Drowning and Near Drowning
• Drowning
– Death as a result of suffocation after
submersion in water
• Near drowning
– Survival, at least temporarily, after suffocation
in water
Drowning Process
Spinal Injuries in Submersion
Incidents
• Suspect spinal injury if:
– Submersion has resulted from a diving mishap or
long fall.
– Patient is unconscious.
– Patient complains of weakness, paralysis, or
numbness.
Spinal Stabilization in Water
• Turn the patient supine.
• Restore the airway and begin ventilation.
• Secure a backboard under the patient.
• Remove the patient from the water.
• Cover the patient with a blanket.
Resuscitation Efforts
• Hypothermia can protect vital organs from hypoxia.
• Documented case of a survivor of a 66-minute cold
water submersion
• Diving reflex may cause heart rate to slow.
Diving Problems
• Descent problems
– Usually due to the sudden increase in pressure on
the body as the person dives
• Bottom problems
– Not commonly seen
• Ascent problems
– Air embolism and decompression sickness
Signs and Symptoms
of Air Embolism (1 of 2)
• Blotching
• Froth at the mouth and nose
• Severe pain in muscle, joints, or
abdomen
• Dyspnea and/or chest pain
Signs and Symptoms
of Air Embolism (2 of 2)
• Dizziness, nausea, and vomiting
• Dysphasia
• Difficulty with vision
• Paralysis and/or coma
• Irregular pulse or cardiac arrest
Decompression Sickness
(The Bends)
• Occurs when bubbles of gas
obstruct blood vessels
• Can result from rapid ascent
• Most common symptom is
abdominal and/or joint pain.
• Symptoms may develop
after hours.
• Treatment is BLS and
hyperbaric chamber.
Scene Size-up
• Never drive through moving water;
be cautious driving through still
water.
• Never attempt water rescue
without proper training and
equipment.
• Consider trauma and spinal
stabilization.
• Check for additional patients.
Initial Assessment
• Pay attention to chest pain, dyspnea, complaints of
sensory changes.
• Be suspicious of alcohol use.
• Maintain airway; suction.
• If pulse cannot be obtained, begin CPR per
guidelines.
• Evaluate for shock and adequate perfusion.
• Treat trauma.
Transport Decision
• Always transport near-drowning patients to
hospital.
• Decompression sickness and air embolism
must be treated in recompression
chamber.
• Perform interventions en route.
Focused History and
Physical Exam
• If responsive, perform exam on lungs and breath
sounds.
• If unresponsive:
– Look for signs of trauma or complications.
– Check divers for indications of air embolism or
bends.
– Focus on pain in joints and abdomen.
– Check for signs of hypothermia; complete
Glasgow Coma Scale score.
Baseline Vital Signs/
SAMPLE History
• Check pulse rate, quality, rhythm.
• Check peripheral, central pulses.
• Check for pupil size, reactivity.
• Determine length of time patient was underwater or
time of onset of symptoms.
• Note physical activity, alcohol/drug use, other
medical conditions.
• Determine dive parameters in history depth, time,
previous dive activity.
Drowning Interventions
• Begin artificial ventilations as soon as possible.
• Stabilize and protect spine.
• Maintain patent airway. If there is no spinal injury,
turn patient on side to allow draining from upper
airway.
• Make sure patient is warm, especially after cold-
water immersion.
Diving Interventions
• Remove patient from water.
• Begin BLS; administer oxygen.
• Place patient in left lateral recumbent position with
head down.
• Provide prompt transport to nearest recompression
facility.
• Administer oxygen and provide rapid transport.
Detailed Physical Exam
• Examine respiratory, circulatory, neurologic
systems.
• Distal circulatory, sensory, and motor function tests
determine extent of injury.
• Examine for peripheral pulses, skin color, and
discoloration, itching, pain, numbness/tingling.
Ongoing Assessment
• May deteriorate rapidly
• Assess mental status frequently.
• Document:
– Circumstances of drowning and extrication
– Time submerged
– Temperature of water
– Clarity of water
– Possible spinal injury
• Bring dive log, dive computer, and dive equipment
to hospital.
Other Water Hazards
• Hypothermia from water immersion
• Breath-holding syncope
• Injuries from recreational equipment or
marine animals
Prevention
• Pools should be surrounded with
appropriate enclosures.
• Alcohol involved in adult and teenage
drownings.
Lightning
• Strikes boaters, swimmers, golfers, anyone in
large, open area
• Cardiac arrest and tissue damage are common.
• Three categories of lightning injuries
1. Mild: Loss of consciousness, amnesia, tingling,
superficial burns
2. Moderate: Seizures, respiratory arrest,
asystole (spontaneously resolves), superficial
burns
3. Severe: Cardiopulmonary arrest
Emergency Medical Care
• Protect yourself.
• Move patient to sheltered
area or stay close to ground.
• Use reverse triage.
• Treat as for other electrical
injuries.
• Transport to nearest facility.
Spider Bites
• Spiders are numerous and widespread in the US.
• Many species of spiders bite.
• Only the female black widow spider and the brown
recluse spider deliver serious, even life-threatening
bites.
• Your safety is of paramount importance.
Black Widow Spider
• Found in all states except Alaska
• Black with bright red-orange marking in
hourglass shape on abdomen
• Venom poisonous to nerve tissue
• Requires patient transport as soon as possible
Brown Recluse Spider
• Mostly in southern and central US
• Short-haired body has violin-shaped mark, brown
to yellow in color, on its back.
• Venom causes local tissue damage.
• Area becomes swollen and tender, with pale,
mottled, cyanotic center.
• Requires patient transport as soon as possible.
Snake Bites
• 40,000 to 50,000 reported snake bites in the
US annually.
• 7,000 bites in the US come from poisonous
snakes.
– Death from snake bites is rare.
– About 15 deaths occur each year in the
US.
Four Types of Poisonous Snakes
in the US
Cottonmouth
Rattlesnake
Copperhead Coral snake
Pit Vipers
• Rattlesnakes,
copperheads, and
cotton mouths
• Store poison in pits
behind nostrils
• Inject poison to
victim through fangs
Signs and Symptoms
of a Pit Viper Bite
• Severe burning at the bite site
• Swelling and bluish discoloration
• Bleeding at various distant sites
• Other signs may or may not include:
– Weakness – Fainting
– Sweating – Shock
Care for Pit Viper Bites (1 of 2)
• Calm the patient.
• Locate bite and cleanse the area.
• Do not apply ice.
• Splint area to minimize movement.
• Watch out for vomiting caused by anxiety.
• Do not give anything by mouth.
Care for Pit Viper Bites (2 of 2)
• If the patient is bitten on the trunk, lay
the patient supine and transport
quickly.
• Monitor patient’s vital signs.
• Mark the swollen area with a pen.
• Care for shock if signs and symptoms
develop.
• Bring the snake to hospital if it has
been killed.
Coral Snakes
• Small snake with red, yellow, and black bands
• “Red on yellow will kill a fellow, red on black,
venom will lack.”
• Injects venom with teeth, using a chewing
motion that leaves puncture wounds
• Causes paralysis of the nervous system
Care for Coral Snake Bites (1 of 2)
• Quiet and reassure the patient.
• Flush the area with 1 to 2 quarts of warm,
soapy water.
• Do not apply ice.
• Splint the extremity.
• Check and monitor baseline vital signs.
Care for Coral Snake Bites (2 of 2)
• Keep the patient warm and elevate the lower
extremities to help prevent shock.
• Give supplemental oxygen if needed.
• Transport promptly. Give advance notice to
hospital of coral snake bite.
• Give the patient nothing by mouth.
Scorpion Stings
• Venom gland and stinger found
in the tail end.
• Mostly found in southwestern US
• With one exception, the
Centruroides sculpturatus, most
stings are only painful.
• Provide BLS care and transport.
Tick Bites (1 of 3)
• Ticks attach themselves
to the skin.
• Bite is not painful, but
potential exposure to
infecting organisms is
dangerous.
• Ticks commonly carry
Rocky Mountain spotted
fever or Lyme disease.
Tick Bites (2 of 3)
• Rocky Mountain spotted fever develops 7 to
10 days after bite.
• Symptoms include:
– Nausea, vomiting
– Headache
– Weakness
– Paralysis
– Possible cardiorespiratory collapse
Tick Bites (3 of 3)
• Lyme disease has now been
reported in over 35 states.
• Lyme disease symptoms may begin
3 days after the bite.
• Symptoms include:
– Target bull’s-eye pattern
– Rash
– Painful swelling of the joints
Caring for a Tick Bite
• Do not attempt to suffocate or burn tick.
• Use fine tweezers to grasp tick by the body and
pull it straight out.
• Cover the area with disinfectant and save the tick
for identification.
• Provide any necessary supportive emergency
care and transport.
Injuries from Marine Animals
• Coelenterates are responsible for more
envenomations than any other marine life animal
• Have stinging cells called nematocysts
• Results in very painful, reddish lesions
• Symptoms include headache, dizziness, muscle
cramps, and fainting.
Care for Marine Stings
• Limit further discharge by minimizing
patient movement.
• Inactivate nematocysts by applying
alcohol.
• Remove the remaining tentacles by
scraping them off.
• Provide transport to hospital.