Biomed Day Two

• Drowning and airway intervention

  • Sobering up on stats

    • Children under 1 drowns in bathtubs

    • 1-4 y/o in pool (adventurers)

    • 14-17 y/o beach

    • Men die twice as much as women in water

  • Deets

    • Country club in summer

    • 18 y/o female has seizure in pool, rapidly sinks to bottom. 3 min later someone screams

    • Unresponsive, not breathing, no pulse, places AED non-shockable rhythm

    • Call ems

    • Packaged transported by EMS to ER: down time 12 min

  • Who wants to define drowning

    • Drowning is the process of experiencing respiratory impairment from submersion in liquid

      • Drowning outcomes classified as “death, morbidity, and no morbidity”

  • Drowning the myths

    • No such thing as wet drowning and dry drowning

      • These terms should be avoided entirely, drowning in drowning

    • There is no near drowning

      • Its a submersion injury

    • Saltwater vs. fresh water

      • Same

  • Drowning associated injuries

    • Hypothermia

    • Seizures

    • Sudden cardiac arrest

    • Trauma

  • Loss of normal breathing pattern, eventual hypoxemia, involuntary inspiration, aspiration, water in respiratory tract, laryngospasm

    • Water causes non-cardiogenic pulmonary edema, oxygen transport problem

    • Low oxygen to tissues

    • 20% have neurological injury

  • EMS report: O2 at pickup is 10% spO2, CPR ongoing

    • Take over for EMS

    • Airway supremacy

      • Min sp)2 goal > 94%

      • Can use NIPPV adjuncts

    • Strip and flip : look for trauma

    • Stab and lab:

    • Stop the seizure

    • Intubated and sedated

      • propofol/ketamine

      • Loaded with anti-epileptic

      • 2 rounds compressions

    • Neurologically in COMA, vitally improving

    • Where should patient go? ICU

    • Who should they talk to? Neurology, neurosurgery, cardiology, general surgery

  • I/O