmonary (pulmonary oedema, pneumonia).

• Neurological (stroke, cerebral hypoxia, cerebral oedema).

• Renal (renal failure).• Haematological (haemolysis).• Metabolic (hyperkalaemia, acidosis).

• Infective (pneumonia, septicaemia).

COMPLICATIONZ

Medico-legal aspects of Drowning

It is estimated that more than 85% of cases of drowning can be prevented by supervision,

swimming instruction, technology, regulation, and public education

Prevention