This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Esophageal Atresia (EA) and Tracheo Esophageal Fistula (TEF)puji123456
Esophageal atresia (EA) is the
congenital malformation that
represent the failure of the esophagus
to develop a continuous passage upto
the stomach
Tracheo esophageal fistula (TEF) is
the congenital malformation where the
trachea and esophagus fails to separate
into distinct structures and a passage is
created between the two.
complete information about the fluid resuscitation in burn patients, types of care given to the patient in the hospital after burning accidents, fluid replacement therapy, medical management, nursing management.
TEST BANK FOR MEDICAL SURGICAL NURSING 9TH EDITION.pdfnursing premium
A Test bank is a ready-made electronic Q&A testing resource that is tailored to the contents of an individual textbook. Feedback is often provided on answers given by students, containing page references to the book.
A cyanotic heart defect is a group-type of congenital heart defects (CHDs). The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. This can be caused by right-to-left or bidirectional shunting, or malposition of the great arteries.
Cyanotic heart defects, which account for approximately 25% of all CHDs, include:
Tetralogy of Fallot (ToF)
Total anomalous pulmonary venous connection
Hypoplastic left heart syndrome (HLHS)
Transposition of the great arteries (d-TGA)
Truncus arteriosus (Persistent)
Tricuspid atresia
Interrupted aortic arch
Pulmonary atresia (PA)
Pulmonary stenosis (critical)
Eisenmenger syndrome(Reversal of Shunt due to Pulmonary Hypertension) .
Patent ductus arteriosus may cause cyanosis in late stage.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: “Taming the Wild Child” - Pearls, Pitfalls and Controversies in Pediatr...Open.Michigan
This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Esophageal Atresia (EA) and Tracheo Esophageal Fistula (TEF)puji123456
Esophageal atresia (EA) is the
congenital malformation that
represent the failure of the esophagus
to develop a continuous passage upto
the stomach
Tracheo esophageal fistula (TEF) is
the congenital malformation where the
trachea and esophagus fails to separate
into distinct structures and a passage is
created between the two.
complete information about the fluid resuscitation in burn patients, types of care given to the patient in the hospital after burning accidents, fluid replacement therapy, medical management, nursing management.
TEST BANK FOR MEDICAL SURGICAL NURSING 9TH EDITION.pdfnursing premium
A Test bank is a ready-made electronic Q&A testing resource that is tailored to the contents of an individual textbook. Feedback is often provided on answers given by students, containing page references to the book.
A cyanotic heart defect is a group-type of congenital heart defects (CHDs). The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. This can be caused by right-to-left or bidirectional shunting, or malposition of the great arteries.
Cyanotic heart defects, which account for approximately 25% of all CHDs, include:
Tetralogy of Fallot (ToF)
Total anomalous pulmonary venous connection
Hypoplastic left heart syndrome (HLHS)
Transposition of the great arteries (d-TGA)
Truncus arteriosus (Persistent)
Tricuspid atresia
Interrupted aortic arch
Pulmonary atresia (PA)
Pulmonary stenosis (critical)
Eisenmenger syndrome(Reversal of Shunt due to Pulmonary Hypertension) .
Patent ductus arteriosus may cause cyanosis in late stage.
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: “Taming the Wild Child” - Pearls, Pitfalls and Controversies in Pediatr...Open.Michigan
This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Adrenal Insufficiency Crisis- for ResidentsOpen.Michigan
This is a lecture by Andrew Wong from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Pediatric Trauma: Special Considerations- Resident TrainingOpen.Michigan
This is a lecture by Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Slideshow is from the University of Michigan Medical School's M2 Respiratory sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Resp
This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC - Measles, Mumps, Rubella - for NursesOpen.Michigan
This is a lecture by Katherine A Perry from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Case of the Week #3- for ResidentsOpen.Michigan
This is a lecture by Alison Haddock from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Stuart Bradin from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Myasthenia Gravis (Case of the Week): Resident TrainingOpen.Michigan
This is a lecture by Dr. Chris Oppong from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC: Procedural Sedation in the Emergency Department: Resident TrainingOpen.Michigan
This is a lecture by Dr. Zach Sturges from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Tim Maxim from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by John W. Martel from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Ghana Grab Bag Pediatric Quiz- Resident TrainingOpen.Michigan
This is a lecture by Hannah Smith, MD and Ruth S. Hwu, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Dr. Jeff Holmes from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Similar to GEMC: Near-Drowning and Drowning: Resident Training (20)
This is a lecture by Jim Holliman, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Rapid Sequence Intubation & Emergency Airway Support in the Pediatric E...Open.Michigan
This is a lecture by Michele Nypaver, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Disorders of the Pleura, Mediastinum, and Chest Wall- Resident TrainingOpen.Michigan
This is a lecture by Andrew Barnosky, DO from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
GEMC- Dental Emergencies and Common Dental Blocks- Resident TrainingOpen.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Dr. Jessica Holly from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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This is a lecture by Dr. Jim Holliman from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
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2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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GEMC: Near-Drowning and Drowning: Resident Training
1. Project: Ghana Emergency Medicine Collaborative
Document Title: Near-Drowning and Drowning
Author(s): Jim Holliman, M.D., F.A.E.C.P., Uniformed Services University,
2012
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3. Near-Drowning and
Drowning
Jim Holliman, M.D., F.A.C.E.P.
Program Manager, Afghanistan Health Care Sector
Reconstruction Project
Center for Disaster and Humanitarian Assistance Medicine
Professor of Military and Emergency Medicine
Uniformed Services University
Bethesda, Maryland, U.S.A.
Jim Holliman, Uniformed
Services University
3
4. Drowning : Definitions
ƒ Drowning : death by suffocation after
submersion in a liquid (pt. dies within 24 hours
of submersion)
ƒ Near drowning : survival (short or long term)
following asphyxia secondary to submersion
ƒ Secondary drowning (or delayed drowning or
postimmersion syndrome) : death more than 24
hours post submersion from complications
related to submersion (pulmonary injury,
sepsis, renal failure, etc.)
4
5. Controversies or Unclear Points
ƒ Drowning
– Should the Heimlich maneuver be a routine part of
resuscitation ?
– Should patients without symptoms after
submersion be taken to an ED and admitted ?
– Should patients arriving in the ED in cardiac arrest
continue to have resuscitation attempted ?
– Does ICP monitoring do any good ?
– Does surfactant administration help ?
5
6. Drowning : Epidemiology
ƒ Third leading cause of accidental death in
U.S. (2nd in children)
ƒ 8000 deaths / year
ƒ Most involve teenage boys and toddlers
(male to female ratio = 5 : 1)
ƒ Most urban drownings are in private
swimming pools
ƒ Most non-urban drownings are in rivers or
canals (ocean drownings are actually rare)
6
7. Locations & Types of Submersions in
Drowning Accidents (in the U.S.A.)
Salt Water
Fresh Water :
Swimming pools : private
public
Lakes, rivers, streams, storm drains
Bathtubs
Buckets of water
Fish tanks or ponds
Toilets
Washing machines
1 to 2 %
98 %
50 %
3%
20 %
15 %
4%
4%
1%
1%
7
8. Human Near-drowning
Sequence
1. Violent struggle to reach the surface
2. Period of calmness and apnea
3. Swallowing large amounts of fluid,
followed by vomiting
4. Gasping respirations and aspiration
5. Convulsions, coma, and death
8
9. Typical Human Response to
Unexpected Submersion
"Wet drowning"
(85 to 90%)
Unexpected
Submersion
Aspiration and
Laryngospasm
Swallows
H2O
(10 to 15 %)
"Dry drowning"
Laryngospasm
aborted : Aspiration of H2O
Laryngospasm
recurs : Anoxia ,
seizures and
Death without
Aspiration
I--------------- Stage 1------------------I-------Stage 2 -------I--------Stage 3------I
(0 to 2 minutes)
(1 to 2 minutes)
(Variable)
9
Jim Holliman, Uniformed Services University
10. Initial & Delayed Effects
of Water Aspiration
Pulmonary
Compliance
Surfactant
Production
Diffusion
Atelectasis
Intrapulmonary shunting
Hypoxemia
Jim Holliman, Uniformed Services University
10
11. Initial & Delayed Effects of
Water Aspiration (cont.)
Pulmonary
Edema
-
Capillary
Injury
-
Infection
Aspiration Pneumonitis
Diffusion Deficit,
V/Q
Hypoxemia
Jim Holliman, Uniformed Services University
11
12. Mammalian Diving Reflex
(may operate if submersion in cold water)
Apnea
Bradycardia
Redistribution of blood supply :
Skin
heart
Muscle
lung
Gut
brain
Jim Holliman, Uniformed Services University
12
13. Drowning : Important Aspects of
the History
ƒ Estimated time of submersion
ƒ Type and temperature of water
ƒ Amount and type of water contamination
ƒ How and when victim was rescued
ƒ Whether vomiting occurred
ƒ How soon after rescue the victim first gasped
ƒ How soon and what type of resuscitation measures
ƒ How soon the patient was transported
ƒ History of epilepsy, drugs or alcohol
ƒ Possibility of child abuse (especially in bathtub
drownings)
13
14. "Shallow Water Blackout"
ƒ Normal duration voluntary apnea :
– 87 seconds
ƒ then PCO2 = 51, PO2 = 73
ƒ Hyperventilation followed by exercise & breath
hold :
– 87 seconds
ƒ then PCO2 = 43, PO2 = 34 to 43
ƒ Therefore can cause loss of consciousness from
hypoxia before PCO2 increases and stimulates
resp. drive (thereby causing drowning)
14
15. Drowning : First Aid
ƒ Start mouth to mouth ventilation while patient in
water, with Sellick maneuver if possible
ƒ Immobilize neck early if diving
ƒ Clear airway of debris
ƒ ? Heimlich maneuver (may cause emesis &
aspiration)
ƒ Do not rely on estimated submersion time
ƒ On beach : position patient parallel to surf line (so
head not above or below heart level)
ƒ O2 always, if available
15
16. Drowning : Salt Water Vs. Fresh
Water : Features Common to Both
ƒ Surfactant loss (washout vs. denatured)
ƒ Persistent hypoxemia due to intrapulmonary
shunt
ƒ Pulmonary edema
ƒ Focal lung hemorrhages
ƒ No major change in blood volume
ƒ No major change in serum electrolytes
ƒ No dysrhythmias (unless Vfib due to hypoxia
or hypothermia)
16
17. Drowning : Patient Classification
ƒ Group A ("Awake")
ƒ Group B ("Blunted") : conscious but
obtunded
ƒ Group C ("Comatose") :
– C1 : Flexion response to pain
– C2 : Extensor response to pain
– C3 : Flaccid
ƒ Prognosis decreases A to C3
17
18. The "ABC" Classification System
for Victims of Near-drowning
Category
Prognosis
A
100 % survival with normal
Patient awake, alert, and oriented brain function
B
Patients with blunted
consiousness who are lethargic,
semicomatose, combative,
agitated or disoriented
C
Comatose patients
89 % of adults and 92 % of
children survive with normal
brain function
73 % of adults and 44 % of
children survive with normal
brain function; an additional 17
% of children survive with
incapacitating brain damage
18
19. Drowning Rx : Group A
ƒ CXR, pulse oximetry for all
ƒ Maybe ABG and CBC
ƒ O2 (usually by nasal prongs)
– +NG tube ; NPO X 12 hours
– Admit overnight
ƒ Discharge if stable & no pulmonary
symptoms next day
19
20. Drowning Rx : Group B
ƒ ABG's, CXR, CBC, Electrolytes
ƒ O2 ; may need intubation
– NG tube
– Admit to ICU
– Serial ABG's and CXR's
– Restrict fluids to prevent cerebral edema
ƒ Discharge if no later secondary
deterioration ; usually need at least a 2
day admission
20
21. Drowning Rx : Group C *
ƒ ABG's, CXR, CBC, Electrolytes
ƒ O2, intubation, hyperventilation, + PEEP
ƒ Admit to ICU
ƒ Fluid restriction + diuretics
ƒ Temperature control
ƒ + paralytic agents
– + barbiturates
– + antibiotics
* Generally similar to
management of closed
head injury
21
26. Drowning :
Additional X-Rays to Remember
ƒ C-spine series if diving accident
ƒ Skeletal survey (R/O non-accidental
trauma) if bathtub drowning
ƒ Head CT scan if normothermic, ? for
diving trauma, and persistent
decreased mental status
26
27. Drowning : Summary Criteria for
Hospital Admission
ƒ History
– Apnea or cyanosis
– LOC
– Required CPR (even if brief)
ƒ Exam
– Hypoxemia
– Acidosis
– Abnormal CXR
– Abnormal physical exam
ƒ Consider ICU Admission if :
– Prolonged resuscitation, or needs assisted
ventilation, or persistent decrease in mental status
27
28. Drowning : Glasgow Coma Scale
in Relation to Prognosis
GCS
5
4 to 5
*3
3 & arrest
Outcome
> 90 % normal
25 to 50 % normal
0 to 39 % normal
0 to 8 % normal
(*flaccid coma)
28
29. Near-Drowning Prognosis : Time to
First Spontaneous Gasp Post-Rescue
ƒ If within 15 to 30 minutes post-rescue:
– Less than 10 % have mental retardation or
spastic quadriplegia
ƒ If not until 60 to 120 minutes post-rescue :
– 50 to 80 % have serious neurologic sequelae
29
30. Prognostic Signs in
Near-drowning Victims
GOOD
- Alert on admission
- Hypothermic
- Older child or adult
- Brief submersion time
- On-scene basic and / or
advanced life support
(probably most important)
- Good response to initial
resuscitation measures
BAD
- Age < 3 years
- Fixed, dilated pupils in ED
- Submerged > 5 minutes
- No resuscitation attempts
for more than 10 minutes
- Preexisting chronic
disease
- Arterial pH < 7.10
- Coma on admission to ED
30
31. Near-Drowning Prognosis :
Orlowski Scale
ƒ Consider these 5 factors :
– Age < 3 years
– Submersion > 5 minutes
– No resuscitation during first 10 minutes
after rescue
– Coma on admission
– pH < 7.1 on admission
ƒ If only one or two of above : 90 %
chance of recovery
ƒ If 3 or more : only 5 % recovery
31
32. Near-Drowning : Problems in
Some Long-Term Survivors
ƒ Fine motor coordination
ƒ Chronic lung disease :
– Large airway dysfunction
– Small airway dysfunction
ƒ Fear of water environments
32
33. Drowning Prevention
ƒ Home swimming pools
– Fully fenced & locked
– Maintain water level up to edge of pool
– Floats and pole available
– Splash alarms
ƒ General
– Swimming training
– Wear life jackets
– Avoid alcohol or drugs
– ? avoid for epileptics or patients with recurrent
syncope (at least they should never swim alone)
– Utilize lifeguards
33
34. Hypothermia and Drowning
ƒ Rapid core cooling from aspiration and
swallowing cold water
0
ƒ BMR decreases to 50 % at 28 C
ƒ Children (large surface to weight ratio) cool
rapidly
ƒ Enhanced cooling from exercise or alcohol (such
as struggling or swimming)
ƒ ? action of diving reflex ( ? more minute
ventilation with less breath holding ability ; ? less
breath holding ability in children)
34