Drowning م عدل.pptx

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1. Drowning

2. By: Omar Al radaee Ali Aldhaibani Mohammed mageed

3. Definition: Is the process of experiencing respiratory impairment from submersion/immersion in liquid.

4. Epidemiology Peak age : children <5years Leading cause of unintentional injury death in children ages 1-4years M:F = 4 :1

5. pathophysiology Submersion aspiration od small amounts of fluid into the larynx breath holding or laryngospasm (activation of inspiration reflex within 1-2 min) larger volumes of water are aspirated into the lungs destroying surfactant, alveolitis and dysfunction of alveolar-capillary gas Exchange. hypoxemia leads to multi-organ affected ( hypoxic brain injury ).

6. Clinical manifestation Tachypnea and tachycardia. increased work of breathing. Decreased breath sound with or without crackles. cold extremities cyanosis due to hypo perfusion and laryngospasm Altered mental status. Seizures.

7. Investigations ABG: help in assessment of pulmonary gas exchange.(detect metabolic and /or resp acidosis) Liver function tests and renal function tests: liver enzymes maybe elevated ; if hypoxemia and ischemia were of long duration. Serum electrolytes. CXR.( to confirm the Dx of pulm . Edema)

8. Treatment 1-Pre hospital Care : 1-Rapid resuscitation of drowning victim[ quickly restoring ventilation and oxygenation ] cervical spine precautions 2-CPR : initial resuscitation

9. 2- Hospital treatment : 1- stabilization [ ABC ] •Airway → clear and Patency . ETT is need it [ apnea - Cyanosis hypoventilation ] • Breathing supplement O₂ •Circulation → IV fluid : - 0.9 % normal slain 2 - supportive or symptomatic : treatment any associated injury or condition : 1-bronchodilators . 2-antibiotic for contaminated water . 3-anticonvolsion for seizure 4-diuretic for Pulmonary edema 5-dextrose 0.5-1g / kg for hypoglycemia 6-rewarming in case of hypothermia

10. Emergency department management Supplementation of oxygen Via noninvasive positive pressure ventilation : in patients without neurological deterioration and with an Spo2 >90% Via endotracheal tube : in patients with signs of neurological deterioration or with an Spo2 <90% oxygen saturation should be between 92- 96%

11. Complications ARDS(acute respiratory distress syndrome ) Pulmonary edema Pneumothorax Acute tubular necrosis (due to hypoxemia) Brain death Elevated intracranial pressure Infection (e.g., pneumonia , meningitis ) Cardiac arrest

12. Prognosis Favorable: 1- The success of immediate resuscitation efforts. 2- Patient Regained consciousness on arrival at hospital intact neurological function. Unfavorable: 1- CPR delayed > 10min. 2- Glasgow coma scale of 5 or less. 3- Fixed, dilated pupils, seizure. 4- coma for more than 72hrs.

13. Prevention Life jacket. Swimming with partner. Lifeguard. Learning to swim. Public education.