Submersion Injuries Richard Dionne MD CCFP-EM Assistant Professor Emergency Medicine - Ottawa Hospital- University of Ottawa Associate Medical Director - Regional Paramedic Program for Eastern Ontario Fellowship Director EMS & Disaster Medicine April 1 st , 2010
29
Embed
Submersion Injuries Richard Dionne MD CCFP-EM Assistant Professor Emergency Medicine - Ottawa Hospital-University of Ottawa Associate Medical Director.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Submersion Injuries
Richard Dionne MD CCFP-EMAssistant Professor Emergency Medicine - Ottawa Hospital-University of OttawaAssociate Medical Director - Regional Paramedic Program for Eastern Ontario
Fellowship Director EMS & Disaster Medicine April 1st , 2010
Near Drowning Objectives
• Understand causal conditions
• Differentiate between fresh & salt water drownings
• Identify potential injuries
• Select appropriate diagnostic & management
• Consider treatment of hypothermia & trauma
Diving Emergency?
Definitions
• Drowning: – terminal outcome from submersion event
• Near-drowning: AHA no longer uses
• Submersion Injuries: – survival, at least temporarily, after suffocation in a
liquid medium
• 3rd most common cause of accidental death overall, leading cause in < 5 yo
• ETOH / Drugs often associated
Risk Factors
• Inability to swim (overestimation of capabilities)
• Risk taking behaviour
• Inadequate supervision (bathtub, pools)
• Co morbidity: trauma, seizure, CVA, cardiac
Pathophysiology
Aspiration of 1-3 mL/kg destroys integrity of pulmonary surfactant
• Prolonged duration of submersion better tolerated
• Risks of malignant dysrhytmias
Poor Prognostic Factors
• > 10 minutes submersion• CPR initiated >10 min after rescue• Severe acidosis (pH < 7.1)• Unreactive pupils• GCS = 3 (comatose)• Hypothermia in ED ?• Need for ongoing CPR• Lack of spontaneous movement at
24hrs
Who can go home?
• Asymptomatic on presentation• Maintains normal room air sat• No CXR or ABG abnormalities …… D/C after 8 hour observation
Prevention
Children supervision
CPR courses to families with pools
Boating sobber & lifevests
Diving injuries
Caution: CAD / Seizure / Diabetics
Submersion Injuries: Overview
• Immediate resuscitative efforts is key!
• Consider associated trauma, ETOH/drugs
• Development of pulmonary injury may take time, initial CXR may be normal
• No clinical difference b/w salt & fresh H2O
• Majority of treatment is supportive, rewarming & not underestimate … Prevention !!!
• Monitor x 6-8 hr for asymptomatic pt with normal investigations