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Understanding Drowning: 2013
Justin Sempsrott, MD
Andrew Schmidt, DO, MPH
Understanding Drowning: 2013
 Justin Sempsrott, EMT, MD
• EM Physician, Disaster/EMS Fellow
• 17 years in open water lifes...
Understanding Drowning: 2013
 Andrew Schmidt, EMT, DO, MPH
• EM Physician
• 14 years in open water lifesaving
• Director, ...
Understanding Drowning: 2013
 Disclosures
▫ No Financial Disclosures
▫ This presentation includes graphic
images and video...
Understanding Drowning: 2013
 HistoryIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Understanding Drowning: 2013
 HistoryIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Understanding Drowning: 2013
 HistoryIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Understanding Drowning: 2013
 HistoryIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Understanding Drowning: 2013
 HistoryIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Understanding Drowning: 2013
Goals and objectives
▫ Understand definition of drowning
▫ Appreciate epidemiology
▫ Emergent...
Understanding Drowning: 2013
 Question:
▫ How many people die from drowning?
• Around the world?
• In the US?
▫ Who is dro...
Understanding Drowning: 2013
 Worldwide
▫ 388,000 deaths a year
• Does not include suicides, homicides,
boat accidents, or...
Understanding Drowning: 2013
 Worldwide
388,000 drowning deaths (WHO)
+ est. 1.55 million unreported deaths
+ est. 6.08 dr...
Understanding Drowning: 2013
 United States
▫  4,000 a deaths a year
▫ 2nd leading cause of injury death in 1-4
year olds
...
Understanding Drowning: 2013
 Who is drowning?
▫ Disease of youth
• 64% of deaths  30 years old
• 25% of deaths  5 years o...
Understanding Drowning: 2013
 Question:
▫ What do the following terms mean?
• Drowning
• Near drowning
• Secondary drownin...
Understanding Drowning: 2013
Introduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
60 years of...
Understanding Drowning: 2013
 The Standard Definition of DrowningIntroduction
Epidemiology
Definition
Pathophysiology
Trea...
Understanding Drowning: 2013
 Uniform Definition of DrowningIntroduction
Epidemiology
Definition
Pathophysiology
Treatment...
Understanding Drowning: 2013
 Question
▫ What happens to the body when some
one drowns?
Introduction
Epidemiology
Definiti...
Understanding Drowning: 2013
 Drowning cascadeIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
R...
Understanding Drowning: 2013
 Drowning cascadeIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
R...
Understanding Drowning: 2013
Introduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Alive/Well
...
Understanding Drowning: 2013
 When to transport
▫ 41,729 oceanfront lifeguard rescues in
Rio de Janeiro from 1972 – 1991
•...
Understanding Drowning: 2013
Understanding Drowning: 2013
Understanding Drowning: 2013
“Do it by the book… but be the author.”
Understanding Drowning: 2013
 Hypoxic arrest
▫ Cardiac BLS/ACLS
– Heart stops, oxygen in blood needs
circulating
– C,A,B
▫...
Understanding Drowning: 2013
Introduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Eric J. Lav...
Understanding Drowning: 2013
 Special ConsiderationsIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposi...
Understanding Drowning: 2013
 Airway
▫ Ventilate / Oxygenate
– Pediatric
– Laryngospasm
– Airway obstruction?
– Foam, Sand...
Understanding Drowning: 2013
Introduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposition
Review
Understanding Drowning: 2013
 In Water Resuscitation
▫ 3X Increased Survival
Introduction
Epidemiology
Definition
Pathophy...
Understanding Drowning: 2013
 Spinal ImmobilizationIntroduction
Epidemiology
Definition
Pathophysiology
Treatment
Disposit...
Understanding Drowning: 2013
 Automated External Defibrillators
▫ Dysrhythmias secondary to hypoxia
▫ AED use safe in wet ...
“Death is not the enemy but occasionally needs help with timing. ”
http://lifeinthefastlane.com/2009/04/laws-for-the-navig...
Understanding Drowning: 2013
 Understand definition of drowning
▫ Process, not an outcome
 Appreciate epidemiology
▫ Highl...
Understanding Drowning: 2013
www . LifeguardsWithoutBorders . org
Understanding Drowning: 2013
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  • Allepo: 1237Ancient China, saw similar techniques in 1700-18001802: “violent shaking of body may extinguish spark of light”, “No more than 5 or 6 assistants should be in the room”
  • Allepo: 1237Ancient China, saw similar techniques in 1700-18001802: “violent shaking of body may extinguish spark of light”, “No more than 5 or 6 assistants should be in the room”
  • Allepo: 1237Ancient China, saw similar techniques in 1700-18001802: “violent shaking of body may extinguish spark of light”, “No more than 5 or 6 assistants should be in the room”
  • Allepo: 1237Ancient China, saw similar techniques in 1700-18001802: “violent shaking of body may extinguish spark of light”, “No more than 5 or 6 assistants should be in the room”
  • Allepo: 1237Ancient China, saw similar techniques in 1700-18001802: “violent shaking of body may extinguish spark of light”, “No more than 5 or 6 assistants should be in the room”
  • Poor data collectionPoor communication
  • Transcript of "Ems expo drowning lecture 2013 (slideshare)"

    1. 1. Understanding Drowning: 2013 Justin Sempsrott, MD Andrew Schmidt, DO, MPH
    2. 2. Understanding Drowning: 2013 Justin Sempsrott, EMT, MD • EM Physician, Disaster/EMS Fellow • 17 years in open water lifesaving • Director, Lifeguards Without Borders Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    3. 3. Understanding Drowning: 2013 Andrew Schmidt, EMT, DO, MPH • EM Physician • 14 years in open water lifesaving • Director, Lifeguards Without Borders Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    4. 4. Understanding Drowning: 2013 Disclosures ▫ No Financial Disclosures ▫ This presentation includes graphic images and videos of fatal and non- fatal drowning victims Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    5. 5. Understanding Drowning: 2013 HistoryIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    6. 6. Understanding Drowning: 2013 HistoryIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    7. 7. Understanding Drowning: 2013 HistoryIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    8. 8. Understanding Drowning: 2013 HistoryIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    9. 9. Understanding Drowning: 2013 HistoryIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    10. 10. Understanding Drowning: 2013 Goals and objectives ▫ Understand definition of drowning ▫ Appreciate epidemiology ▫ Emergent Management ▫ When to Transport ▫ Don’t blow smoke up pt’s (or colleagues) asses Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    11. 11. Understanding Drowning: 2013 Question: ▫ How many people die from drowning? • Around the world? • In the US? ▫ Who is drowning? Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    12. 12. Understanding Drowning: 2013 Worldwide ▫ 388,000 deaths a year • Does not include suicides, homicides, boat accidents, or natural disasters ▫ 97% in low to middle income countries Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    13. 13. Understanding Drowning: 2013 Worldwide 388,000 drowning deaths (WHO) + est. 1.55 million unreported deaths + est. 6.08 drowning “incidents” _________________________________ _ 7.63 million drowning persons Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    14. 14. Understanding Drowning: 2013 United States ▫ 4,000 a deaths a year ▫ 2nd leading cause of injury death in 1-4 year olds Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    15. 15. Understanding Drowning: 2013 Who is drowning? ▫ Disease of youth • 64% of deaths 30 years old • 25% of deaths 5 years old ▫ Drowning surpasses all other causes of death in children 1-14 years old: • Arizona Montana • Alaska Nevada • California Oregon • Florida Utah • Hawaii Washington Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    16. 16. Understanding Drowning: 2013 Question: ▫ What do the following terms mean? • Drowning • Near drowning • Secondary drowning Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    17. 17. Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review 60 years of drowning literature 33 different definitions for “drowning”
    18. 18. Understanding Drowning: 2013 The Standard Definition of DrowningIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review The process of experiencing respiratory impairment due to submersion or immersion in a liquid Injury No Injury Death
    19. 19. Understanding Drowning: 2013 Uniform Definition of DrowningIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review Terms to avoid Near Drowning Wet Drowning Dry Drowning Active Drowning Passive Drowning Secondary Drowning
    20. 20. Understanding Drowning: 2013 Question ▫ What happens to the body when some one drowns? Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    21. 21. Understanding Drowning: 2013 Drowning cascadeIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review Submersion • Airway drops below surface of water Struggle • Victim attempts to resurface Breath Hold • Voluntary attempt to protect airway Gasp • Involuntary attempt to inhale oxygen ( 30 mL aspirated)
    22. 22. Understanding Drowning: 2013 Drowning cascadeIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review Gasp • Involuntary attempt to inhale oxygen ( 30 mL aspirated) Respiratory Failure •Airway obstruction •Alveolar damage (airspace collapse) •Hypoxic vasoconstriction •Pulse Ox lag HYPOXIA •Lack of oxygen •Decreased systemic oxygen • Reflexive swallowing of water • Only 1-3 ml/kg at autopsy
    23. 23. Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review Alive/Well Dead
    24. 24. Understanding Drowning: 2013 When to transport ▫ 41,729 oceanfront lifeguard rescues in Rio de Janeiro from 1972 – 1991 • 93% treated and released at scene • 2,304 required additional medical care – 89% lived – 11% died Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    25. 25. Understanding Drowning: 2013
    26. 26. Understanding Drowning: 2013
    27. 27. Understanding Drowning: 2013 “Do it by the book… but be the author.”
    28. 28. Understanding Drowning: 2013 Hypoxic arrest ▫ Cardiac BLS/ACLS – Heart stops, oxygen in blood needs circulating – C,A,B ▫ Drowning, Peds, Traumatic BLS/ACLS – Heart stops because no oxygen in blood – A,B,C Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    29. 29. Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review Eric J. Lavonas, Farida M. Jeejeebhoy and Andrea Gabrielli Terry L. Vanden Hoek, Laurie J. Morrison, Michael Shuster, Michael Donnino, Elizabeth Sinz, Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 12: Cardiac Arrest in Special Situations : 2010 American Heart Association Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 2010 American Heart Association, Inc. All rights reserved. is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231Circulation doi: 10.1161/CIRCULATIONAHA.110.971069 2010;122:S829-S861Circulation. http://circ.ahajournals.org/content/122/18_suppl_3/S829 World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circ.ahajournals.org/content/124/15/e405.full.pdf http://circ.ahajournals.org/content/123/6/e239.full.pdf An erratum has been published regarding this article. Please see the attached page for: can be obtained via RightsLink, a service of the Copyright Clearance Center, not the EditorialCirculationin Requests for permissions to reproduce figures, tables, or portions of articles originally publishedPermissions:
    30. 30. Understanding Drowning: 2013 Special ConsiderationsIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    31. 31. Understanding Drowning: 2013 Airway ▫ Ventilate / Oxygenate – Pediatric – Laryngospasm – Airway obstruction? – Foam, Sand, Mud, Del Taco – Vomitus – 86% of Drowning resuscitations Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    32. 32. Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    33. 33. Understanding Drowning: 2013 In Water Resuscitation ▫ 3X Increased Survival Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    34. 34. Understanding Drowning: 2013 Spinal ImmobilizationIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review Prevalence of C-spine injuries associated with drowning incidents is 1 % Usually clear signs of trauma or obvious evidence of diving/high velocity trauma Universal immobilization unnecessary, should not delay resuscitation
    35. 35. Understanding Drowning: 2013 Automated External Defibrillators ▫ Dysrhythmias secondary to hypoxia ▫ AED use safe in wet environments • Avoid direct contact with patient • Place pads firmly on chest ▫ Should not delay ventilations Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    36. 36. “Death is not the enemy but occasionally needs help with timing. ” http://lifeinthefastlane.com/2009/04/laws-for-the-navigation-of-life/ Dr. Peter Safar (12 April 1924 – 2 August 2003)
    37. 37. Understanding Drowning: 2013 Understand definition of drowning ▫ Process, not an outcome Appreciate epidemiology ▫ Highly prevalent worldwide, children 4 Emergent Management ▫ Rapid O2 O2 O2, warm pt to 94 F, anticipate vomitus, ignore foam ▫ Hypoxic vs Cardiac cause of arrest When to Transport ▫ ALL Symptomatic patients Don’t blow smoke up pt’s (or colleagues) asses Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
    38. 38. Understanding Drowning: 2013 www . LifeguardsWithoutBorders . org
    39. 39. Understanding Drowning: 2013

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