Drowning accounts for 500,000 deaths worldwide, 4,000 the US is responsible.
Most commonly being in toddlers
Nonfatal drowning is generally defined as survival at least temporarily after suffocation in a liquid medium
Southern and coastal states are usually at highest risk of drowning
However, the bathtub surpasses any reason.
This cases tends to be toddlers and young children, they require not that large amount to drown in
One of the most public cases was when a group of six anesthesiologists vacationed together and had a large group, they were all together and one of the toddlers was found in the pool.
She is now a water safety advocate
Drowning is fast
Risk factors
Inadequate adult supervision
Inability to swim
Risk taking behavior
Use of alcohol and drugs
Hypothermia
Trauma, stroke, cardiac dysfunction
Seizure disorder\
prolong qt system,
Pathophysiology
Fatal and nonfatal drowning typically begins with a period of panic
Breathing pattern and struggle affects survival rates
Components of morbidity and mortality being related to hypoxia
High oxygen level in blood
Low oxygen level in tissue
Brain will be most difficult and have the most issues
Organs are affected but not as long or severe
Heart
Acid based electrolytes
Kidneys
Acute kidney injury
Every other organ in the body will recover if they get blood flow back, the brain is the only problem at this point
Coagulation- or body does not do well cold
If you arrive to the er and you are awake, alert, and aware, the doctors must watch you for oxygen levels for seven hours
However if you lose any amount of oxygen, you will be immediately admitted
Cervical spine injury
Uncommon in drowning patients
Can't intubate and extend the neck if there is a spine injury
High level of suspicion
Two organs most significant in the ICU is the brain and the lungs
You cannot survive without the brain
If there was a pulse back at the scene then there will be some degree of meaningful recovery because of the short amount of time without a heartbeat
If there was not a pulse back at the scene, the next question would be do they have the pulse back once given to the EMS
Typically without a pulse upon arrival, this will be a devastating injury
At this point, she will try to minimize swelling and death
Goal from this point forward is to keep the body normal and quiet
Keep the head elevated
Keep head midline
This is a global energy to the whole brain
Hypoxic anoxic
Traumatic brain injury is usually blunt force trauma, one
Neurosurgery will take off a piece of the skull off to let the brain swell outside of the skull
This only applies to small places
You cannot use this tactic in drowning because the whole brain is affected
At this point, brain dead and no responsiveness is the expected result
You cannot have fluid overload or overhydration
Only thing we can manipulate is fluid, blood, brain
By manipulating blood,when CO2 is low it decreases blood transport to the brain. In vice versa with an increase in blood flow, it will create more pressure
However, with such a low CO2 amounts, then you could risk a stroke
What we do is keep CO2 levels 35-38, completely normal
Body is regulated by ph
Manipulating ventilator to maintain a completely normal ph
Keep everything normal except for the sodium level
Sodium and glucose are the two big molecules
Water tends to follow these
When your body is in a stress state, every cell in your body produces glucose and your liver creates large amount
If you bring the glucose down, you have low blood glucose which is much more dangerous than high
It will cause a seizure every single time
Every cell with water will follow sodium
We will make your sodium count higher to lead the water out through urine
a brain under stress is at a very high risk for seizure
Your thermoregulatory center is in the brain
It is very common for patients to have high body temps and have fever
Might have to put them on a cooling blanket to cool them down
When put on cooling blankets, they will shiver and you will have to put them on a medicine that paralyzes them
However you won't be able to tell if they're having a seizure so you will have to put them on an EG to regulate their state.
When you regress to brain death, it is when the brain has no more blood flow and the brain will die
Herniation is the medical term for this
When this happens, you have to do brain death exams, at the second exam of brain death, it is the time of death
Your highest likeness of regressing to brain death is two-three days
If not the brain, the lungs are your cause for the state
Surfactant is the liquid we make to help keep us alive
It has been attempted to give the lungs surfactant to help cure the lungs
Pulmonary edema is inside the lung itself, you cannot drain this synthetically.
Cardiovascular
When you first come into the ICU, your blood vessels clamp down to get blood to the heart and brain, as they rewarm blood pressure may suddenly drop
Outcome
Highly dependent on return of the pulse and the time between pulse back and lost pulse
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