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
2. WHAT IS DROWNING?
ïâThe process of experiencing
respiratory impairment from
submersion/immersion in liquid â
ïIt is a form of asphyxia.
ïCaused due to aspiration of fluids
3. Epidemiology
ïIncidence of drowning- 2.5 lakhs to 3.5
lakhs every year
ïIndia & China account for 43% deaths.
ïMales>Females
ï1-4 yrs & 15-19 yrs(M.C)
ïDrowning second most common
accidental cause of death in children
4. Causes of Drowning
ïCHILDREN YOUNGER THAN 1 YR :
âŠâą BATHTUB(71%)
⊠⹠HOUSEHOLD BUCKETS(16%)
ïCHILDREN 1-4 YR :
⊠⹠POOL
⊠⹠IRRIGATION DITCHES
⊠⹠NEARBY PONDS & RIVERS.
ïâą SCHOOL AGE CHILDREN
âŠâą SWIMMING OR BOATING ACTIVITIES.
âŠâą NATURAL WATER RESERVOIRS :
LAKES, PONDS, RIVERS, CANALS.
5. Causes of Drowning
ïADOLESCENT
l M : F = 10 : 1.
âŠ(LIKELY DUE TO GREATER RISK
TAKING & ALCOHOL USE.)
âŠ70 % DEATHS DUE TO DROWNING IN
NATURAL WATER RESERVOIRS.
ïâą UNDERLYING CONDITIONS
⊠EPILEPSY
⊠VENTRICULAR ARRHYTHMIAS
⊠ALCOHOL USE
⊠WATER SPORTS & RECREATIONAL
ACTIVITIES
6. Classification of drowning.
ïAccording to type of water
âŠFresh-water drowning: Lakes,pools,rivers
âŠSalt-water drowning: seas (about 3%
saline)
ïâą According to water temperature
âŠWarm-water drowning: temperatures of >
20° C
lCold-water drowning: temperatures of
<20° C
âŠVery-cold-water drowning: temperatures of
<5ÂșC
8. WET DROWNING
ïWater is inhaled into lungs
ïVictim has severe chest pain
ïOn resuscitation: no pleasant
recollections
ïDeath occurs due to Cardiac arrest or
ventricular fibrillation
9. Dry drowning
ïWater does not enter lungs
ïOn resuscitation : panoramic views of
past life.
ïDeath occurs by immediate sustained
laryngeal spasm due to inrush of water
into nasopharynx and larynx
10. Secondary drowning (near
drowning)
ïRefers to a submerged victim who is
resuscitated and survives for 24 hours
ïDeath occurs ( from 1/2 h to several
days) by cerebral anoxia & irreversible
brain damage
11. Immersion Syndrome
ïDeath occurs by cardiac arrest caused
by vagal inhibition (cold water
stimulating nerve endings & water
striking epigastrium & Alcohol induce
such effect)
ïMostly seen in suicide cases.
12.
13. Stages of drowning
ïStage of surprise(5-10 secs)
ïStage of 1st resp.arrest.(1-2 min)
ïStage of deep respiration(1 min)
ïStage of 2nd resp.arrest (1 min)
ïStage of terminal gasp.
16. Cause of death
ïAsphyxia: due to airway obstruction
ïHypothermia
ïVentricular fibrillation: due to anoxia &
disturbed sodium-potassium ratio
ïLaryngeal spasm
ïVagal inhibition: in icy water due to high
emotion & unexpected immersion
ïExhaustion
ïInjury
17. SYMPTOMS AND SIGNS
ï75% of kids who develop symptoms do
so within 7 hours of event
ïComa to agitated alertness
ïCyanosis, coughing, and the production
of frothy white sputum
ïTachypnea, tachycardia
ïLow-grade fever
ïRales, rhonchi & less often wheezes
ïSigns of associated trauma to the head
and neck should be sought
ïHistory is the most important
19. ïVASCULAR ENDOTHELIAL INJURY MAY INITIATE
âŠDIC,
âŠHEMOLYSIS,
âŠTHROMBOCYTOPENIA.
ï GASTROINTESTINAL DAMAGE :
âŠBLOODY DIARRHEA WITH MUCOSAL
SLOUGHING.
âŠSERUM LEVELS OF HEPATIC
TRANSAMINASES AND PANCREATIC
ENZYMES ARE OFTEN ACUTELY INCREASED.
ïVIOLATION OF NORMAL MUCOSAL
PROTECTIVE BARRIERS PREDISPOSES THE
VICTIM TO BACTEREMIA AND PULMONARY
INFECTIONS
21. Pre hospital management
ïABCâs
ïInitiation of ventilation is the only way to
interrupt the submersion time
ïC-Spine control, backboard
ïIV, O2, monitor, pulse ox
ïCorrection of acidosis by sodium
bicarbonate
ïNO HEIMLICH
ïPassive Rewarming
ïRapid Transport
ïAll near drowning victims need
evaluation at a medical facility
22.
23. Hospital management
ïOBSERVATION 6-8 HRS
ïMONITORING-VITALS
ïREPEAT RESPIRATORY SYSTEM
EXAMINATION AND NEUROLOGICAL
STATUS
ïIf SYMPTOMS DECREASE AND
SAO2 ACHIEVED VICTIM CAN BE
DISCHARGED
24. Hospital management
ïManagement in ED
âŠABCâs, with C-spine control
âŠIV, O2, Monitor, Pulse Ox
âŠCXR
âŠABGs
âŠElectrolytes
âŠTrauma workup
25. Acc to GCS
ïGCS >12
âŠOxygen to keep sat >
95%
âŠObserve 4-6 hours
âŠChest signs absent
âŠSaturation normal
âŠDischarge home
âŠNo investigation
needed
ïGCS>12
âŠOxygen to keep sat >
95%
âŠObserve 4-6 hours
âŠChest signs
present
âŠRequires oxygen
âŠDeteriorates
âŠAdmit to Monitored
bed
26. Acc to GCS
ïGCS <13
âŠHigh flow oxygen
âŠIntubation for low PaO2
âŠCXR, Labs
âŠContinuous cardiac monitoring
âŠFrequent reassessments
27. Cardiopulmonary
resuscitationïETT INTUBATION
ïADEQUATE OXYGENATION
ïFLUID RESUSCITATION-ISOTONIC FLUIDS
ïINOTROPIC AGENTS SHOULD BE
JUDICIOUSLY USED
ïPERSISTENT CARDIOPULMONARY
ARREST ON ARRIVAL ALONG WITH
âą APNEA.
âą ABSENCE OF PUPILLARY RESPONSES.
âą HYPERGLYCEMIA.
âą SUBMERSION DURATIONS >10 MIN.
âą FAILURE OF RESPONSE TO CPR GIVEN
FOR 25 MIN.