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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

Drowning and Near Drowning

Temple College

EMS Professions

definitions
Definitions
  • Drowning = Death by suffocation after immersion in liquid
  • Near drowning = Episode in which person initially survives immersion in liquid
drowning types
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
wet lung fresh water
Wet Lung: Fresh Water
  • Water moves from alveoli to bloodstream
  • Hemodilution occurs
  • O2 carrying capacity
wet lung fresh water5
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
wet lung salt water
Wet Lung: Salt Water
  • Water moves from bloodstream to alveoli
  • Hemoconcentration occurs Shock
  • Pulmonary edema occurs
near drowning
Near Drowning
  • Do not attempt swimming rescue without proper training
  • Throw - Tow - Row - Go
near drowning8
Near Drowning
  • Consider possible neck injury:
    • Diving accidents
    • Swimming pools
    • Inadequate history
  • Place patient on spineboard in water
near drowning9
Near Drowning
  • If possible, begin pulmonary resuscitation in water
  • Resuscitate all cold water drowning (<72oF)
    • Mammalian Diving Reflex
    • Survivability
transport all near drownings

Transport all near drownings!

Regardless of how good they look!

scuba
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
scuba13
SCUBA
  • Use causes:
    • Collection of pressurized air in body air spaces (alveoli, sinuses, middle ear)
    • Dissolving of gas (particularly nitrogen) in body fluids
scuba14
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
nitrogen narcosis
“Rapture of the Deep”

Caused by breathing compressed air under pressure

Pressurized N2 is toxic to CNS

Disorientation, confusion result

Problem disappears on surfacing

Nitrogen Narcosis
air embolism
Patient holds breath, surfaces suddenly

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!

air embolism signs symptoms
Sudden extremity weakness, numbness

Hemiplegia

Dilated pupil on affected side

Seizures, coma

Air Embolism Signs/Symptoms
air embolism signs symptoms20
Air Embolism Signs/Symptoms

What problem does air embolism resemble?

Why?

management of air embolism
High concentration O2

Assist ventilations, as needed

Left side, 300 head down

Transport to recompression chamber

Management of Air Embolism
decompression sickness
“Bends”

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
decompression sickness types
Pain only (joint) bends  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
decompression sickness management
High concentration oxygen

Assisted ventilations, as needed

Recompression

Decompression Sickness Management