Tuesday, 22 May 2018

Drowning

Drowning
Drowning is a major cause in head injuries and death
• Initial peak
– Toddler age group
• Second peak
– Male adolescents
• Children younger than 1 year of age
– Often drown in bathtubs, buckets, and toilets
• Children 1–4 years of age
– Likely drown in swimming pools where they haveb beenunsupervised temporarily (usually for < 5 min)
– Typical incidents involve a toddler left unattendedt temporarilyor under the supervision of an older sibling
• Adolescent and young adult age groups (ages 15–24 years)
– Most incidents occur in natural water
• Approximately 90 % of drowning occur within 10 yardso ofsafety
• Parent should be within an arm’s length of a swimmingc hild (anticipatory guidance)
Mechanism of injury
• Initial swallowing of water
• Laryngospasm
• Loss of consciousness
• Hypoxia
• Loss of circulation
• Ischemia
• CNS injury (the most common cause of death)
• Acute respiratory distress syndrome (ARDS) may develop
• Salt water drowning classically associated with:
– Hypernatremia
– Hemoconcentration
– Fluid shifts and electrolyte disturbances are rarely seenc linically
• Fresh water drowning classically associated with:
– Hyponatremia and hemodilution
– Hyperkalemia
– Hemoglobinuria and renal tubular damage
• Management of drowning and near drowning
– Cardiopulmonary resuscitation (CPR) at the scene
– Admit regardless of clinical status
– All children with submersion should be monitoredi inthe hospital for 6–8 h
– If no symptoms develop can be discharged safely
– 100 % oxygen with bag and mask immediately
– Nasogastric tube for gastric decompression
– Cervical spine immobilization if suspected cervicali injuries
– Positive end expiratory pressure (PEEP) and positivep ressure ventilations in case of respiratory arrest
– Continuous cardiac monitoring
– Bolus of normal saline or Ringer’s lactate
– Vasopressors
– Defibrillation if indicated

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