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18 Cards in this Set
- Front
- Back
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Drowning and Near Drowning
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Incidence
9000 deaths annually 50,000 near drownings 40% are under the age of 5 |
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Drowning
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Death from suffocation after submersion in water or other fluid medium.
Near drowning is survival from potential drowning. |
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Causes of Drowning
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Exhaustion while swimming, entanglement under water, c-spine injury from diving, impaired judgment from alcohol or drugs
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Pathophysiology of Drowning
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Aspiration of water into the tracheal bronchial tree with resultant pulmonary edema.
Hypotonic fresh water quickly crosses the alveolar membrane and enters circulation causing fluid overload and pulmonary edema. Contaminants such as chlorine, mud, and algae breakdown surfactant and increase fluid seepage into alveoli. Hypertonic salt water draws fluid from capillary beds into alveoli causing hypovolemia and hemoconcentration. Some victims don’t aspirate due to powerful bronchospasm. Death is from airway obstruction. |
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Pathophysiology of Drowning con't
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The body attempts to compensate for hypoxia by shunting blood to the lungs. This worsening respiratory status creates high pulmonary pressure.
Poor oxygenation causes anaerobic metabolism and metabolic acidosis. |
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Survival of Drowning
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Pt have been resuscitated after submersion in cold water for up to 40 minutes.
Mammalian diving reflex improves survival. Decreases metabolic rate and oxygen demand |
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Treatment of Drowning
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Correct hypoxia
Acid base balance Fluid imbalance Support body functions Rewarm if hypothermia present |
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Treatment of Drowning con't 1
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Assess airway, breathing, circulation, immobilize c-spine.
Administer O2 100% face mask. Mechanical ventilation with positive end expiratory pressure (PEEP) or continuous positive airway pressure if pulmonary edema present. IV access NS for hemodynamic stability Mannitol or Lasix to decrease free water and cerebral edema (deterioration in neuro status |
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Treatment of Drowning con't 2
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Warm pt if needed
Observe in hospital 24 hr can have a delayed pulmonary edema. Pt and family education – adequate pool gates, life jackets, CPR, water safety, avoiding alcohol or drugs with water sports. |
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A child is brought into the ER in a near drowing in fresh water. The nurse expects these s/s?
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fluid overload and pulmonary edema
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A child is brought into the ER in a near drowing in fresh water. The nurse expects these other possible s/s?
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contaminants such as chlorine, mud and algea will breakdown surfactant and increase fluid seepage into the aveoli
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A child is brought into the ER in a near drowing in salt water. The nurse expects these s/s?
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opposite- draws fluid from capillary beds into the aveoli causing hypovolemia and hemoconcentration
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A teenager is brought into the ER due to drowning. After death there are no signs of fluid in the lungs. The nurse knows this is because?
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He apparently did not aspirate water but had a powerful bronchospasm that caused an airway obstruction
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The nurse knows that a powerful bronchospam is caused by?
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the body trying to compensate for hypoxia by shunting blood to the lungs, which just worsens respiratory status by creating high pulmonary pressure
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The nurse knows that hypoxia in a drowing victum causes?
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anaerobic metabilism and metabolic acidosis
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The nurse overhears the doctor talking about a near drowing victum that was underwater in a cold pond for 30 mins. They make mention of a reflex that helped this victum stay alive. What is it?
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Mammalian diving reflex- it decreases metabolic rate and oxygen demand
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There is word that a near drowing victum will be brought to the ER soon. The nurse goes over what needs to be done generally, in order of priorty.
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Correct hypoxia -ABC
correct the acid base balance Fluid imbalance support body function rewarm if hypothermia present |
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There is word that a near drowing victum will be brought to the ER soon. The nurse goes over what needs to be done immediatly in order of priorty.
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1. ABC's assess airway, circulation
2. immobilize C-spine 3. administer O2 100% face mask 4. ventilation by PEEP or continous positive airway pressure if pulmonary edema is present 5. IV assess for hemodynamic stability 6. Mannitol or Lasix to decrease free water and cerebral edema |
