drowning presentation

7/30/2019 Drowning Presentation

1/49

Advocacy Project:

Drowning Prevention

Lindsay M. Stewart, MD

July 26, 2012University of Nevada School of Medicine


2/49

Disclosures

No current research

No financial investments


3/49

Objectives

1. MEDICAL KNOWLEDGE2. PATIENT CARE

3. INTERPERSONAL & COMMUNICATIONSKILLS4. PRACTICE-BASED LEARNING &

IMPROVEMENT

5. SYSTEMS-BASED PRACTICE6. PROFESSIONALISM


4/49


5/49

In the Community

July 11, 2012


6/49

1. MEDICAL KNOWLEDGE

Learn what constitutes a drowning

Understand the pathophysiology Review findings at autopsy


7/49

Drowning

the process ofexperiencing respiratory

impairment fromsubmersion/immersion inliquid

Can be any kind of fluid

Peden M, McGee K, Sharma K. The injury chart book: a graphical overview of theglobal health burden of injuries. Geneva: World Health Organization, 2002.


8/49

Terminology

1. Nonfatal drowning- if the person is rescued atany time; the process of drowning is

interrupted2. Fatal drowning- if the person dies at any timeas a result of drowning

3. Water rescue- any submersion or immersionwithout evidence of respiratory impairment

Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl JMed2012;366:2102-10.


9/49

Phases of Drowning

1. Submersion2. Struggle

3. Exhaustion4. Drowning5. Loss of consciousness6. Death


10/49

Pathophysiology

Fresh water - water passes from lungs toblood- hemodilution; denaturation of surfactant ->alveolar collapse -> decr lung compliance -> severe V-Qmismatch -> hypoxia -> neuro damage

Electrolyte shifts -> Cardiac arrhythmias

(0.6% NaCl)

Blood Lung Tissue Blood Lung Tissue


11/49

Pathophysiology

Sea water - water passes fromblood into lung tissue- hemoconcentration

Na incr -> severe pulm edema

(3% NaCl)

Blood Lung Tissue


12/49

Histology

Pulmonary edema Plant material in bronchus


13/49

Findings on Autopsy

Fine white froth in the mouth,

nose, lungs and air passages Water-logged lungs Venous congestion and fluid

blood

Water in the stomach andintestines


14/49

Findings on Autopsy

Middle ear hemorrhages


15/49

2. PATIENT CARE

Identify patients at risk

Perform accurate H&P Develop appropriate treatment plan


16/49

More at Risk?

OR

Centers for Disease Control and Prevention, National Center for Injury Prevention andControl. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. [cited

2011 Apr 6]. Available from URL: http://www.cdc.gov/injury/wisqars

Males: ~80% Females: ~20%


17/49

More at Risk?

OR

1-4 yo 5-8 yo


2011 Apr 6]. Available from: URL: http://www.cdc.gov/injury/wisqars

Children ages 1 to 4


18/49

More at Risk?

OR


2011 Apr 6]. Available from: URL: http://www.cdc.gov/injury/wisqars

Minorities: AA 1.3x W; NA & Alaskan 1.7x W

OR


19/49

More at Risk?

OR


20/49

Others at RiskLow income, neglected Poor education

Aquatic exposure Alcohol use, risky behavior

Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J Med2012;366:2102-10.


21/49

Also at Risk

Risk of drowning is

15-19 times higherthan those withoutepilepsy!!!

Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl JMed2012;366:2102-10.

Epilepsy pts


22/49

Also at Risk

Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J

Med2012;366:2102-10.


23/49

H&P for Well Child Check

What questions shouldyou ask?

When should you askthem?

What should you look for

on physical exam?


24/49

Initial Resuscitation

CPR Resp? -> rescue

breathing only

Cardiac? -> ABC 5 rescue breaths 30 compressions 2 rescue breaths 30 compressions

Aspiration risk


Med2012;366:2102-10.


25/49

Pre-Hospital Care

BLS until PALS available O2 by face mask at 15L

Early intubation & mech ventilation Peripheral IV or IO Correct hypotension with crystalloids

If CPR does not result in cardiac activity,epi or norepi may be considered


Med2012;366:2102-10.


26/49

ED

Secure airway Insert NG tube Thermal insulation

Find out if precipitatedby injury or medicalcondition

Phys exam, CXR, ABG


Med2012;366:2102-10.


27/49

PICU

Follow guidelines for ARDS Keep on vent at least 24 hrs even if gas

exchange appears to be adequate

Little evidence supporting glucocorticoid use Pneumonia often misdiagnosed No evidence supporting use of specific fluid

therapy, diuretics or water restrictions

Induced hypothermia (32-34C) for 24 hrs maybe neuroprotective


Med2012;366:2102-10.


28/49

Complications

SIRS Sepsis & DIC possible in first 72 hrs after

resuscitation

Renal insufficiency or failure (rare)


Med2012;366:2102-10.


29/49

3. INTERPERSONAL &COMMUNICATION SKILLS

Apply skills to different cultural

backgrounds, SES, developmental levels Develop rapport Use a team approach


30/49

Counseling

Dont lecture Dont talk down to or belittle Do ask questions Do offer suggestions

Do assess for understanding


31/49

How do you develop rapport?


32/49

Drowning Prevention

Formal swimming lessons Designated supervision Buddy system Seizure disorder safety

Learn CPR Use personal flotation

devices

Barriers such as fences Lock up pool toys No holding breath contests Obey beach warnings

Watch for signs of ripcurrents

Avoid alcohol


33/49


34/49

4. PRACTICE-BASED LEARNING &IMPROVEMENT

Acknowledge barriers

Analyze your skills & practice them Evaluate the effectiveness of your

encounter

Identify ways to improve compliance


35/49

Possible Barriers?


36/49

Evaluate Your Encounter

Did you have good rapport? What did you do well?

What can you improve on?


37/49

Ways to Improve Compliance

Handouts

Videos Make it relevant Repetition

Follow up on it


38/49

5. SYSTEMS-BASED PRACTICE

Review incidence rates

Understand cultural norms & healthbeliefs Invest in the health literacy & awareness

in your community


39/49

Incidence

In 2007 there were ~4,000 fatal unintentionaldrownings in the U.S.

~3,500 non-boating related

~500 boating-related incidents > 1 in 5 people who die from drowning are

children 14 and younger

2nd leading cause of unintentional injury-relateddeath for children ages 1 to 14 years

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-basedInjury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 July 23]. Available from URL:

http://www.cdc.gov/injury/wisqars


40/49

Statistics

19% of drowning deaths in children occur inpublic pools with certified lifeguards present

Of all preschoolers who drown, 70% are in thecare of one or both parents at the time of thedrowning and 75% are missing from sight for 5min or less

92% of children who survive are discovered

within 2 min following submersion, and 86% ofchildren who die are found after 10 min

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-basedInjury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 July 23]. Available from URL:

http://www.cdc.gov/injury/wisqars


41/49

Statistics

Among children 1-4 yo, most drowningsoccur in residential swimming pools, and11% occur in portable pools

>50% of drownings among infants occurin bathtubs, buckets or toilets

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-basedInjury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 July 23]. Available from URL:http://www.cdc.gov/injury/wisqars


42/49

Southern NV Health District

Southern Nevada Health District [online]. Drowning and Near Drowning Statistics. [cited 2012 July 20].Available from URL: http://www.southernnevadahealthdistrict.org/stats-reports/drowning-statistics.php


43/49

Myths About Swimming

1. You shouldnt swim right after eating.2. Clear pool water means clean pool water.3. I only need to take a shower before swimming

if I havent bathed that day.

4. As long as a child is wearing a diaper in thepool, theres no chance for contamination ofthe water.

5. When I smell the strong odor of poolchemicals, it means the water is very clean.

Water Quality and Health Council [online]. [cited 2012 July 20]. Available from URL:http://www.healthypools.org/resources/swimming-pools-myths-facts/


44/49

Support In Our Community

Swim Lessons: Clark County Parks & Recreation- Free

Swim Squad- 1st Assessment $20YMCA- 4 lessons $50

Bubble Swim School- $15, one day/wk x5

Private lessons- $22.50 Group swim- $15


45/49


CPR Lessons: UMC- Free ($10 deposit required & refunded)

UNLV & Amer Red Cross- Free

Safe Sitter Courses (ages 11-13):

UMC- Free, monthly


46/49


Life Jackets: Walmart: $6.96 $13.96 $16.00

Recommend checking local Goodwill etc.

Amazon: ~$5 -Ebay: ~$12
http://www.walmart.com/ip/Sterns-Puddle-Jumpers-Life-Vest/20567536http://www.walmart.com/ip/Stearns-Adult-Boating-Vest-Universal/13848791


47/49

6. PROFESSIONALISM

Demonstrate cultural competency

Emphasize medical ethics Reflect on professional impact


48/49

Professional Impact


49/49

References

1. Peden M, McGee K, Sharma K. The injury chart book: a graphicaloverview of the global health burden of injuries. Geneva: WorldHealth Organization, 2002.

2. Centers for Disease Control and Prevention, National Center forInjury Prevention and Control. Web-based Injury Statistics Query

and Reporting System (WISQARS) [online]. [cited 2012 July 23].Available from: http://www.cdc.gov/injury/wisqars3. Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts:

Drowning. N Engl J Med 2012;366:2102-10.4. Southern Nevada Health District [online]. Drowning and Near

Drowning Statistics. [cited 2012 July 20]. Available from URL:http://www.southernnevadahealthdistrict.org/stats-reports/drowning-statistics.php

5. Water Quality and Health Council [online]. [cited 2012 July 20].Available from URL: http://www.healthypools.org/resources/swimming-pools-myths-facts/

drowning presentation

Documents