Submersion injury, non-fatal
drowning, etc.
Nonfatal drowning
• Nonfatal drowning generally is defined as
survival, at least temporarily, after suffocation
by submers...
Indications for intubation
• Signs of neurologic deterioration or inability to
protect the airway
• Inability to maintain ...
Management
Other types of resp support
• In symptomatic patients who do not require immediate intubation, supplemental
oxy...
Patient disposition
• Most victims are hospitalized because of the severity of
illness or concern for clinical deteriorati...
Outcome
• OUTCOME — Evidence pertaining to survival following a submersion injury is limited to case
studies. The followin...
Nonfatal Drowning
Nonfatal Drowning
Nonfatal Drowning
Nonfatal Drowning
Nonfatal Drowning
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Nonfatal Drowning

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Transcript of "Nonfatal Drowning"

  1. 1. Submersion injury, non-fatal drowning, etc.
  2. 2. Nonfatal drowning • Nonfatal drowning generally is defined as survival, at least temporarily, after suffocation by submersion in a liquid medium
  3. 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. 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. 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. 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
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