Drowning and Near Drowning

1. Drowning and Near Drowning Temple College EMS Professions

2. Definitions • Drowning = Death by suffocation after immersion in liquid • Near drowning = Episode in which person initially survives immersion in liquid

3. Dry Lung 15% of cases Small amount of H20 aspirated Laryngospasm occurs, closes airway Patient asphyxiates Wet Lung 85% of cases Large amounts of water enter lungs Fluid, electrolyte imbalances occur Drowning Types

4. Wet Lung: Fresh Water • Water moves from alveoli to bloodstream • Hemodilution occurs • O2 carrying capacity

5. Wet Lung - Fresh Water • Water moves into red cells • Red cells swell, rupture • Potassium Arrhythmias • Release of hemoglobin into bloodstream Renal failure • Loss of surfactant Collapse of alveoli

6. Wet Lung: Salt Water • Water moves from bloodstream to alveoli • Hemoconcentration occurs Shock • Pulmonary edema occurs

7. Near Drowning • Do not attempt swimming rescue without proper training • Throw - Tow - Row - Go

8. Near Drowning • Consider possible neck injury: • Diving accidents • Swimming pools • Inadequate history • Place patient on spineboard in water

9. Near Drowning • If possible, begin pulmonary resuscitation in water • Resuscitate all cold water drowning (<72oF) • Mammalian Diving Reflex • Survivability

10. Transport all near drownings! Regardless of how good they look!

11. Scuba Emergencies

12. SCUBA • Self-contained underwater breathing apparatus • Regulator on compressed air cylinder matches pressure of inhaled air to surrounding water pressure • Allows diver to expand chest normally

13. SCUBA • Use causes: • Collection of pressurized air in body air spaces (alveoli, sinuses, middle ear) • Dissolving of gas (particularly nitrogen) in body fluids

14. SCUBA • Diver must control ascent to prevent: • Rapid expansion of gas in lungs, sinuses, middle ear • Formation of nitrogen bubbles in blood and body tissues

15. Inability to equalize pressure in sinuses, middle ear Causes pain SCUBA Problems: Squeeze

16. Inability to equalize pressure in middle ear Perforation of tympanic membrane Causes disequilibrium SCUBA Problems: Ear Drum Rupture

17. “Rapture of the Deep” Caused by breathing compressed air under pressure Pressurized N2 is toxic to CNS Disorientation, confusion result Problem disappears on surfacing Nitrogen Narcosis

18. Patient holds breath, surfaces suddenly Compressed air in alveoli expands  Lung tissue tears Air enters pulmonary circulation, is pumped to brain Air Embolism Air embolism can occur in a swimming pool!

19. Sudden extremity weakness, numbness Hemiplegia Dilated pupil on affected side Seizures, coma Air Embolism Signs/Symptoms

20. Air Embolism Signs/Symptoms What problem does air embolism resemble? Why?

21. High concentration O2 Assist ventilations, as needed Left side, 300 head down Transport to recompression chamber Management of Air Embolism

22. “Bends” Diver dives deeply or too long Does not ascend slowly enough to let dissolved nitrogen leak out of blood gradually Nitrogen bubbles form in tissues, obstruct vessels Decompression Sickness

23. Pain only (joint) bends  Aching, boring pain in joints CNS bends  Bubbles affect blood flow to brain or spinal cord “Chokes”  Bubbles obstruct blood flow through lungs Decompression Sickness Types

24. Decompression sickness can occur only if the dive was > 33 feet Signs, symptoms may be delayed

25. High concentration oxygen Assisted ventilations, as needed Recompression Decompression Sickness Management