DAY THREE: Submersion injuries with Cassie Woodwall, PA-C
Every year, drowning accounts for at least 500,000 deaths worldwide
Epidemiology:
Age distribution of submersion injury is bimodal.
Risk factors
Inadequate adult supervision
Inability to swim or overestimation of swimming capabilities
Risk-taking behavior
Use of alcohol and illicit drugs (more than 50 percent of adult drowning deaths are believed to be alcohol related)
Hypothermia
Seizure disorder or developmental/behavioral disorders in children
Pathophysiology
Laryngospasm when water enters
One bad organ system is always been in drowning cases (either lung or brain)
End organ effects
Hypoxemia ultimately produces tissue hypoxia, which affects virtually all tissues and organs within the body
Pulmonary
Neurologic
Cardiovascular
Acid-base and electrolytes
Renal
coagulation
Sodium attracts water and it moves it away from the brain
Management
Prehospital car, emergency department (ED) care, and impatient care
Cervical spinal cord injury is uncommon in nonfatal drowning and clinians moves with caution
Inpatient management
Neurologic injuries
Duration of loss of consciousness and the neurologic state of the patient upon presentation
The goal of hospital management is to prevent secondary neurologic injuries due to ongoing ischemia, etc
The head fo the bed should be elevated to 30 degrees if potential cervical spine injuries
Diuretics can be used to avoid hypervolemia, but care should be taken to avoid volume depletion
For patients in imminent danger of cerebral herniation, hyperventilation may be used acutely as a temporising measures to reduce intracranial pressure by decreasing intracranial blood volume
Neurologic injuries
Seizure activity,which increases cerebral oxygen consumption and blood flow
Neuromuscular blocking agents should be avoided
Both hypoglycemia and hyperglycemia
Cardiovascular: hypovolemia and hypotension due to a cold diuresis. This occurs because during the early phase of vasoconstriction, blood moves to the core, causing central volume receptors to sense fluid overload and resulting in decreased antidiuretic hormone production
Comments