ALL ABOUT DROWNING AND NEAR DROWNING,
THEIR SYMPTOMS AND SIGNS
HOW TO MANAGE THEM AT SITE OF INCIDENT,EMERGENCY DEPARTMENT,ICU
PEDIATRIC DROWNING ALSO COVERED
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
A brief yet comprehensive description of a very common problem faced in KSA especially during hajj season. It is meant to enhance the awareness among ER and ICU physicians.
Asphyxia
Classification of Asphyxia
Mechanical Asphyxia
Mugging/ throttling
Mechanical Asphyxia
Pathological Asphyxia
Toxic or chemical Asphyxia
Environmental Asphyxia
Traumatic Asphyxia
Positional/postural Asphyxia
Iatrogenic Asphyxia
Tardieu’s or Bayard’s ecchymosis/spots
Hanging
Classification of Hanging
Cause of Death in Hanging
Fatal period in Hanging
Factors which influence the appearance of ligature mark ??
Judicial Hanging
Hangman’s fracture
Strangulation
ligature strangulation
Cause of death
Throttling or Manual Strangulation
Hyoid Bone Fractures
AUTOEROTIC
CHEMICAL Asphyxia
CHOKING
SMOTHERING Asphyxia
POSITIONAL Asphyxia
Drowning
Classification of Drowning
Typical or wet drowning
Mechanism of fresh water drowning
Mechanism of death in fresh water drowning
Mechanism of sea water drowning
Mechanism of death in sea water drowning
Atypical drowning
Dry drowning
Immersion syndrome
Near drowning
Shallow water drowning
Epidemiology of drowning
Cause of Death
Postmortem Examination
Froth
Reference
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
A brief yet comprehensive description of a very common problem faced in KSA especially during hajj season. It is meant to enhance the awareness among ER and ICU physicians.
Asphyxia
Classification of Asphyxia
Mechanical Asphyxia
Mugging/ throttling
Mechanical Asphyxia
Pathological Asphyxia
Toxic or chemical Asphyxia
Environmental Asphyxia
Traumatic Asphyxia
Positional/postural Asphyxia
Iatrogenic Asphyxia
Tardieu’s or Bayard’s ecchymosis/spots
Hanging
Classification of Hanging
Cause of Death in Hanging
Fatal period in Hanging
Factors which influence the appearance of ligature mark ??
Judicial Hanging
Hangman’s fracture
Strangulation
ligature strangulation
Cause of death
Throttling or Manual Strangulation
Hyoid Bone Fractures
AUTOEROTIC
CHEMICAL Asphyxia
CHOKING
SMOTHERING Asphyxia
POSITIONAL Asphyxia
Drowning
Classification of Drowning
Typical or wet drowning
Mechanism of fresh water drowning
Mechanism of death in fresh water drowning
Mechanism of sea water drowning
Mechanism of death in sea water drowning
Atypical drowning
Dry drowning
Immersion syndrome
Near drowning
Shallow water drowning
Epidemiology of drowning
Cause of Death
Postmortem Examination
Froth
Reference
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
drowning and near drowning are the common type of accident in children. this PPT will aquaint you with the definitions, types and indetail pathophysiology and its management.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. WHAT IS DROWNING?
“The process of experiencing
respiratory impairment from
submersion/immersion in liquid ”
It is a form of asphyxia.
Caused due to aspiration of fluids
3. Epidemiology
Incidence of drowning- 2.5 lakhs to 3.5
lakhs every year
India & China account for 43% deaths.
Males>Females
1-4 yrs & 15-19 yrs(M.C)
Drowning second most common
accidental cause of death in children
4. Causes of Drowning
CHILDREN YOUNGER THAN 1 YR :
◦• BATHTUB(71%)
◦ • HOUSEHOLD BUCKETS(16%)
CHILDREN 1-4 YR :
◦ • POOL
◦ • IRRIGATION DITCHES
◦ • NEARBY PONDS & RIVERS.
• SCHOOL AGE CHILDREN
◦• SWIMMING OR BOATING ACTIVITIES.
◦• NATURAL WATER RESERVOIRS :
LAKES, PONDS, RIVERS, CANALS.
5. Causes of Drowning
ADOLESCENT
l M : F = 10 : 1.
◦(LIKELY DUE TO GREATER RISK
TAKING & ALCOHOL USE.)
◦70 % DEATHS DUE TO DROWNING IN
NATURAL WATER RESERVOIRS.
• UNDERLYING CONDITIONS
◦ EPILEPSY
◦ VENTRICULAR ARRHYTHMIAS
◦ ALCOHOL USE
◦ WATER SPORTS & RECREATIONAL
ACTIVITIES
6. Classification of drowning.
According to type of water
◦Fresh-water drowning: Lakes,pools,rivers
◦Salt-water drowning: seas (about 3%
saline)
• According to water temperature
◦Warm-water drowning: temperatures of >
20° C
lCold-water drowning: temperatures of
<20° C
◦Very-cold-water drowning: temperatures of
<5ºC
8. WET DROWNING
Water is inhaled into lungs
Victim has severe chest pain
On resuscitation: no pleasant
recollections
Death occurs due to Cardiac arrest or
ventricular fibrillation
9. Dry drowning
Water does not enter lungs
On resuscitation : panoramic views of
past life.
Death occurs by immediate sustained
laryngeal spasm due to inrush of water
into nasopharynx and larynx
10. Secondary drowning (near
drowning)
Refers to a submerged victim who is
resuscitated and survives for 24 hours
Death occurs ( from 1/2 h to several
days) by cerebral anoxia & irreversible
brain damage
11. Immersion Syndrome
Death occurs by cardiac arrest caused
by vagal inhibition (cold water
stimulating nerve endings & water
striking epigastrium & Alcohol induce
such effect)
Mostly seen in suicide cases.
12.
13. Stages of drowning
Stage of surprise(5-10 secs)
Stage of 1st resp.arrest.(1-2 min)
Stage of deep respiration(1 min)
Stage of 2nd resp.arrest (1 min)
Stage of terminal gasp.
16. Cause of death
Asphyxia: due to airway obstruction
Hypothermia
Ventricular fibrillation: due to anoxia &
disturbed sodium-potassium ratio
Laryngeal spasm
Vagal inhibition: in icy water due to high
emotion & unexpected immersion
Exhaustion
Injury
17. SYMPTOMS AND SIGNS
75% of kids who develop symptoms do
so within 7 hours of event
Coma to agitated alertness
Cyanosis, coughing, and the production
of frothy white sputum
Tachypnea, tachycardia
Low-grade fever
Rales, rhonchi & less often wheezes
Signs of associated trauma to the head
and neck should be sought
History is the most important
19. VASCULAR ENDOTHELIAL INJURY MAY INITIATE
◦DIC,
◦HEMOLYSIS,
◦THROMBOCYTOPENIA.
GASTROINTESTINAL DAMAGE :
◦BLOODY DIARRHEA WITH MUCOSAL
SLOUGHING.
◦SERUM LEVELS OF HEPATIC
TRANSAMINASES AND PANCREATIC
ENZYMES ARE OFTEN ACUTELY INCREASED.
VIOLATION OF NORMAL MUCOSAL
PROTECTIVE BARRIERS PREDISPOSES THE
VICTIM TO BACTEREMIA AND PULMONARY
INFECTIONS
21. Pre hospital management
ABC’s
Initiation of ventilation is the only way to
interrupt the submersion time
C-Spine control, backboard
IV, O2, monitor, pulse ox
Correction of acidosis by sodium
bicarbonate
NO HEIMLICH
Passive Rewarming
Rapid Transport
All near drowning victims need
evaluation at a medical facility
22.
23. Hospital management
OBSERVATION 6-8 HRS
MONITORING-VITALS
REPEAT RESPIRATORY SYSTEM
EXAMINATION AND NEUROLOGICAL
STATUS
If SYMPTOMS DECREASE AND
SAO2 ACHIEVED VICTIM CAN BE
DISCHARGED
25. Acc to GCS
GCS >12
◦Oxygen to keep sat >
95%
◦Observe 4-6 hours
◦Chest signs absent
◦Saturation normal
◦Discharge home
◦No investigation
needed
GCS>12
◦Oxygen to keep sat >
95%
◦Observe 4-6 hours
◦Chest signs
present
◦Requires oxygen
◦Deteriorates
◦Admit to Monitored
bed
26. Acc to GCS
GCS <13
◦High flow oxygen
◦Intubation for low PaO2
◦CXR, Labs
◦Continuous cardiac monitoring
◦Frequent reassessments
27. Cardiopulmonary
resuscitationETT INTUBATION
ADEQUATE OXYGENATION
FLUID RESUSCITATION-ISOTONIC FLUIDS
INOTROPIC AGENTS SHOULD BE
JUDICIOUSLY USED
PERSISTENT CARDIOPULMONARY
ARREST ON ARRIVAL ALONG WITH
• APNEA.
• ABSENCE OF PUPILLARY RESPONSES.
• HYPERGLYCEMIA.
• SUBMERSION DURATIONS >10 MIN.
• FAILURE OF RESPONSE TO CPR GIVEN
FOR 25 MIN.