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.
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