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Drowning and Near Drowning. Temple College EMS Professions. Definitions. Drowning = Death by suffocation after immersion in liquid Near drowning = Episode in which person initially survives immersion in liquid. Dry Lung 15% of cases Small amount of H 2 0 aspirated

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Drowning and Near Drowning

Temple College

EMS Professions


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Definitions

  • Drowning = Death by suffocation after immersion in liquid

  • Near drowning = Episode in which person initially survives immersion in liquid


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Dry Lung

15% of cases

Small amount of H20 aspirated

Laryngospasm occurs, closes airway

Patient asphyxiates

Wet Lung

85% of cases

Large amounts of water enter lungs

Fluid, electrolyte imbalances occur

Drowning Types


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Wet Lung: Fresh Water

  • Water moves from alveoli to bloodstream

  • Hemodilution occurs

  • O2 carrying capacity


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Wet Lung - Fresh Water

  • Water moves into red cells

  • Red cells swell, rupture

    • Potassium Arrhythmias

    • Release of hemoglobin into bloodstream Renal failure

  • Loss of surfactant Collapse of alveoli


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Wet Lung: Salt Water

  • Water moves from bloodstream to alveoli

  • Hemoconcentration occurs Shock

  • Pulmonary edema occurs


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Near Drowning

  • Do not attempt swimming rescue without proper training

  • Throw - Tow - Row - Go


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Near Drowning

  • Consider possible neck injury:

    • Diving accidents

    • Swimming pools

    • Inadequate history

  • Place patient on spineboard in water


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Near Drowning

  • If possible, begin pulmonary resuscitation in water

  • Resuscitate all cold water drowning (<72oF)

    • Mammalian Diving Reflex

    • Survivability


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Transport all near drownings!

Regardless of how good they look!



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SCUBA

  • Self-contained underwater breathing apparatus

  • Regulator on compressed air cylinder matches pressure of inhaled air to surrounding water pressure

  • Allows diver to expand chest normally


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SCUBA

  • Use causes:

    • Collection of pressurized air in body air spaces (alveoli, sinuses, middle ear)

    • Dissolving of gas (particularly nitrogen) in body fluids


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SCUBA

  • Diver must control ascent to prevent:

    • Rapid expansion of gas in lungs, sinuses, middle ear

    • Formation of nitrogen bubbles in blood and body tissues


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Inability to equalize pressure in sinuses, middle ear

Causes pain

SCUBA Problems: Squeeze


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Inability to equalize pressure in middle ear Perforation of tympanic membrane

Causes disequilibrium

SCUBA Problems: Ear Drum Rupture


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“Rapture of the Deep” of tympanic membrane

Caused by breathing compressed air under pressure

Pressurized N2 is toxic to CNS

Disorientation, confusion result

Problem disappears on surfacing

Nitrogen Narcosis


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Patient holds breath, surfaces suddenly of tympanic membrane

Compressed air in alveoli expands  Lung tissue tears Air enters pulmonary circulation, is pumped to brain

Air Embolism

Air embolism can occur in a swimming pool!


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Sudden extremity weakness, numbness of tympanic membrane

Hemiplegia

Dilated pupil on affected side

Seizures, coma

Air Embolism Signs/Symptoms


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Air Embolism Signs/Symptoms of tympanic membrane

What problem does air embolism resemble?

Why?


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High concentration O of tympanic membrane2

Assist ventilations, as needed

Left side, 300 head down

Transport to recompression chamber

Management of Air Embolism


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“Bends” of tympanic membrane

Diver dives deeply or too long

Does not ascend slowly enough to let dissolved nitrogen leak out of blood gradually

Nitrogen bubbles form in tissues, obstruct vessels

Decompression Sickness


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Pain only (joint) bends of tympanic membrane Aching, boring pain in joints

CNS bends  Bubbles affect blood flow to brain or spinal cord

“Chokes”  Bubbles obstruct blood flow through lungs

Decompression Sickness Types



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High concentration oxygen feet

Assisted ventilations, as needed

Recompression

Decompression Sickness Management


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