nonfatal drowning

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Submersion injury, non-fatal drowning, etc.

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Page 1: Nonfatal Drowning

Submersion injury, non-fatal drowning, etc.

Page 2: Nonfatal Drowning

Nonfatal drowning

• Nonfatal drowning generally is defined as survival, at least temporarily, after suffocation by submersion in a liquid medium

Page 3: Nonfatal Drowning

Indications for intubation

• Signs of neurologic deterioration or inability to protect the airway

• Inability to maintain a PaO2 above 60 mmHg or oxygen saturation (SpO2) above 90 percent despite high-flow supplemental oxygen

• PaCO2 above 50 mmHg

Salomez F, Vincent JL. Resuscitation. 2004.

Page 4: Nonfatal Drowning

ManagementOther types of resp support• In symptomatic patients who do not require immediate intubation, supplemental oxygen

should be provided to maintain the SpO2 above 94 percent. • CPAP or BiPAP can improve oxygenation and decrease ventilation-perfusion mismatch • Note that positive airway pressure increases intrathoracic pressure and patients must be

carefully monitored for possible hypotension

Re-warming• Wet clothing should be removed and rewarming initiated in hypothermic patients. • Passive rewarming (use of blankets or other insulators to reduce heat loss)• Active external rewarming (application of warm blankets, heating pads, radiant heat, forced

warm air)• Active internal rewarming (pleural and peritoneal irrigation with warm saline, continuous

arteriovenous rewarming, and cardiopulmonary bypass)

Christensen DW, Jansen P, Perkin RM. Pediatrics.

Page 5: Nonfatal Drowning

Patient disposition

• Most victims are hospitalized because of the severity of illness or concern for clinical deterioration. – Recent review of 75 pediatric patients found that all who

ultimately developed symptoms did so within seven hours of immersion

• Symptomatic patients should be admitted to a monitored setting until symptoms and physiologic disturbances resolve

• Asymptomatic patients should be closely observed for approximately eight hours and admitted if any deterioration occurs

Page 6: Nonfatal Drowning

Outcome• OUTCOME — Evidence pertaining to survival following a submersion injury is limited to case studies. The

following factors at presentation have been associated with a poor prognosis [4,67-75]:

• Duration of submersion >10 minutes

• Time to effective basic life support >10 minutes

• Resuscitation duration >25 minutes

• Water temperature >10ºC (50ºF)

• Age <3 years

• Glasgow coma scale <5 (comatose)

• Persistent apnea and requirement of cardiopulmonary resuscitation in the emergency department

• Arterial blood pH <7.1 upon presentation

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