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
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
Wet Lung: Fresh Water
Water moves from alveoli to bloodstream Hemodilution occurs O2 carrying capacity
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 alveoli
Collapse of
Wet Lung: Salt Water
Water moves from bloodstream to alveoli Hemoconcentration occurs Shock Pulmonary edema occurs
Near Drowning
Do not attempt swimming rescue without proper training Throw - Tow - Row - Go
Near Drowning
Consider possible neck injury:
• Diving accidents • Swimming pools • Inadequate history
Place patient on spineboard in water
Near Drowning
If possible, begin pulmonary resuscitation in water Resuscitate all cold water drowning (<72oF)
• Mammalian Diving Reflex • Survivability
Transport all near drownings!
Regardless of how good they look!
Scuba Emergencies
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
SCUBA
Use causes: • Collection of pressurized air in body air spaces (alveoli, sinuses, middle ear) • Dissolving of gas (particularly nitrogen) in body fluids
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
SCUBA Problems: Squeeze
Inability to equalize pressure in sinuses, middle ear Causes pain
SCUBA Problems: Ear Drum Rupture
Inability to equalize pressure in middle ear Perforation of tympanic membrane Causes disequilibrium
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
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 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
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
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 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 can occur only if the dive was > 33 feet
Signs, symptoms may be delayed
Decompression Sickness Management
High concentration oxygen Assisted ventilations, as needed Recompression