Drowning and Near Drowning - PowerPoint by KUn8X34


									    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
• Suspect spinal injury if:
   – Submersion has resulted from a diving mishap or
     long fall.
   – Patient is unconscious.
   – Patient complains of weakness, paralysis, or
    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
• 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
• Never attempt water rescue
  without proper training and
• Consider trauma and spinal
• 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
• Evaluate for shock and adequate perfusion.
• Treat trauma.
        Transport Decision
• Always transport near-drowning patients to
• Decompression sickness and air embolism
  must be treated in recompression
• Perform interventions en route.
                  Focused History and
                    Physical Exam

• If responsive, perform exam on lungs and breath
• If unresponsive:
   – Look for signs of trauma or complications.
   – Check divers for indications of air embolism or
   – 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
• 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
• Administer oxygen and provide rapid transport.
                  Detailed Physical Exam

• Examine respiratory, circulatory, neurologic
• 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
• Pools should be surrounded with
  appropriate enclosures.
• Alcohol involved in adult and teenage
•   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
    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
• 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
• 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
   – Death from snake bites is rare.
   – About 15 deaths occur each year in the
     Four Types of Poisonous Snakes
                in the US


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
• Monitor patient’s vital signs.
• Mark the swollen area with a pen.
• Care for shock if signs and symptoms
• 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
• 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
• Remove the remaining tentacles by
  scraping them off.
• Provide transport to hospital.

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