Survival, at least temporarily, after aspiration of fluid into the lungs - with or without loss of consciousness.
What is the 'current consensus' definition of drowning?
100
- panic
- loss of normal breathing pattern
- breath holding
- air hunger
- struggle to remain above water
Initially, what does the patient experience?
100
- wash out surfactant
- non-cardiogenic pulmonary edema
- ARDS
- insidious or rapid onset with normal or abnormal CXR
What are the pulmonary effects?
100
Ventilation - NOT chest compressions.
What is the most important initial treatment?
100
- inability to protect airway
- inability to maintain a SpO2 above 90% despite high flow oxygen
- PaCO2 above 50 mmHg
- PaO2 below 60 mmHg despite high flow oxygen
What are the indications for intubation?
200
Survival, at least temporarily, after aspiration of fluid into the lungs.
What is 'wet' nonfatal drowning?
200
A reflex inspiratory effort leading to hypoxemia by either aspiration or laryngospasm as water contacts the lower respiratory tract.
What is the initial serious pathological insult to the patient?
200
Hypoxemia leading to neuronal damage with cerebral edema and increased ICP with up to 20% of survivors sustaining neurological sequelae limiting functional recovery.
What are the neurological effects?
200
If the patient does not respond to the delivery of 2 high quality rescue breaths.
When to start chest compressions?
200
Orogastric tube - gastric distension is common.
If the patient is intubated what other tube should be placed?
300
Survival, at least temporarily, after a period of asphyxia secondary to laryngospasm.
What is 'dry' nonfatal drowning?
300
Hypoxemia of every organ system, primarily cerebral hypoxia.
What is the major component of morbidity and mortality?
What is the goal SpO2 if the patient is not intubated?
400
Bimodal age distribution - children less than 5 years old and males 15-25 years old.
What is age distribution of drowning?
400
- 11 mL/kg
- 22 mL/kg
How much water must be aspirated for changes in blood volume to occur; for changes in electrolytes?
NB: nonfatal drownings typically aspirate 3-4 mL/kg
400
Metabolic and/or respiratory acidosis WITHOUT significant electrolyte abnormalities.
What are the acid/base and electrolyte effects?
400
Heimlich maneuver or postural drainage techniques.
What are of no proven value in drowning patients?
400
- STAT glucose
- remove wet clothing and rewarm if cold
- trauma evaluation
- ECG
- chemistries including kidney function
- CBC, troponins if indicated
- cervical spine stabilization/evaluation if indicated
What are the steps/studies needed to further manage a drowning patient in the ED?
500
- poor or non-swimmer
- risk taking
- intoxicated due to alcohol and/or drugs
- cold
- trauma/stroke/MI
- seizure disorder or developmental disorder
- undetected cardiac arrhythmia, eg. long QT
- hyperventilation prior to a shallow dive
What happens at the pulmonary level to lead to hypoxemia?
500
Renal failure secondary to ATN from hypoxemia, shock, hemoglobinuria, or myoglobinuria.
What are the possible renal complications?
500
High flow oxygen.
What should be administered to all spontaneously breathing patients?
500
When the patient has been asymptomatic for at least 8 hours. In addition, both a negative CXR and normal labs obtained close to the end of the observation period.
NB: Consider antibiotics if patient was in contaminated water.