Emergency Strategy - How to treat near drowning
Emergency strategy - How to treat near drowning
Near drowning is divided into wet near drowning and dry near drowning. Wet near drowning is defined as survival after aspiration of fluid in the lung. The survival may be temporary. Dry near drowning is defined as survival after asphyxia while immersing in the liquid secondary to laryngospasm.
The symptoms and signs may be divided into central nervous system effects, cardiovascular effects, urea and electrolytes instability and the respiratory effects.
The central nervous system effects are acidosis and cerebral hypoxia which lead to cerebral edema. In term of cardiovascular effects, initially the patient may present with atrial fibrillation or sinus bradycardia. Arrhythmias may occur in near drowning due to hypoxemia and hypothermia. Asystole and ventricular fibrillation are least common.
Hypoxia may result in severe respiratory acidosis or metabolic acidosis. Hypercalcemia, hypermagnesemia and hypernatremia may occur especially due to ingestion of large amount of sea water fluid. Acute respiratory distress syndrome and non cardiogenic pulmonary edema may occur due to wash out of surfactant by fresh water or salt water. Symptoms and signs such as wheezing, crepitation and shortness of breath are common due to rapid or insidious onset of pulmonary insufficiency.
Other symptoms and signs are hypothermia, myoglobinuria, hypoxia, acidosis, hemoglobinuria and hypoperfusion which lead to renal failure. Disseminated intravascular coagulation may also present at the same time.
The investigations require are full blood count, urea and electrolytes, arterial blood gases, DIC screening, ECG, serum and urine assays, CT scan and chest x ray. CT scan and chest x ray findings are normal, localized, diffuse or perihilar pulmonary edema.
Cardio- pulmonary resuscitation is performed as soon as possible. The neck should be supported in a neutral position. Always suspect injury to the cervical spinal cord. Intubation is considered in apnoeic patient while high flow of oxygen supplement via face mask is considered in patient who can breath spontaneously. The hypothermic patient will be rewarmed. The management is always identical to salt water or fresh water drowning.
While in hospital, cardio - pulmonary resuscitation should be continued if required. Observe and evaluate any spinal cord or head injuries. Elective intubation is considered in cases of deterioration of neurological function and despite high percentage of supplemental oxygen unable to maintain partial pressure of oxygen more than 60 mmHg. Beta agonist is considered in any cases of bronchospasm. Antibiotics are given if the patient develop pneumonia ( clinical pulmonary infection) from water borne pathogen such as proteus, pseudomonas, or aeromonas or submerged in heavily contaminated water.
Hypoxic cardiomyopathy commonly develop near drowning patient. It develop as the patient with hypothermia usually have hypotension and hypovolemia due to cold diuresis. Inotropic support and optimal fluid replacement are considered in this case.
Neurological injuries may occur due to hypoxemia, cerebral edema and ischemia. The outcomes of injuries to the nervous system are influenced by neurological status and duration of coma of the patient. The treatment for this condition include maintaining partial pressure of carbon dioxide to 26- 30 mmHg by mild hyperventilation. Intracranial hypertension is treated with IV mannitol or furosemide. Phenytoin is considered as an anti convulsant to control seizures.
Near drowning is divided into wet near drowning and dry near drowning. Wet near drowning is defined as survival after aspiration of fluid in the lung. The survival may be temporary. Dry near drowning is defined as survival after asphyxia while immersing in the liquid secondary to laryngospasm.
The symptoms and signs may be divided into central nervous system effects, cardiovascular effects, urea and electrolytes instability and the respiratory effects.
The central nervous system effects are acidosis and cerebral hypoxia which lead to cerebral edema. In term of cardiovascular effects, initially the patient may present with atrial fibrillation or sinus bradycardia. Arrhythmias may occur in near drowning due to hypoxemia and hypothermia. Asystole and ventricular fibrillation are least common.
Hypoxia may result in severe respiratory acidosis or metabolic acidosis. Hypercalcemia, hypermagnesemia and hypernatremia may occur especially due to ingestion of large amount of sea water fluid. Acute respiratory distress syndrome and non cardiogenic pulmonary edema may occur due to wash out of surfactant by fresh water or salt water. Symptoms and signs such as wheezing, crepitation and shortness of breath are common due to rapid or insidious onset of pulmonary insufficiency.
Other symptoms and signs are hypothermia, myoglobinuria, hypoxia, acidosis, hemoglobinuria and hypoperfusion which lead to renal failure. Disseminated intravascular coagulation may also present at the same time.
The investigations require are full blood count, urea and electrolytes, arterial blood gases, DIC screening, ECG, serum and urine assays, CT scan and chest x ray. CT scan and chest x ray findings are normal, localized, diffuse or perihilar pulmonary edema.
Cardio- pulmonary resuscitation is performed as soon as possible. The neck should be supported in a neutral position. Always suspect injury to the cervical spinal cord. Intubation is considered in apnoeic patient while high flow of oxygen supplement via face mask is considered in patient who can breath spontaneously. The hypothermic patient will be rewarmed. The management is always identical to salt water or fresh water drowning.
While in hospital, cardio - pulmonary resuscitation should be continued if required. Observe and evaluate any spinal cord or head injuries. Elective intubation is considered in cases of deterioration of neurological function and despite high percentage of supplemental oxygen unable to maintain partial pressure of oxygen more than 60 mmHg. Beta agonist is considered in any cases of bronchospasm. Antibiotics are given if the patient develop pneumonia ( clinical pulmonary infection) from water borne pathogen such as proteus, pseudomonas, or aeromonas or submerged in heavily contaminated water.
Hypoxic cardiomyopathy commonly develop near drowning patient. It develop as the patient with hypothermia usually have hypotension and hypovolemia due to cold diuresis. Inotropic support and optimal fluid replacement are considered in this case.
Neurological injuries may occur due to hypoxemia, cerebral edema and ischemia. The outcomes of injuries to the nervous system are influenced by neurological status and duration of coma of the patient. The treatment for this condition include maintaining partial pressure of carbon dioxide to 26- 30 mmHg by mild hyperventilation. Intracranial hypertension is treated with IV mannitol or furosemide. Phenytoin is considered as an anti convulsant to control seizures.
