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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

Ems expo drowning lecture 2013 (slideshare) Ems expo drowning lecture 2013 (slideshare) Presentation Transcript

  • 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 lifesaving • Director, Lifeguards Without Borders Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • 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
  • 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
  • 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 Management ▫ When to Transport ▫ Don’t blow smoke up pt’s (or colleagues) asses Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • 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
  • 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
  • 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
  • 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
  • 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
  • Understanding Drowning: 2013  Question: ▫ What do the following terms mean? • Drowning • Near drowning • Secondary drowning Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review 60 years of drowning literature 33 different definitions for “drowning”
  • 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
  • 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
  • Understanding Drowning: 2013  Question ▫ What happens to the body when some one drowns? Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • 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)
  • 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
  • Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review Alive/Well Dead
  • 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
  • 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 ▫ Drowning, Peds, Traumatic BLS/ACLS – Heart stops because no oxygen in blood – A,B,C Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • 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:
  • Understanding Drowning: 2013  Special ConsiderationsIntroduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • 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
  • Understanding Drowning: 2013 Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • Understanding Drowning: 2013  In Water Resuscitation ▫ 3X Increased Survival Introduction Epidemiology Definition Pathophysiology Treatment Disposition Review
  • 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
  • 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
  • “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)
  • 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
  • Understanding Drowning: 2013 www . LifeguardsWithoutBorders . org
  • Understanding Drowning: 2013