Your SlideShare is downloading. ×
Nonfatal Drowning
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Nonfatal Drowning

200
views

Published on

Published in: Health & Medicine

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
200
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Submersion injury, non-fatal drowning, etc.
  • 2. Nonfatal drowning • Nonfatal drowning generally is defined as survival, at least temporarily, after suffocation by submersion in a liquid medium
  • 3. Indications for intubation • Signs of neurologic deterioration or inability to protect the airway • Inability to maintain a PaO2 above 60 mmHg or oxygen saturation (SpO2) above 90 percent despite high-flow supplemental oxygen • PaCO2 above 50 mmHg Salomez F, Vincent JL. Resuscitation. 2004.
  • 4. Management Other types of resp support • In symptomatic patients who do not require immediate intubation, supplemental oxygen should be provided to maintain the SpO2 above 94 percent. • CPAP or BiPAP can improve oxygenation and decrease ventilation-perfusion mismatch • Note that positive airway pressure increases intrathoracic pressure and patients must be carefully monitored for possible hypotension Re-warming • Wet clothing should be removed and rewarming initiated in hypothermic patients. • Passive rewarming (use of blankets or other insulators to reduce heat loss) • Active external rewarming (application of warm blankets, heating pads, radiant heat, forced warm air) • Active internal rewarming (pleural and peritoneal irrigation with warm saline, continuous arteriovenous rewarming, and cardiopulmonary bypass) Christensen DW, Jansen P, Perkin RM. Pediatrics.
  • 5. Patient disposition • Most victims are hospitalized because of the severity of illness or concern for clinical deterioration. – Recent review of 75 pediatric patients found that all who ultimately developed symptoms did so within seven hours of immersion • Symptomatic patients should be admitted to a monitored setting until symptoms and physiologic disturbances resolve • Asymptomatic patients should be closely observed for approximately eight hours and admitted if any deterioration occurs
  • 6. Outcome • OUTCOME — Evidence pertaining to survival following a submersion injury is limited to case studies. The following factors at presentation have been associated with a poor prognosis [4,67-75]: • Duration of submersion >10 minutes • Time to effective basic life support >10 minutes • Resuscitation duration >25 minutes • Water temperature >10ºC (50ºF) • Age <3 years • Glasgow coma scale <5 (comatose) • Persistent apnea and requirement of cardiopulmonary resuscitation in the emergency department • Arterial blood pH <7.1 upon presentation