1. Presentation 6: DROWNING
Emergency Care
CLS 243
Dr.Bushra Bilal

2. INTRODUCTION
Drowning is death within 24 hours from suffocation by submersion in a liquid, normally fresh water or sea water. It occurs more frequently in males and the young
Near drowning is survival for more than 24 hours (even if temporary) from suffocation by submersion.

3. TYPES OF DROWNING
In wet drowning, the person has inhaled water which interferes with respiration and causes the circulatory system to collapse.
In the less common instance of dry drowning, the airway closes up due to spasms caused by the presence of water

4. THREE PEAKS
Toddlers
Adolescents
Elderly

5. PREDISPOSING FACTORS Poor swimming ability Exhaustion Panic
Hypothermia
Trauma
Coma, seizures
Alcohol/Drugs
Hyperventilation
Rapidly moving water

6. PATHOPHYSIOLOGY Central Nervous System Injury Pulmonary Injury
3 Major metabolic abnormalities
Anoxia
Acidosis
Hypercapnia

7. DRY-DROWNING 10-20% of submersions Laryngospasm Hypoxia
Loss of consciousness

8. WET-DROWNING Aspiration of water Dilution of surfactant
Diminished gas transfer
Atelectasis
Ventilation perfusion mismatch

9. END ORGAN DAMAGE Renal injury Hypoxia Myoglobinuria Hemoglobinuria
Hematologic
Hemolysis
DIC

10. PREHOSPITAL CARE Resuscitation Removal from water C-spine protection
CPR ASAP

11. AIRWAY Breathing -High flow oxygen by facemask Not Breathing
Bag valve mask
Endotracheal tube
Unconscious
Protect from aspiration

12. DON’T FORGET Warm patient Hypothermia Monitor IV access
Warm isotonic fluids

13. ED TREATMENT Continue EMS care Airway Oxygen Ventilation Warmed fluids
Warming adjuncts
Treat associated injuries

14. HOSPITAL MANAGEMENT Supportive Avoid ARDS Pneumonia rare
Dopamine, epinephrine drips
48 hour window

15. PREVENTION Infants Parental vigilance Toddler Pool fencing
Adolescent/Young Adult
Control Alcohol/Drug Use
Swimming lessons
Elderly-Same as infant/toddler

16. PREVENTION Fences Self-locking gates Immersion alarms Keep pool full
Decrease intoxicants around the pool!
Proper protective gear
survival suit
Flotation device
Cold water training
Supervise patients with seizures

17. DROWNING CLAIMS
>50,000 deaths/year