Drowning and Near Drowning

1. Drowning and Near Drowning • Drowning • Death as a result of suffocation after submersion in water • Near drowning • Survival, at least temporarily, after suffocation in water

2. Drowning Process

3. Spinal Injuries in SubmersionIncidents • Suspect spinal injury if: • Submersion has resulted from a diving mishap or long fall. • Patient is unconscious. • Patient complains of weakness, paralysis, or numbness.

4. Spinal Stabilization in Water • Turn the patient supine. • Restore the airway and begin ventilation. • Secure a backboard under the patient. • Remove the patient from the water. • Cover the patient with a blanket.

5. Resuscitation Efforts • Hypothermia can protect vital organs from hypoxia. • Documented case of a survivor of a 66-minute cold water submersion • Diving reflex may cause heart rate to slow.

6. Diving Problems • Descent problems • Usually due to the sudden increase in pressure on the body as the person dives • Bottom problems • Not commonly seen • Ascent problems • Air embolism and decompression sickness

7. Signs and Symptomsof Air Embolism (1 of 2) • Blotching • Froth at the mouth and nose • Severe pain in muscle, joints, or abdomen • Dyspnea and/or chest pain

8. Signs and Symptomsof Air Embolism (2 of 2) • Dizziness, nausea, and vomiting • Dysphasia • Difficulty with vision • Paralysis and/or coma • Irregular pulse or cardiac arrest

9. Decompression Sickness (The Bends) • Occurs when bubbles of gas obstruct blood vessels • Can result from rapid ascent • Most common symptom is abdominal and/or joint pain. • Symptoms may develop after hours. • Treatment is BLS and hyperbaric chamber.

10. Scene Size-up • Never drive through moving water; be cautious driving through still water. • Never attempt water rescue without proper training and equipment. • Consider trauma and spinal stabilization. • Check for additional patients.

11. Initial Assessment • Pay attention to chest pain, dyspnea, complaints of sensory changes. • Be suspicious of alcohol use. • Maintain airway; suction. • If pulse cannot be obtained, begin CPR per guidelines. • Evaluate for shock and adequate perfusion. • Treat trauma.

12. Transport Decision • Always transport near-drowning patients to hospital. • Decompression sickness and air embolism must be treated in recompression chamber. • Perform interventions en route.

13. Focused History and Physical Exam • If responsive, perform exam on lungs and breath sounds. • If unresponsive: • Look for signs of trauma or complications. • Check divers for indications of air embolism or bends. • Focus on pain in joints and abdomen. • Check for signs of hypothermia; complete Glasgow Coma Scale score.

14. Baseline Vital Signs/SAMPLE History • Check pulse rate, quality, rhythm. • Check peripheral, central pulses. • Check for pupil size, reactivity. • Determine length of time patient was underwater or time of onset of symptoms. • Note physical activity, alcohol/drug use, other medical conditions. • Determine dive parameters in history depth, time, previous dive activity.

15. Drowning Interventions • Begin artificial ventilations as soon as possible. • Stabilize and protect spine. • Maintain patent airway. If there is no spinal injury, turn patient on side to allow draining from upper airway. • Make sure patient is warm, especially after cold-water immersion.

16. Diving Interventions • Remove patient from water. • Begin BLS; administer oxygen. • Place patient in left lateral recumbent position with head down. • Provide prompt transport to nearest recompression facility. • Administer oxygen and provide rapid transport.

17. Detailed Physical Exam • Examine respiratory, circulatory, neurologic systems. • Distal circulatory, sensory, and motor function tests determine extent of injury. • Examine for peripheral pulses, skin color, and discoloration, itching, pain, numbness/tingling.

18. Ongoing Assessment • May deteriorate rapidly • Assess mental status frequently. • Document: • Circumstances of drowning and extrication • Time submerged • Temperature of water • Clarity of water • Possible spinal injury • Bring dive log, dive computer, and dive equipment to hospital.

19. Other Water Hazards • Hypothermia from water immersion • Breath-holding syncope • Injuries from recreational equipment or marine animals

20. Prevention • Pools should be surrounded with appropriate enclosures. • Alcohol involved in adult and teenage drownings.

21. Lightning • Strikes boaters, swimmers, golfers, anyone in large, open area • Cardiac arrest and tissue damage are common. • Three categories of lightning injuries • Mild: Loss of consciousness, amnesia, tingling, superficial burns • Moderate: Seizures, respiratory arrest, asystole (spontaneously resolves), superficial burns • Severe: Cardiopulmonary arrest

22. Emergency Medical Care • Protect yourself. • Move patient to sheltered area or stay close to ground. • Use reverse triage. • Treat as for other electrical injuries. • Transport to nearest facility.

23. Spider Bites • Spiders are numerous and widespread in the US. • Many species of spiders bite. • Only the female black widow spider and the brown recluse spider deliver serious, even life-threatening bites. • Your safety is of paramount importance.

24. Found in all states except Alaska Black with bright red-orange marking in hourglass shape on abdomen Venom poisonous to nerve tissue Requires patient transport as soon as possible Black Widow Spider

25. Mostly in southern and central US Short-haired body has violin-shaped mark, brown to yellow in color, on its back. Venom causes local tissue damage. Area becomes swollen and tender, with pale, mottled, cyanotic center. Requires patient transport as soon as possible. Brown Recluse Spider

26. Snake Bites • 40,000 to 50,000 reported snake bites in the US annually. • 7,000 bites in the US come from poisonous snakes. • Death from snake bites is rare. • About 15 deaths occur each year in the US.

27. Four Types of Poisonous Snakesin the US Cottonmouth Rattlesnake Copperhead Coral snake

28. Pit Vipers • Rattlesnakes, copperheads, and cotton mouths • Store poison in pits behind nostrils • Inject poison to victim through fangs

29. Signs and Symptomsof a Pit Viper Bite • Severe burning at the bite site • Swelling and bluish discoloration • Bleeding at various distant sites • Other signs may or may not include: • Weakness – Fainting • Sweating –Shock

30. Care for Pit Viper Bites (1 of 2) • Calm the patient. • Locate bite and cleanse the area. • Do not apply ice. • Splint area to minimize movement. • Watch out for vomiting caused by anxiety. • Do not give anything by mouth.

31. Care for Pit Viper Bites (2 of 2) • If the patient is bitten on the trunk, lay the patient supine and transport quickly. • Monitor patient’s vital signs. • Mark the swollen area with a pen. • Care for shock if signs and symptoms develop. • Bring the snake to hospital if it has been killed.

32. Coral Snakes • Small snake with red, yellow, and black bands • “Red on yellow will kill a fellow, red on black, venom will lack.” • Injects venom with teeth, using a chewing motion that leaves puncture wounds • Causes paralysis of the nervous system

33. Care for Coral Snake Bites (1 of 2) • Quiet and reassure the patient. • Flush the area with 1 to 2 quarts of warm, soapy water. • Do not apply ice. • Splint the extremity. • Check and monitor baseline vital signs.

34. Care for Coral Snake Bites (2 of 2) • Keep the patient warm and elevate the lower extremities to help prevent shock. • Give supplemental oxygen if needed. • Transport promptly. Give advance notice to hospital of coral snake bite. • Give the patient nothing by mouth.

35. Scorpion Stings • Venom gland and stinger found in the tail end. • Mostly found in southwestern US • With one exception, the Centruroides sculpturatus, most stings are only painful. • Provide BLS care and transport.

36. Tick Bites (1 of 3) • Ticks attach themselves to the skin. • Bite is not painful, but potential exposure to infecting organisms is dangerous. • Ticks commonly carry Rocky Mountain spotted fever or Lyme disease.

37. Tick Bites (2 of 3) • Rocky Mountain spotted fever develops 7 to 10 days after bite. • Symptoms include: • Nausea, vomiting • Headache • Weakness • Paralysis • Possible cardiorespiratory collapse

38. Tick Bites (3 of 3) • Lyme disease has now been reported in over 35 states. • Lyme disease symptoms may begin 3 days after the bite. • Symptoms include: • Target bull’s-eye pattern • Rash • Painful swelling of the joints

39. Caring for a Tick Bite • Do not attempt to suffocate or burn tick. • Use fine tweezers to grasp tick by the body and pull it straight out. • Cover the area with disinfectant and save the tick for identification. • Provide any necessary supportive emergency care and transport.

40. Injuries from Marine Animals • Coelenterates are responsible for more envenomations than any other marine life animal • Have stinging cells called nematocysts • Results in very painful, reddish lesions • Symptoms include headache, dizziness, muscle cramps, and fainting.

41. Care for Marine Stings • Limit further discharge by minimizing patient movement. • Inactivate nematocysts by applying alcohol. • Remove the remaining tentacles by scraping them off. • Provide transport to hospital.