Journal Review – Near Drowning
The article I did my review on for near drowning is “Pre-hospital Use of Continuous Positive
Airway Pressure for Saltwater Near-Drowning.” The people involved in the article are: “David
Pavlakovich RRT, Russell K. Miller MD FACEP. Mr. Pavlakovich is the Senior Respiratory Therapist for
Emergency Services at the University of Texas Medical Branch, Galveston, Texas. Dr. Miller is Clinical
Assistant Professor of Surgery and Emergency Medicine at UTMB and is the Medical Director for the
Galveston County Beach Patrol and Galveston EMS.”
The article discussed that in Galveston, they experience approximately 10-15 near drownings
every summer. These near drownings are usually followed by acute respiratory failure (ARF). These
near drownings are a good portion of their pre-hospital intubations. The lungs and other areas of the
body fill with the salt water causing the swimmer to suffer from hypoxemia and become tachypneic.
David and Russell’s argument is that with these intubations, patients are having longer hospital stays
and are increasing the ICUs admittance. They believe that with nasal CPAP & a full face mask, they could
prevent these lengthy stays & decrease the amount of ICU admits. They have used the full face mask &
the nasal CPAP on patients for years suffering from ARF in the hospital.
What they decided to do was a trial run to test their theory. In the trial they gave the EMS of
Galveston the proper equipment & told to apply the nasal CPAP when they would normally intubate.
Out of the 10 near drowning swimmers only 1 died due to sand in the lungs. The other 9 were
continued on CPAP when they reached the hospital and were discharged the following day. The one
that passed, did have to be intubated.
Their conclusion was that the hospital stay was shortened, but the amount of admits did not
change.
I found this article on http://www.rcjournal.com/abstracts/2003/?id=OF-03-188
Near Drowning
In the journal article, Cervical spinal cord injury associated with near-drowning does not
increase pneumonia risk or mortality by, Butler T, Shin S, Collins J, Britt RC, Reed SF, Weireter
LJ, and Britt LD explain and tested the theory of how cervical spinal cord injury associating with
near-drowning does not increase pneumonia risk or mortality. A 5 year span study was done at
Eastern Virginia Medical School throughout 2003-2008. The study included 141 patients who
were treated for cervical spinal cord injury with similar severity injury, mean age, and male
gender distribution. 30 of the patients had cervical spinal cord injury associated with near
drowning and 111 without an association to it. With the study, they found that patients with
cervical spinal cord injury associated with near drowning had a shorter hospital stay and an
earlier discharge date than the patients without an association to near drowning. In addition with
their final result they were able to conclude that cervical spinal cord injury associated with near
drowning did not increase pneumonia risk or mortality because both groups developed
pneumonia with 10% mortality.
The article made me realize that with or without associated near drowning patients still
developed pneumonia with a 10% mortality. The only thing I thought that may have been a little
off with their study was that not even 50% of the patients had an association to near drowning.
The ratio was off, and it would’ve been nice to see a equal number of patients with and without
an association to near drowning.
http://www.ncbi.nlm.nih.gov/pubmed/21679550?tool=MedlinePlus
Near-drowning
I found a journal on www.medscape.com that told about a 50-year- old
gentleman who pulled off of the road near a drainage canal, and fell asleep with his car
still in gear. He went into the canal and was pulled out within fifteen minutes after he
was submerged. He was rushed to the hospital he was treated for shock, hypothermia,
and respiratory distress, which required mechanical ventilation for two days. Cultures
of blood, sputum, and urine, all grew Aeromonas veronii and Enterobacter cloacae. The
gentleman improved and was sent home with a 14-day course of ciprofloxacin and
corticosteroids.
After only eight days, he returned to another hospital with fever, chills a
headache and left-sided weakness. Chest x-rays showed 2-rounded nodular opacities,
and a CT scan showed several bilateral nodules and also densities in the brain. The
initial exam presented crackle at the bilateral bases of the lungs. The patient was alert
and orientated, with a left facial drooping. It was believed that the new symptoms were
from a pneumonia acquired by being on the ventilator, or aspiration of microbes, from
either the drainage water or his stomach contents during the near drowning.
The article told me that infections are highly likely for patients who are on a
ventilator because of the damage to the patient epithelial lining in their lungs. The
article also said that nosocomial pneumonia is often caused by gram-negative aerobic
organisms. The hospital performed neurosurgical intervention, bronchoscopy, and
transesophageal echocardiography, and placed the patient on antibiotics and antifungal
medication. Seven days later, cultures grew pseudallescheria boydii (P. boydii). After
the surgery the patient had a poor recovery, with minimal arousal. Seven days after
surgery the patient passed away. The final diagnosis was disseminated P. boydii
infection after a near drowning.
It seems that this bacterium is from rotting vegetation in stagnant water. The fact
that the man ingested even a small amount in his near drowning made him susceptible to
the infection. P. boydii I found after I googled it is rare in healthy individuals, it usually
affects people who are immunocompromised. It is immune to amphotericin B making it
hard to treat. The best drug today for is voriconazole, it has shown the most promise.
The article also said that almost 60% fatality rate of near-drowning patients with
pneumonia.
I would have to say that the best way to survive a near-drowning would be to be
healthy and in clean water.
www.medscape.com. A Near-Drowning Victim with Pneumonia and Hemiparesis.
Authors were; Jennifer C. Bartczak, MD, Russell W. Steele, MD, Alfredo A. Lopez, MD;
Louisiana State University Health Sciences Center, New Orleans Series Editor: Russell
W. Steele, MD
Drowning and Near Drowning
Emmanuel Onyekwelu MD, Department of Pediatrics, Royal Victoria Teaching Hosp.
http://www.ispub.com/journal/the_internet_journal_of_health/volume_8_number_2_12/a
rticle/drowning_and_near_drowning.html
In this article I learned that there are different types of drowning, I didn’t realize
they classified it like that. Near drowning was classified as a death caused by
suffocation, a result of liquid taking oxygen from air which leads to asphyxia. Now it is
known as the process of experiencing respiratory insufficiency or submersion of a body
in liquid. Soon after they gave a new definition to secondary drowning, they defined it
as death due to chemical or biological changes in the lungs after a near drowning event.
I do like the fact that they no longer call it suffocation because there really is so much
more that takes place. I do like the changes they made when they go more in depth
about chemical and biological changes in the lung.
I found this journal to be especially interesting. They go in depth about age
groups that are at higher risk the global mortality rate for drowning is 6.8 per 100,000
people. Children are about one third of that. About 90% of drowning occur in fresh
water (rivers, lakes and pools) 10% in sea water. Many drowning happen with
inadequate supervision of young children or sudden turbulence or an increase in the
flow intensities of the water. There is also the automobile accident or capsized boat, in
which people get compromised by barriers or clothing. Drowning can result from the use
of drugs such as;
Alcohol
Sedatives
Hypnotics
Other factors that play a role in near drowning include but not are not limited to,
are conditions such as;
Cold
Hypothermia
Shock
Injury
Exhaustion
Swimming pranks
Swimming in poorly illuminated water
Unexpected health issues while swimming include but are not limited to, are
conditions such as;
Heart attacks
Seizures
adverse cerebrovascular
seizure disorders
and unclassified paroxysmal events
I also learned that when people are playing around there is a greater chance of
them suffering something called a deep water blackout. Swimming pranks induced
autonomic dysfunctions such as underwater blackouts. These are usually followed by
rapid breathing in order to extend a breath-hold dive, due to hypoxia. Near drowning
cases have a range of symptoms such as but are not limited to;
aspiration
pneumonitis
pulmonary edema
respiratory distress
metabolic acidosis
acute tubular necrosis
hypothermia
multiple electrolyte derangements
central nervous system dysfunctions such as seizures and coma
fatal arrhythmias
shock syndrome
death
Title: Nasal-Continuous Positive Airway
Pressure in the Treatment of Near-Drowning
Authors: Maurizio Dottorini, Amir Eslami, Stefano Baglioni,
Giuseppe Fiorenzano and Tommaso Todisco
URL:http://chestjournal.chestpubs.org/content/110/4/1122.full.pd
f
This study was about two patients who had experienced near
drowning in freshwater who were both successfully treated with
nasal continuous positive airway pressure (N-CPAP). Both of
these patients had a radiographic appearance of bilateral
pulmonary edema. N-CPAP was suggested because it is easier and
less costly instead of tracheal intubation for near drowning
patients who are breathing spontaneously and have not
experienced loss of consciousness. First case report was on a 13
year old girl who was submerged underwater while swimming in a
pool. She was resuscitated with mouth to mouth respiration and
then admitted into the hospital. She was also put on nasal
cannula because her SpO2 was 80.2%. Then she was put on an N-
CPAP plus oxygen administration of 2 liters per minute that
corrected her hypoxemia. Days later the chest x-ray showed
normal finding and she was discharged completely recovered.
Second case report was a 19 year old male who has epilepsy who
was receiving anticonvulsant therapy accidently fell into a
swimming pool. He was admitted to the hospital and his SpO2 was
75.3%. He had a poor response to oxygen therapy alone, N-CPAP
was added and his SpO2 was 96.6%. After a week in the hospital
and another chest x-ray was done showed complete resolution of
alveolar infiltrates. Results in near drowning patients is early
resuscitation and hypoxemia. Application of N-CPAP or positive
end expiratory pressure is the best way to improve oxygenation.
I think they should have done more near drowning patients using
CPAP. Also they can’t assume that CPAP worked on these two
patients that it will work on all near drowning patients.
Journal Review on a Near Drowning
In the journal articles, “Pneumonia Associated with Near-Drowning,” by Peter T. Ender and
Matthew J. Dolan, explains that young and otherwise healthy individuals that experience near-
drowning has the potential for infection leading to pneumonia. The authors explain, near-
drowning is an episode of sufficient severity, such as suffocation, to warrant medical attention.
According to authors mentioned in the article that near-drowning-associated pneumonia has been
more commonly reported in males and the fatality rate associated with near-drowning-associated
pneumonia. Hypoxemia and ischemia-induced organ damage are the mechanism for injury in
near-drowning, according to the article. The primary risk of near-drowning pneumonia and
include several factors that cause pneumonia including: aspiration, primary or secondary event,
gastric aspiration, contaminated aspiration, water temperature, chemical composition, and
nosocomial pneumonia. According to the Ender and Dolan, the pulmonary lining is damaged
from water temperature, chemical composition and gastric aspiration. The most common bacteria
found in near-drowning individuals that acquire pneumonia are aerobic gram-negative bacteria,
aeromonas hydrophila according to this article. The authors explain that many of the cases
reported are probably nosocomial and classifications are difficult, since cultures from the
location of drowning are rarely obtained. Pseudomonas aeruginosa found in near-drowning
individuals is hard to differentiate between aspiration and nosocomial process. Near-drowning
individuals are more susceptible to pneumonia in aquatic environment than a “dry” drowning.
According to the article, the therapeutic approach to helping reduce the risk of pneumonia by
slowly introducing empirical antibiotics to treat the pathogen. The article concludes by stating
that corticosteroids and hypothermia have not been proven beneficial and could be harmful to the
patient and should be avoided for a therapy choice.
I learned by reading this article, that near-drowning associated pneumonia hard to diagnosis how
it is acquired; it could be during or after the near drowning. I can see the correlation with the
damage caused by a near-drowning in the lungs and how much easier it is to acquire pneumonia
during or after a near-drowning. I also learned that there are many different types of ways to
acquire pneumonia, such as aspiration or nosocomial. After reading this article, I understand that
pretreating the potential for pneumonia is difficult to do because of the variety of bacteria and
fungus maybe causing the pneumonia. After reading this article, I am more aware of the risks
during and after the accident of near-drowning, how pneumonia is diagnosed and little
preventable therapeutic procedures are beneficial to near-drowning individuals that are at risk of
pneumonia. I believe that this article is important because as a future therapist I could potentially
be working with near-drowning individuals.
http://cid.oxfordjournals.org/content/25/4/896.full.pdf
In an article entitled “A Near-Drowning Victim with Pneumonia and Hemiparesis” discusses a 50 year old
male’s near drowning experience and his medical issues following it. The victim had decided to pull his
car to the side of the road near a drainage canal, as he was he was beginning to feel drowsy. Before
falling asleep, he neglected to put his car in park, causing his vehicle to roll into the canal as he slept. It
took nearly fifteen minutes for him to be pulled out of his car and be rescued. The article then
continued with the victim’s hospitalization. He was treated for shock, hypothermia, and respiratory
distress. Due to his circumstances he was put on mechanical ventilation for two days and discharged
after fourteen days.
Only eight days after discharge the victim was admitted to a different facility after presenting
with fever, chills, a headache, and total left sided weakness. Upon initial assessment left sided drooping
was noted with a poor left shoulder shrug, crackles were ascultated in bilateral lower lobes. A CT of the
brain and chest were performed, each with disappointing results. Multiple nodules were present in his
lungs. Meanwhile his brain appeared with densities in the right parietal lobe which extended to the
posterior right basal nuclei. In doing further evaluations the patient’s doctor concluded that he quite
possibly aspirated some of the stagnant water from the canal, explaining the development of Aermonas
veronii and Enterbacter cloacae in sputum samples. During his hospitalization drainage of the patient’s
brain abscess was performed. The sample obtained from the abscess was positive for septate hyphae.
Sadly, on day 29 the patient passed away. His final diagnosis was Pseudoallescheria boydii infection
secondary to near drowning.
From this article I learned that prophylactic antibiotics are not indicated when treating patients
with suspected aspiration. In this case there was an exception since the patient indeed had a bacterial
infection. Distributing antibiotics to near drowning patients without signs of infection decreases the
effectiveness of their already compromised immune system. In reading this journal article I was also
enlightened to the fact that the most common organism that causes pneumonia in near drowning
patients is the exact organism which led to this patient’s death. Pseudallescheria boydii is found in soil,
manure, and muddy/stagnant water. Although the patient was first treated with antibiotics, I found it
interesting to learn that the effects of near drowning experiences aren’t present immediately. From this
article I concluded that it might become important to test all near drowning patients for
Pseudallescheria boydii to immediately intervene, decreasing the chances of re hospitalization or even
death.
Title of Article: Mild hypothermia after near drowning in twin toddlers
Author: Ortrud V Hein, Andreas Triltsch, Christoph von Buch, Wolfgang J
Kox, and Claudia Spies
Source: http://ccforum.com/content/8/5/r353
This article tells the story of twins, a boy and a girl, who suffered near drowning. The
children were two years and three months old at the time. It was early spring and they
were left unsupervised for about ten minutes when they were discovered in the
neighbors garden pond. Their father found them lifeless. Although they both suffered
from near drowning they had different treatments and different neurological outcomes.
When they were found CPR was performed. They were both hypothermic, had dilated
pupils with no pupillary reflexes and they had both aspirated.
The young girls body was warmed to 32°C, she was stabilized and then admitted to the
ICU. She was being treated with mild hypothermia. After she was warm her pupils
were normal and reflexes were present. After 72 hours she was not showing the
development of rebound hyperthermia. She was put on pressure controlled ventilation
initially and was doing ok until 72 hours after she was found when her oxygenation
deteriorated. An x-ray showed bilateral infiltrations in the lung. She was in the ICU for
three days when she became septic and was having multiple organ failure. Seven days
after the accident she was switched to conventional pressure controlled ventilation her
organ failure improved. Four days later she was extubated and 13 days after that she
was discharged with her health completely restored.
The twin boy was haemodynamically sable 2.5 hours after he was admitted to the
hospital. His pupils were reactive to light but slightly dilated. He was ventilated on a
pressure controlled mode for six days and was then extubated. His x-rays showed
bilateral infiltrations of the lung from aspiration. Once he was done with the sedation
apallic syndrome developed. His initial CT scan was normal at 36 hours after the
accident but his CT from 32 days after the accident had cerebral atrophy and a marked
expansion of the internal and external cerebral fluid interspaces. He was discharged
after 41 days of being in the hospital but he was still in an apallic state with flexion and
extension posturing.
Although these children both had a near drowning experience their outcomes were very
different. Both of the children were taken to hospitals with pediatric units but they chose
different methods of treatment. The girl was treated while going back to a normothermic
slowly and had a better recovery than the boy who was treated after returning to a
normothermic state.
Near Drowning
Author: Michael J Verive, MD; Chief Editor: Jonathan Adler, MD
http://emedicine.medscape.com/article/908677-overview#a0104
I found this article that talks about the different type of drownings that there are, and what type
of effects on the body each one can have. In this article they also talk about who is most likely at
risk for near drownings and the amount of drownings that occur in the United Stated each year.
The reason that I chose this article is because it talks a lot about drowning and near drowning in
children.
I learned in this article that near drownings are also sometimes called submersion or immersion
injuries, and are one of the main causes of death in children in the United States. In fact near
drownings are second only to traumas like car accidents and falls. There are nearly 60,000
reported near drownings in the United States every year. The article states that a near drowning
is when a victim survives submersion after the twenty four hour mark, while drowning is if they
do not survive twenty four hours after submersion. Near drownings can also be classified as cold
water or a warm water drowning. Warm water drownings are in waters that are at least 20
degrees Celsius while cold water are water temperatures of under 20 degrees Celsius. Cold water
near drownings are better than warm water near drownings especially in young children.
In this article they also talk about what happens to the body when a person goes through a near
drowning. When you are submerged in water your body tries to breathe, when it does this it
either will aspirate water, which is also known as wet drowning. Or you will have a
laryngospasm without aspiration, also known as dry drowning. Most near drownings will
aspirate a small amount of water or gastric content. In the article they discuss how hypoxemia is
the main reason for death and long term injury in near drowning cases. CNS damage is also very
likely to occur especially with prolonged tissue hypoxia. Some problems that are seen with
prolonged hypoxia are sustained acidosis, cerebral edema, hyperglycemia, hypotension, and
seizures.
In this article they also talk about pulmonary effects that can be seen with near drownings. One
of the main pulmonary complications is that fluid aspiration results in impaired gas exchange
because of altered surfactant function. The differences between fresh water and salt water near
drownings are also discussed. In fresh water near drowning the water is more hypotonic
compared to plasma which causes a disruption of alveolar surfactant. In salt water cases the
water is more hyperosmolar which increases the osmotic gradient causing a diluting of the
surfactant. This impaired gas exchange and decreased levels of surfactant may lead to atelectasis
which would then lower your functional residual capacity. It could also cause a pulmonary
edema. There are also reports that patient that have near drownings are also at higher risks of
getting ARDS from the lowered surfactant functions, along with pulmonary edema.
One of the things that I found interesting in this article was the Orlowski Score. This is a scoring
system that helps identify the neurologically intact survival. The system works by giving one
point for each of the following item, if a score is less than 2 there is likely that there will be
complete recovery. A score of three or more usually have only a 5% chance of survival.
Age 3 years or older
Submersion time of more than 5 minutes
No resuscitative efforts for more than 10 minutes after rescue
Comatose on admission to the emergency department
Arterial Ph. of less than 7.10
I found this article very helpful in understanding the different type of drownings and near
drownings that there are. I also now know that you should always be helpful in near drownings
and start resuscitation even if you think that it is too late.
Title: Tracheobronchitis caused by Aeromonas veronii biovar sobria after near- drowning
Author: Mara Bossi – Kupfer, Aaron Genini, Raffaele Peduzzi and Antonella Demarta
Source: http:/jmm.sgmlournals.org/content/56/11/1563.full
This article talks about a case where a 19 year old male experienced a near death drowning and
ended up getting tracheobronchitis due to swallowing pathenogenic bacteria from the Aeromonas
family, classified as A. veronii biovar sobria. Apparently, there is an elevated risk factor for
respiratory tract infection if a near- drowning accident takes place in freshwaters that are
polluted. There are eighteen Aeromonas species that have been identified but only five are
considered to be pathenogenic to humans causing pneumonia .Unfortunately, 60% of the near –
death drowning victims who acquire pneumonia through the Aeromonas spp. end up dyeing.
For any health care worker it’s good to know what you are up against and the most effective way
to treat it. Perhaps there should be a protocol for any near –death drowning patient to be checked
for the Aeromonas bacteria that causes pneumonia. We should not underestimate the possibility
of this infectious agent in near – death drowning patients as its presence is quite common.
Secondly, it is good to know through microbiological analysis which antibiotic works well and
which does not. In this situation, Aeromonas veronii biovar sobria was cultured and a resistance
to amoxicillin and ampicillin was noted, however gentamicin, tetracycline, tobramyocin were
noted as being effective antibiotics. Thirdly, this patient had yellow –reddish secretions in which
the Aeromonas ssp was identified .
I found this article to be very educational. I thought that oxygenation, ventilation and perfusion
were the only concerns in a near –death drowning. I guess I can add respiratory tract infection
due to pathogenic bacteria.
Clinical, laboratory and X-ray findings of drowning and near-drowning
in the Gulf of Aqaba
Eastern Mediterranean Health Journal
Volume 5, Issue 4, 1999, Page 706-709
By: A. Al-Talafieh, R. Al-Majali and G. Al-Dehayat
http://www.emro.who.int/publications/emj/0504/08.htm
This article reviews the clinical and x-ray findings of drowning and near-drowning cases on a beach in
Jordan which is located on the Gulf of Aqaba. This study evaluated 34 drowning and near-drowning
cases. Out of this study 29 survived and five people died. Ages of the victims ranged from 8-60 years
old. Every victim underwent resuscitation and arterial blood gases were taken immediately at the
Emergency Department. A chest X-ray and EKG were also done within 15 minutes of arrival at the
hospital. ABG results showed that 15 patients had significant respiratory acidosis and19 patients had
metabolic acidosis. Fourteen patients were placed on a mechanical ventilator. Chest X-rays confirmed
pulmonary edema in 18 patients, aspiration pneumonia in 6 patients and 1 patient suffered a
pneumothorax. The conclusion of this article is that initial resuscitative efforts need to be aimed at
establishing a patent airway and providing CPR. Initial management of CPR at the site of drowning is
crucial in saving more lives from near-drowning.
I learned by reading this article that near-drowning occurs when a person is submerged in water,
attempts to breathe, and either aspirates water (wet drowning) or has laryngospasm without aspiration
(dry drowning). It was also stated in the article that the signs and symptoms of near-drowning can differ
from person to person depending in part on how long the individual has been submerged, the person's
age, and the temperature of the water. I learned that arterial hypoxemia and metabolic acidosis are the
most significant pathophysiological abnormalities of near-drowning victims. The speed of rescue and
early effective CPR is so critical in the outcome of near-drowning victim.
The article I chose to review is an article called, Near drowning in humans. It was based on a study of 36
near drowning victims and the clinical findings that were studied after the event. Much of the article
consisted of ratios and graphs of statistics on the victims. There were a limited amount of case studies
for the victims online. The interesting part of the article was where they discussed certain elements
pertaining to the near drowning.
The first item discussed was the ABG analysis. Overall, hypoxemia and metabolic acidosis are the
prevalent abnormalities found in the victims. It seems that the manifestations of these victims are close
to those with pulmonary edema due to a failing heart. The authors think the severe metabolic acidosis
might be related to an accumulation of lactate during severe hypoxemia. They also think it may be
attributed to the physical struggling to resist aspiration of fluid. Respiratory acidosis is not something
prevalent in near drowning victims in comparison to that in pulmonary edema. They think this is
because the victims are often manually ventilated when rescued and before the ABG is obtained.
Electrolyte imbalances are another item discussed. In this case, I don’t feel that they were significant.
There were only small elevations in sodium and small reductions in potassium in the victims.
Chest X-ray is next on the list. From what the authors found, there were a wide variety of findings on the
x-rays. They ranged from patchy alveolar infiltrates to the extreme which was an x-ray that looked just
like pulmonary edema. The most common findings were diffuse alveolar infiltration bilaterally,
concentrated in the perihilar and basal areas.
Treatment for the victims also ranges. The basic treatment agreed upon by the authors is some king of
resuscitative measures wherever the victim is rescued. Once oxygen is available, this should be given.
Postural drainage or suctioning should also be used whenever possible. Ventillatory assistance should be
continued regardless of consciousness. If there is absence of cardiac activity, chest compressions should
be started and continued until electrical activity can be measured. ABG should be drawn and any
abnormalities treated. Also an appropriate airway should be established, and condition should be
monitored for 12-24 hours post event.
www.http://Chestjournal.chestpubs.org
Title of Article: Cold Water Near -Drowning
Author: Lesile Y. Lin
URL : http://www.miseagrant.umich.edu/upwellings/issues/09dec/PDF/MICHU-SG-80-316-Cold-Water-
Near-Drowning.pdf
The research into near-drowning and survival were studied by Dr. Martin Neiroff a pulmonary specialist
at the University of Michigan. The standards or guidelines followed at this time were very narrow and
stated that anyone without oxygen for four minutes had irreversible brain damage and after 6 minutes
death would occur. After reading a journal about survival of children in cold water near- drowning in
some cases where victims had been submerged from 15 to 60 min. and reading another article about
the mammalian diving reflex which mammals such as dolphins use to concentrate the majority of their
oxygen by vasoconstriction to their extremities to oxygenate there heart, lungs, and brain, Dr. Neiroff
used combined both to created a standard /procedure that is used today. This procedure calls for
immediate CPR administration be given and bicarbonate solution to be injected into patient and internal
warming of the body via the lungs at temperatures at 108 degrees to warm up the heart more quickly.
The heart has to be at a certain temperature before it will start and this method is safer than external
warming due to the fact that the stagnant blood in your extremities may have high concentrations of
acid with dangerous levels of toxic metabolites. Most patients do suffer from some brain damage
immediately after but recover soon after with no permanent damage. Patients that don’t show signs of
improvement after 24 hours the prognosis is either “vigil coma” or death. His studies on warm water
death and statistics related to low recovery rates were attributed to the lack cool water to slow down
metabolism and the inability for the blood to clot causing major hemorrhaging to which the cause is not
yet known.
I think an important point to remember when one comes across a drowning victim is not to look at the
amount of time they have been submerged or their appearance but to give immediate CPR to improve
their chances of survival and not to assume they are dead. This is especially true for cold water and the
young but many success stories have happened in reviving middle age adults.
I thought this article gave me insight on the history of near drowning and the development of procedure
used to revive patients. It was also interesting to know that this research and treatment was discovered
by a University and pulmonary Dr. so close to home and is now accepted as the standard procedure in
the US and many other countries.
Near Drowning
PubMed.gov
A study from Finland suggests that the majority of people who survive a near-drowning as
a child will not suffer significantly as an adult.
Most children that suffered a near-death experience a decade ago, report the same quality
of life as their peers who have not suffered such an event in childhood.
However, it's important that doctors keep an eye on these patients over the years after the
event, because thinking, memory, and learning problems may not show up until the child is
much older.
The child’s long term health will depend on the specific nature of the near-drowning and
how long the child was under water. If a child is submerged for ten minutes or longer, the
quality of life is significantly lower than of those who were submerged for a lesser amount
of time.
The researcher’s tracked 64 children who had been admitted to the intensive care unit
following a near-drowning when the child had to be given CPR. Eleven of the children died
in the hospital, and nine more died within six months from a brain injury related to the
accident.
The researchers were able to contact 29 out of 40 patients still alive, and they returned a
questionnaire asking about their current communication skills, amount of schooling they
received, and whether they suffered from depression or had trouble sleeping. Most of the
children stated that the event happened when they were very young and most happened
about ten years before receiving the questionnaire. Teenagers and young adults reported
slightly lower quality of life compared to a group of people who have not experienced a
near drowning incident. But in children age 11 and younger, there was no difference. Kids
under eight reported the best quality of life of all near-drowning survivors, but the
researchers believe that this is probably because the parents filled out the questionnaire
for them. The parents may simply be reflecting on the relief that their child has survived
the incident and that small neurological deficits don’t matter that much. But if there are
learning problems, they will become more noticeable as the child enters school.
The children had been underwater between 30 seconds and 45 minutes. Those who were
submerged for a longer period of time reported a worse quality of life than others.
It is important that a child get CPR quickly after a near drowning in order for them to
survive and do well later on. Researchers concluded that most children who survive will go
on to have a decent quality of life.
The results show that after a near-drowning, not only can a child survive; they can survive
with a good level of function.
I found it interesting to look at this study and its facts. When we hear of a near-drowning,
we automatically assume the worse outcome for a child, but this study shows that children
are able to survive with minimal effects on them later in life.
Journal Review: Near Drowning
This article is about a young woman who was in a motor vehicle accident and
ended up upside-down in a river. She required endotracheal intubation, and was
unresponsive on scene. Her breath sounds we decreased with expiratory wheezes and
was difficult to mechanically ventilate. She was found to have sand and gravel in her
airways causing the difficulty ventilating. The sand and gravel, along with the aspiration
of water and bacteria while being submerged caused inflammation and infection in her
airways. After antibiotic treatment and one week of mechanical ventilation, she began
to recover, and after 3 weeks was discharged. After discharge, the patient recovered
well, with some scarring on her chest x-ray. This article also discusses the fact that
sand aspiration is under-diagnosed in near-drowning cases. Sand aspiration can be a
cause of respiratory failure because I can block airways.
This article brings to attention the fact that there are other dangers that should be
considered when a patient has a near-drowning incident. In most bodies of water, there
is sand, gravel, bacteria, and many other microorganisms that can be introduced to the
body. Since this is often undiagnosed and not checked for, this article is important to
know about incase problems occur and all other troubleshooting fails.
This article made me start to think about all the different things that can be
overlooked when a near-dorwning victim is assessed. Aside from aspirating water, they
could aspirate sand, gravel, bacteria, bugs, weeds and other plant life. When I thought
of near drowning before reading this article, I just thought of complications with water
entering the airways, but now it has made me think about all the things that could be a
problem if I even run into a situation like the patient in this article.
Authors: DONNIE P. DUNAGAN, JOSEPH E. COX, MICHAEL C. CHANG, and
EDWARD F. HAPONIK
Title: Sand Aspiration with Near-Drowning
URL: http://ajrccm.atsjournals.org/cgi/content/full/156/1/292
Drowning, Near Drowning and Immersion Syndrome
Author: SR Lord, PR Davis
http://www.ramcjournal.com/2005/hostile_environments/lord.pdf
In this article the Army medical corps explains how the care and timing of a person that has
been submerged under water. There are a few things that can influence the outcome such as; water
temperature, time till rescue and the type of care given. The sooner a person can be pulled from the
water the better the chance of success. The cold water slows down all the bodies systems and can be
beneficial to resuscitation. By understanding the things that can occur to the body while submerged the
rescuers have a better chance of saving the person. This article points out the effects of hypoxia,
aspiration and hypothermia and what can be done pre hospital to give the person a chance. Once the
person is in the highest level of care their chances become better.
I think that this article shows that the medical field is always trying to improve the care it gives.
We do not just settle on existing methods but strive to learn new more effective ways to help our
patients. No matter what level of care you are involved in learning and teaching are always important in
providing outstanding care for our patients.
Near Drowning article
Respiratory Disease
Most Kids Do Okay After Near-Drowning: Study
http://www.medscape.com/viewarticle/744349
A study in Finland that was reported on in June 2009, states that a majority of childhood near-
drowning survivors do not have significant suffering in adulthood.
In reading this article, I was struck by the parameters used to define the population used for the
study.
the near-drowning event occurred during a 22 year span
the victim was admitted to one specific intensive care unit
some patients died and of those contacted, just under one third responded
the method of information gathering was a questionnaire.
It is a very narrow population, and the results are subjective, based on an ambiguous definition and
subjective self-evaluation of quality of life. In their efforts to focus on quality of life, the researchers
asked for information regarding "current thinking and communication skills, activities they were
involved in, how much school they had completed, and whether they suffered from depression or had
trouble sleeping."
The conclusions stated were that near-drowning events that had more underwater time caused a
lower quality of life later, and that the speed and intensity of CPR is a factor for surviving and how well
these survivors do later in life.
Perhaps reading the actual study would lend more veracity, I feel that this article doesn't.