Portugal drowning lecture

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Portugal drowning lecture

  1. 1. Resuscitation of the drowning victim Andrew Schmidt, DO, MPH Emergency Medicine (USA) Conference Surfing Medicine - Sagres 2013
  2. 2. Introduction • Andrew Schmidt, DO, MPH – Emergency Medicine Physician – 14 years in open water lifesaving – Director, Lifeguards Without Borders Conference Surfing Medicine EASD - Sagres 2013
  3. 3. Why is this important • Surfers are often rescuers • The first 5 minutes are the most important • Acting in the wrong manner can be deadly
  4. 4. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  5. 5. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  6. 6. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  7. 7. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  8. 8. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  9. 9. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  10. 10. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  11. 11. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  12. 12. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  13. 13. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  14. 14. History of drowning resuscitation Conference Surfing Medicine EASD - Sagres 2013
  15. 15. Teaching Points • The Definition of drowning • Who is drowning? • The drowning process • The treatment of drowning
  16. 16. The Definition of Drowning Conference Surfing Medicine EASD - Sagres 2013
  17. 17. The Definition of Drowning 60 years of drowning research 33 different definitions for “drowning” Conference Surfing Medicine EASD - Sagres 2013
  18. 18. The Definition of Drowning The Standard Definition for drowning Conference Surfing Medicine EASD - Sagres 2013 G2 Final Recommendations of the World Congress on Drowning Amsterdam 26—28 June 2002 The Maatschappij tot Redding van Drenkelingen was established in 1767 to promote awareness of drowning in the Netherlands. The organization has initiated the World Congress project in 1998 to facilitate involved experts, institutions and organizations to further develop insight in methods to reduce drowning and improve the outcome after drowning. The activities merged together during an interdisciplinary, international and interactive convention in Amsterdam in June 2002. An important result of the World Congress on Drowning, that was attended by more than 500 experts from all over the world, was the establishment of recommendations. The recommendations were prepared by task-forces in the preceding years and extensively discussed by experts during the congress. Implementation of each recommendation is expected to contribute to a reduction of the annual number of drowning (some 500,000 drowning deaths each year worldwide) and to the improvement of treatment. On behalf of all participating experts of the World Congress on Drowning, we would like to inform you about these recommendations. We would advocate to study all the recommendations, select those of importance for your organization and include the implementation of the relevant recommendations in your action plans for the coming three years. It is beyond the capacities of our national organization to take care of the implementations worldwide. The Maatschappij tot Redding van Drenkelingen will contact experts and other organizations
  19. 19. The Definition of Drowning • The Standard Definition for Drowning The process of experiencing respiratory impairment due to submersion or immersion in a liquid –3 possible outcomes • No morbidity (no injury) • Morbidity (injury) • Mortality (death) Conference Surfing Medicine EASD - Sagres 2013
  20. 20. The Definition of Drowning • Terms to avoid – NEAR DROWNING – Wet and dry drowning – Active and passive drowning – Secondary drowning Conference Surfing Medicine EASD - Sagres 2013
  21. 21. Who is drowning? Conference Surfing Medicine EASD - Sagres 2013
  22. 22. Who is drowning? • Worldwide – Estimated 388, 000 drowning deaths (WHO) – Estimated 4 unreported for every reported death • 1.55 million unreported deaths (1.94 million total) – Estimated 4-10 non fatal for every fatal • 4 x 1.94 million (conservative estimate) ---------------------------------------- Estimated 7.63 million drowning persons Conference Surfing Medicine EASD - Sagres 2013
  23. 23. Who is drowning? Conference Surfing Medicine EASD - Sagres 2013
  24. 24. Who is drowning? Conference Surfing Medicine EASD - Sagres 2013
  25. 25. Who is drowning? Conference Surfing Medicine EASD - Sagres 2013
  26. 26. Who is drowning? • 96% of drowning deaths occur in low to middle income countries • China and India account for 43% of deaths • Rates highest in WHO African Region Conference Surfing Medicine EASD - Sagres 2013
  27. 27. Who is drowning? • Primarily a disease of childhood – Children under 5 have highest rate globally – Australia: leading cause injury death in 1-3 yo – Bangladesh: 20% of all deaths in 1-4 yo – China: leading cause injury death in 1-14 yo – USA: 2nd leading cause injury death 1-14 yo Conference Surfing Medicine EASD - Sagres 2013
  28. 28. The Drowning Process Conference Surfing Medicine EASD - Sagres 2013
  29. 29. The Drowning Process • Drowning cascade – Airway under the water – Voluntary breath hold – Involuntary gasp and swallowing • Usually < 30 ml – Loss of consciousness • 1-3 ml/kg water into airways Conference Surfing Medicine EASD - Sagres 2013
  30. 30. The Drowning Process • Drowning cascade – Airway obstruction – Direct alveolar damage – Surfactant washout Conference Surfing Medicine EASD - Sagres 2013
  31. 31. The Drowning Process • Drowning cascade – All roads lead to HYPOXIA Conference Surfing Medicine EASD - Sagres 2013
  32. 32. The Drowning Process • Hypoxia – The primary cause of all systemic injury and death associated with drowning – The primary goal of the initial resuscitation of a drowning victim is reversal of this hypoxia Conference Surfing Medicine EASD - Sagres 2013
  33. 33. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  34. 34. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  35. 35. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013 Alive / Well Dead
  36. 36. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013 Alive / Well Dead
  37. 37. Drowning Resuscitation • When to treat/transport – Brazilian data • 41,729 oceanfront rescues from 1972 to 1991 • 93% treated and released at scene • 2,304 required additional medical care – 89% lived – 11% died Conference Surfing Medicine EASD - Sagres 2013
  38. 38. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  39. 39. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  40. 40. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  41. 41. Drowning Resuscitation 21 > 0 Conference Surfing Medicine EASD - Sagres 2013
  42. 42. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  43. 43. Drowning Resuscitation • CPR Conference Surfing Medicine EASD - Sagres 2013
  44. 44. Drowning Resuscitation • CPR – Likely cardiac in origin – The tank is full but the engine has stopped – Compressions take priority Conference Surfing Medicine EASD - Sagres 2013
  45. 45. Drowning Resuscitation • CPR Conference Surfing Medicine EASD - Sagres 2013
  46. 46. Drowning Resuscitation • CPR – Likely respiratory in origin – The tank is empty but the engine “works” – Ventilations take priority Conference Surfing Medicine EASD - Sagres 2013
  47. 47. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  48. 48. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  49. 49. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  50. 50. Drowning Resuscitation Conference Surfing Medicine EASD - Sagres 2013
  51. 51. Drowning Resuscitation • The use of the Heimlich Maneuver to “drain the lungs” is not recommended by: – European Resuscitation Council – American Heart Association – International Lifesaving Federation – United States Lifesaving Association – American Academy of Pediatrics Conference Surfing Medicine EASD - Sagres 2013
  52. 52. Drowning Resuscitation • Special Situations – In-water Resuscitation • 3 x increased survival • Technically difficult Conference Surfing Medicine EASD - Sagres 2013
  53. 53. Drowning Resuscitation • Special Situations – In-water Resuscitation • European Resuscitation Council Guidelines – Initiate if properly trained – Ideally performed with flotation device – Initially 10-15 breaths over 1 min – If < 5 minutes to shore  continue IWR while towing – If > 5 minutes to shore  give 1 more minute and tow in Conference Surfing Medicine EASD - Sagres 2013
  54. 54. Drowning Resuscitation • Special Situations – Spinal Immobilization • Prevalence of C-spine injuries associated with drowning incidents is < l% • Usually clear signs of trauma or obvious evidence of diving/high velocity trauma • Universal immobilization unnecessary • Should not delay resuscitation Conference Surfing Medicine EASD - Sagres 2013
  55. 55. www . LifeguardsWithoutBorders . org www . OnDrowning . blogspot . com

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