Water Emergencies: Prevention and Response

1. Chapter 29 Water Emergencies

2. Objectives 29.1 Compare and contrast dry drowning and wet drowning. 29.2 Describe the physiologic response of the mammalian diving reflex. 29.3 Define the following terms: • submersion injury • arterial gas embolism • drowning • decompression sickness • near-drowning continued

3. Objectives 29.4 Describe the following gas laws: • Boyle’s law • Dalton’s law • Henry’s law 29.5 List three types of barotrauma and indicate their causes. 29.6 List nine ways in which a water-based emergency may be prevented. continued

4. Objectives 29.7 List the signs and symptoms of the following water-related emergencies: • arterial gas embolism • decompression sickness 29.8 Describe how to manage a patient who has suffered a water-related emergency.

5. Topics • Anatomy and Physiology • Common Water Emergencies • Preventing Water Emergencies • Assessment • Management • Chapter Summary

6. Case Presentation • A young man is found floating in the lake near shore; you can see rocks on the bottom. No one admits to seeing what happened, although his friends pull him to the shore. He is unresponsive, cyanotic, not breathing, has a weak carotid pulse and a large gash on the top of his head.

7. Anatomy and Physiology • The breathing process • Drowning process • Dry vs. wet • Mammalian diving reflex • The gas laws • Boyle’s • Henry’s • Dalton’s

8. Anatomy and Physiology

9. Common Water Emergencies • Submersion injuries • Barotrauma • Nitrogen narcosis • Swimmer’s ear • Breath holding • Trauma • Marine animals • Aggravation of existing conditions

10. Submersion Injuries • Only the airway needs to be submerged • Types • Drowning • Near drowning • Secondary drowning • Temperature and salinity effects • Aspiration and pathogens

11. Submersion Injuries

12. Barotrauma • Affects air-filled body structures (lungs, middle ear, blood vessels, etc.). • Scuba divers mostly affected. • Types of dive injuries: • Decompression sickness • Arterial gas embolism • Squeeze and reverse squeeze

13. Swimmer’s Ear • Acute bacterial infection of the ear canal • Causes vary • Severe ear pain, yellowish discharge, and tenderness • Preventive treatments involve creating a hostile environment in the to prevent bacterial growth.

14. Breath Holding • Results from intentional hyperventilation • CO2 purge results in loss of breathing stimulus • Person may pass out without warning • Most often seen at swimming pools with children/young adults

15. Trauma • Soft tissue damage from submerged objects • Spinal injury from diving into shallow water • Injuries from falls in or around the water • Boating accidents

16. Trauma

17. Marine Animals • Traumatic or toxicologic injuries may occur • Injuries may involve soft tissues or the result of toxins

18. Preventing Water Emergencies • Behavioral precautions (i.e., avoid alcohol around water) • Knowledge of environment (i.e., watch for rip currents, never swim alone, confirm water depth, etc.)

19. Case Update • You assist in removing the patient from the water while maintaining C-spine precautions. You direct some of your companions to summon help and then immediately begin rescue breathing using a pocket mask.

20. Assessment • Standard assessment procedures to start: ABCDs, vitals, and LOC. • Ensure personal safety. • Use spinal precautions. • Take history of time in the water and pre-existing conditions. • Be aware that in near drowning, symptoms may be delayed. continued

21. Assessment • Arterial gas embolism: assess for signs and symptoms: • Assess possibility of decompression sickness (the Bends) • Type I – resolves within a short time • Type II – life threatening

22. Management • Remove from water ASAP • Establish airway, simultaneously check breathing/pulse, CPR /rescue breathing as needed • Spinal precautions • Dry the skin, treat for hypothermia and shock, use high flow oxygen • Treat other injuries • Contact DAN if diving disorder continued

23. Management continued

24. Management • Transport all patients • Symptoms may be delayed • Specialized treatment may be needed • Even if apparently dead, resuscitation may be possible, especially from cold water submersion • “They’re not dead until they are warm and dead”

25. Case Disposition • You continue rescue breathing while others dry the patient off and cover him with towels, while ensuring that full spinal immobilization is maintained. Within a few minutes, he starts to breathe on his own. Other rescuers who have arrived transport the patient to a trauma center, where he is diagnosed with a cervical spine fracture. Although his recovery will be long, he is expected to regain full neurologic function after spinal surgery.

26. Chapter Summary • Spinal cord injury should be suspected in any patient with a submersion injury to which there was no witness. • All near-drowning patients should be transported to a hospital. • Consider DCS and AGE in all patients with a history of diving. • Provide high-flow oxygen to all patients who have suffered a submersion injury. continued

27. Chapter Summary • The mammalian diving reflex may enable a person to survive prolonged submersion. • They’re not dead until they’re warm and dead!