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بسم الله الرحمن الرحیم

بسم الله الرحمن الرحیم. NEAR-DROWNING. DEFINITION. DROWNING :submersion injuries that result in death in less than 24 h. NEAR-DROWNING : survival longer than 24 h after a submersion event. EPIDEMIOLOGY. In the U.S., drowning is the forth leading cause of accidental death overall.

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بسم الله الرحمن الرحیم

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  1. بسم الله الرحمن الرحیم

  2. NEAR-DROWNING

  3. DEFINITION • DROWNING :submersion injuries that result in death in less than 24 h. • NEAR-DROWNING : survival longer than 24 h after a submersion event.

  4. EPIDEMIOLOGY • In the U.S., drowning is the forth leading cause of accidental death overall. • It’s the second cause of death in those under 15 years of age. • Additional injuries or disorders that either precipitate or are associated with submersion events include: 1 ) spinal cord injuries 2 ) hypothermia 3 ) panicking 4 ) syncope 5 ) seizures 6 ) other premorbid condition ( e.g., heart disease )

  5. PREVENTION • Child abuse should be considered with the victim is less than 6 months of age, or in toddlers with atypical presentations. • Teen and young adult drowning may be reduced by the control of alcohol and illicit drug consumption. • Drowning locations in elderly closely parallel locations of infant and toddler drowning.

  6. PATHOPHYSIOLOGY • After submersion, the degree of pulmonary, and in particular central nervous system (CNS) insult determines the ultimate outcome. • Diving reflex ( i.e., bradycardia, apnea, peripheral vasoconstriction, and central shunting of blood flow) is protection mechanism. • Diving reflex is stronger in infants < 6 months old, but the effects decrease with age. • In fresh-water aspiration, there is transient hemodilution, and if large enough volumes are aspirated, significant hemolysis is possible. • Rarely, DIC can be a complicating factor in near-drowning.

  7. TREETMENT • Prehospital care : - rapid, cautious rescue - spinal precautions - cardipulmonary resusciation - supplemental oxygen ( all patients ) - transport ( all patient ) • Emergency department and hospital care

  8. PRESENTATION GCS >= 13 cervical spine clear ______________________ Ancillary test only as indicated _________________________ Respiratory Oxygen to Support keep Sao2 > 95 % Monitor O2 saturation PRESENTATION GCS < 13 _______________________ Clear _______________________ CXR-ECG-ABG-CBC-BS-PT/PTT Electrplytes-UA-CK-urine myoglobin-urine drug screen _____________________________ Oxygen to keep Sao2 > 95% Intubation and positive-pressure ventilation as needed ( PEEP-CPAP ) _________________________________ Oxygen saturation-Acid base status Temperature-Volume status ( urine output, CVP HOSPITAL CARE OF SUBMERSION VICTIMS

  9. PROGNOSIS AND DISPOSITION • Uncomplicated : 4 to 6 h observed. • Complicated : frequently, neurologic and cardiovascular examinations are normal within 24 h of the submersion event. • Victims who later die in hospital usually demonstrate deteriorating cardiovascular status. • Victims undergoing ED CPR have a poor prognosis.

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