Chapter 25 Submersion Incidents Drowning for EMT

EMT

1. Chapter 25 Submersion Incidents: Drowning and Diving Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care , Ninth Edition Joseph J. Mistovich • Keith J. Karren

2. Water-Related Emergencies

3. https://www.youtube.com/watch?v=eRztXmSU8Tc

4. Some drownings related to swimming Many caused by diving, deep-water exploration, boating and water skiing Precautions for water safety Fence pools Supervise children Do not mix alcohol and water activities Use personal flotation devices and life preservers Water Related Emergencies

5. Definitions

6. Two common terms used in the past: drowning and near-drowning It is now recommended that all submersion incidents be referred to as a drowning : a submersion incident resulting in a primary respiratory impairment; the person may live or die Water Related Submersions

7. Incidence of Drowning

8. Third leading cause of accidental death Causes in various age groups Conditions leading to submersion

9. Pathophysiology of Drowning

10. Primary injury Second injury Surfactant Emergency medical care?

11. Primary injury Second injury Surfactant CPAP?

12. Diving Emergencies

13. You should always assume that a diver has sustained neck and spine injuries.

14. Safety Measures in Water-Related Emergencies

15. Safety around water Criteria to enter Reach, throw, row, go

16. Possible Spine Injury

17. When to suspect spine injuries Emergency care Pg 776

18. Resuscitation

19. Mammalian diving reflex Cold-water versus warm-water drowning

20. Assessment-Based Approach: Drowning and Water-Related Emergencies Scene Size-Up

21. Scene Size-Up Safety Critical in water-related emergencies Assistance from other departments

22. Assessment-Based Approach: Drowning and Water-Related Emergencies Primary Assessment

23. Primary Assessment General impression Level of responsiveness ABCs CPR if necessary Transport priority

24. Assessment-Based Approach: Drowning and Water-Related Emergencies Secondary Assessment

25. Secondary Assessment Signs and symptoms Asymptomatic Symptomatic Cardiac arrest Obviously dead

26. Assessment-Based Approach: Drowning and Water-Related Emergencies Emergency Medical Care

27. Emergency Medical Care Remove patient from water Backboard in water if necessary Place patient on left side if no spine injury suspected Prepare to suction Ventilate if necessary Begin CPR, if needed Provide gastric distention relief Manage other conditions Transport quickly

28. Assessment-Based Approach: Drowning and Water-Related Emergencies Reassessment

29. Reassessment Monitor for changes Every five minutes for unstable patient Every 15 minutes for stable patient

30. Scuba- or Deep-Water Diving Emergencies

31. Availability of scuba or deep-water diving sites Complications

32. Basic Laws of Physics Related to Scuba- or Deep-Water Diving Emergencies

33. Dysbarism - effects on the body of changes in ambient pressure Boyle ’ s Law - At a constant temperature, the volume of a gas is inversely related to the pressure Dalton ’ s Law - The total pressure of a mixture of gases equals the sum of the partial pressures of the individual gases Henry ’ s Law - At a constant temperature, the amount of gas that dissolves in a liquid it is in contact with is proportionate to the pressure of the gas around it Charles ’ s Law - All gases will expand equally upon being heated

34. Decompression Sickness Pathophysiology

35. Pathophysiology Effects on body Predisposing factors Predisposing physical characteristics Environmental factors

36. Decompression Sickness Categories of Decompression Sickness

37. Categories of Decompression Sickness Type I Decompression Sickness - mild, “The Bends,” pain occurs in the joints of the arms or legs, back, or muscles. Type II Decompression Sickness - Mild weakness or tingling may progress over hours to irreversible paralysis. Pain in back/abdomen. Inability to control bladder/bowels. Arterial gas embolism - gas bubbles enter or form in the arterial vasculature and occlude blood flow. SOB, chest pain, and confusion.

38. Decompression Sickness Barotrauma

39. Barotrauma Cause Signs and symptoms Complications

40. Decompression Sickness Emergency Medical Care

41. Emergency Medical Care Establish in-line spine stabilization Open airway Initiate CPR and apply AED Transport Hyperbaric Chamber