Drowning and near drowning

drowning and near drowning are the common type of accident in children. this PPT will aquaint you with the definitions, types and indetail pathophysiology and its management.

1. DROWNING AND NEAR DROWNING Presented by: Mrs.J . Samhitha Assistant professor Department of child health nursing Narayana college of nursing, nellore

2. DROWNING It is a form of asphyxia c aused due to aspiration of fluids Submersion: child airway under water Immersion: water splashed over child face

3. D efinition “A process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.” - World health organization

4. EPIDEMIOLOGY Drowning is the third leading cause of death worldwide for children aged 5-14 years. Significant proportion of drowning deaths occurring in India with more than a third occurring among under-five children. Boys are almost twice as likely as girls to drown – 9 per 100 000 versus 5.2 per 100 000 population.

5. Cont.…. The overwhelming majority (98.1%) of child drowning deaths occur in low-income and middle-income countries. Drowning deaths three times higher in rural areas than in urban areas due to open water sources in or near rural communities e.g., well, pond, river, and canal. Seasonal increase during April to September monsoon season

6. Places of drowning

7. CAUSES OF DROWNING Children younger than 1 year : • bathtub (71%) • Household buckets (16%) Children 1-4 year : • pool • Irrigation ditches • Nearby ponds & rivers. School age children • Swimming or boating activities. • Natural water reservoirs : lakes, ponds, rivers, canals.

8. Cont.…. Adolescent M : F = 10 : 1 (Likely due to greater risk taking & alcohol use.) 70 % deaths due to drowning in natural water reservoirs. Underlying conditions Epilepsy Ventricular arrhythmias Alcohol use Water sports & recreational activities

9. Classification of drowning. According to type of water Fresh-water drowning: Lakes,pools,rivers Salt-water drowning: seas (about 3% saline) According to water temperature Warm-water drowning: temperatures of > 20° C Cold-water drowning: temperatures of <20° C Very-cold-water drowning: temperatures of <5ºC

10. Types of drowning.

11. WET DROWNING Water is inhaled into lungs Victim has severe chest pain On resuscitation: no pleasant recollection Death occurs due to Cardiac arrest or ventricular fibrillation Water does not enter lungs On resuscitation: panoramic views of past life. Death occurs by immediate sustained laryngeal spasm due to inrush of water into nasopharynx and larynx DRY DROWNING

12. Secondary drowning (near drowning) Refers to a submerged victim who is resuscitated and survives for 24 hours Death occurs (from 1/2hours to several days) by cerebral anoxia & irreversible brain damage Death occurs by cardiac arrest caused by vagal inhibition (cold water stimulating nerve endings & water striking epigastrium & alcohol induce such effect) Mostly seen in suicide cases. Immersion Syndrome

13. Pathophysiology

14. Respiratory system

15. FRESH W A TER DROWNING - HYPOTONIC

16. SALT W A TER DROWNING - HYPERTONIC

17. Effects on other systems

18. STAGES of drowning Stage of surprise(5-10 secs) Stage of 1 st resp iratory arrest.(1-2 min) Stage of deep respiration (1 min) Stage of 2 nd re spiratory arrest (1 min) Stage of terminal gasp.

19. CAUSE OF DEATH

20. SIGNS AND SYMPTOMS

21. Management Pre-hospital management Hospital based management Cardiorespiratory Neurological Hypothermia Other

22. Pre hospital management A ( airway), B (breathing) and C (circulation) management Support cervical spine using hard card board Monitor po2 by pulse ox imetry administer IV fluids and oxygen Administer sodium bicarbonate to correct acidosis P rovide warmth using p assive r ewarming Rapi d transportation to health facility

23. H ospital management In emergency department Assess and reassess ABC and maintain C-Spine control Observe for 6-8 hours Check and record vital signs Monitor po2 by pulse ox imetry administer IV fluids and oxygen Perform ABG analysis, serum electrolytes and CXR

24. CARDIOPULMONARY RESUSCITATION Manage airway by endotracheal tube intubation Provide adequate oxygenation A dminister IV fluids (isotonic fluids) Persistent cardiopulmonary arrest on arrival along with * Apnea * Absence of pupillary responses. * Hyperglycemia . * Submersion durations >10 min. * Failure of response to CPR given for 25 min.

25. NEUROLOGICAL MANAGEMENT

26. OTHER MANAGEMENT ISSUES  Acute renal Failure : Diuretics, Fluid restriction. Dialysis if requ ired  Profuse bloody diarrhoea and mucosal sloughing : Bowel rest. N a sogas t ric suction.  Fever Common in 50% cases within 24 hrs Prophylactic antibiotics are recommended only if pneumonia is suspected