Submersion injury - Revision history

Rossdonaldson1: /* Video */

2024-04-17T20:09:46Z

Video

← Revisión anterior		Revisión del 20:09 17 abr 2024
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	*[[Water-related injuries]]		*[[Water-related injuries]]
	*[[Immersion pulmonary edema]]		*[[Immersion pulmonary edema]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=FznXbFcHLdM}}~~

	==References==		==References==

Rossdonaldson1 at 12:43, 29 May 2022

2022-05-29T12:43:01Z

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 *[[ACS]]
 *[[Non-accidental trauma]]
 ===Pathophysiology===
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 **Normal mental status, SpO2 >95% on room air, normal CXR and respiratory exam
 *Admit all others
 ==See Also==

Rossdonaldson1: /* Drowning OutcomesSzpilman, David; Bierens, Joost J.L.M.; Handley, Anthony J.; Orlowski, James P. (4 October 2012). "Drowning". The New England Journal of Medicine. 366 (22): 2102–2110. doi:10.1056/NEJMra1013317. PMID 22646632. */

2022-05-29T12:40:16Z

Drowning OutcomesSzpilman, David; Bierens, Joost J.L.M.; Handley, Anthony J.; Orlowski, James P. (4 October 2012). "Drowning". The New England Journal of Medicine. 366 (22): 2102–2110. doi:10.1056/NEJMra1013317. PMID 22646632.

← Revisión anterior		Revisión del 12:40 29 may 2022
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	\| nearly 100%		\| nearly 100%
	\|-		\|-
	~~\| colspan="2" \| Signs of brain-stem injury predict death or severe neurological consequences~~
	\|}		\|}
			^Signs of brain-stem injury predict death or severe neurological consequences

	==See Also==		==See Also==

Rossdonaldson1: /* Disposition */

2022-05-29T12:39:28Z

Disposition

@@ Línea 95: / Línea 95: @@
 **Normal mental status, SpO2 >95% on room air, normal CXR and respiratory exam
 *Admit all others
 ==See Also==

Idreamtichased at 18:00, 28 April 2022

2022-04-28T18:00:52Z

Rossdonaldson1: /* ClassificationSzpilman D. Near-drowning and drowning classification:a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 112(3):660-665, 1997. */

2021-03-25T16:44:18Z

ClassificationSzpilman D. Near-drowning and drowning classification:a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 112(3):660-665, 1997.

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	\| 5 \|\| Unresponsive but has a pulse \|\| Positive pressure ventilation with likely progression to intubation, IV fluids and vasopressors if needed, admit to ICU \|\| ~60%		\| 5 \|\| Unresponsive but has a pulse \|\| Positive pressure ventilation with likely progression to intubation, IV fluids and vasopressors if needed, admit to ICU \|\| ~60%
	\|-		\|-
	\| 6 \|\| Unresponsive with no pulse after 5 rescue breaths \|\| ACLS protocol \|\| 7%		\| 6 \|\| Unresponsive with no pulse after 5 rescue breaths \|\| [[ACLS]] protocol \|\| 7%
	\|}		\|}

Rossdonaldson1: /* Evaluation */

2021-03-25T16:43:56Z

Evaluation

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	===Diagnosis===		===Diagnosis===
	*Typically a clinical diagnosis		*Typically a clinical diagnosis
	*Classification
			===Classification<ref>Szpilman D. Near-drowning and drowning classification:a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 112(3):660-665, 1997.</ref>===
	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-
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	\|-		\|-
	\| 6 \|\| Unresponsive with no pulse after 5 rescue breaths \|\| ACLS protocol \|\| 7%		\| 6 \|\| Unresponsive with no pulse after 5 rescue breaths \|\| ACLS protocol \|\| 7%
	\|} ~~<ref>Szpilman D. Near-drowning and drowning classification:a proposal to stratify mortality based on the analysis of 1,831 cases. Chest 112(3):660-665, 1997.</ref>~~		\|}

	==Management==		==Management==

Bobbycarey: /* Background */

2021-03-11T06:09:06Z

Background

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	*Definition: "The process of experiencing respiratory impairment from submersion/immersion in liquid"<ref name="WHO">World Health Organization (WHO) "Global Report on Drowning". http://www.who.int/violence_injury_prevention/global_report_drowning/Final_report_full_web.pdf (Accessed 02/01/2017)</ref>		*Definition: "The process of experiencing respiratory impairment from submersion/immersion in liquid"<ref name="WHO">World Health Organization (WHO) "Global Report on Drowning". http://www.who.int/violence_injury_prevention/global_report_drowning/Final_report_full_web.pdf (Accessed 02/01/2017)</ref>
	**Term "near-drowning" no longer used		**Term "near-drowning" no longer used
	*Three possible outcomes = death, survival with morbidity, survival without morbidity

	===Consider Secondary Causes===		===Consider Secondary Causes===

Bobbycarey: /* Evaluation */

2021-03-11T06:07:00Z

Evaluation

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 ===Diagnosis===
 *Typically a clinical diagnosis
 ==Management==

Elcatracho: /* Pathophysiology */

2021-02-06T01:30:16Z

Pathophysiology

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	*Submersion → voluntary breath holding → aspiration → coughing/laryngospasm → aspiration continues → hypoxia → death<ref name="Szpilman">Szpilman, D., Bierens, J. J., Handley, A. J., & Orlowski, J. P. (2012). Drowning. N Engl J Med, 366(22), 2102-2110. doi: 10.1056/NEJMra1013317</ref>		*Submersion → voluntary breath holding → aspiration → coughing/laryngospasm → aspiration continues → hypoxia → death<ref name="Szpilman">Szpilman, D., Bierens, J. J., Handley, A. J., & Orlowski, J. P. (2012). Drowning. N Engl J Med, 366(22), 2102-2110. doi: 10.1056/NEJMra1013317</ref>
	*Aspiration destroys surfactant which → alveolar collapse, atelectasis, non-cardiogenic pulmonary edema, and V-Q mismatch.		*Aspiration destroys surfactant which → alveolar collapse, atelectasis, non-cardiogenic pulmonary edema, and V-Q mismatch.
			*Fresh vs salt water has no clinical relevance<ref>Orlowski JP, Szpilman D. Drowning. Rescue, resuscitation, and reanimation. Pediatr Clin North Am. 2001;48(3):627-646. doi:10.1016/s0031-3955(05)70331-x</ref>

	==Clinical Features==		==Clinical Features==

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	==Management==		==Management==
	===Prehospital===		===Prehospital===
	*Immediate ~~recitation~~ if indicated <ref>Schmidt AC, et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning. Wilderness Environ Med. 2016 Jun;27(2):236-51</ref>		*Immediate resuscitation if indicated <ref>Schmidt AC, et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning. Wilderness Environ Med. 2016 Jun;27(2):236-51</ref>
	*Assess need for [[CPR]] but do not delay removal from water		*Assess need for [[CPR]] but do not delay removal from water
	*Ventilation is a higher priority in drowning victims in cardiac arrest than in other situations requiring CPR		*Ventilation is a higher priority in drowning victims in cardiac arrest than in other situations requiring CPR
	*Deliver two rescue breaths immediately upon reaching shallow water or a stable surface; early breaths have been associated with improved survival <ref>Szpilman D, et al. In-water resuscitation: Is it worthwhile? Resuscitation 2004; 63: pp. 25</ref>		*Deliver two rescue breaths immediately upon reaching shallow water or a stable surface; early breaths have been associated with improved survival <ref>Szpilman D, et al. In-water resuscitation: Is it worthwhile? Resuscitation 2004; 63: pp. 25</ref>
	*If no response to rescue breaths with chest rise, continue to standard CPR algorithm		*If no response to rescue breaths with chest rise, continue to standard CPR algorithm
	*Administer high flow 02 and intubate apneic patients		*Administer high flow O2 and intubate apneic patients
	*Do not routinely immobilize c-spine without suspicion based on mechanism or clinical signs <ref>Vanden Hoek TL et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S829</ref>		*Do not routinely immobilize c-spine without suspicion based on mechanism or clinical signs <ref>Vanden Hoek TL et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S829</ref>

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	**Comatose or unable to protect airway		**Comatose or unable to protect airway
	**Hypoxemia or hypercapnia on [[ABG]] despite high flow O2 (PaO2 below 60, PaCO2 above 50)		**Hypoxemia or hypercapnia on [[ABG]] despite high flow O2 (PaO2 below 60, PaCO2 above 50)
	*Continue ~~recitation~~ efforts in hypothermic patients until core temperature rises to at least 30 C (not dead until warm and dead) <ref>American Heart Association; ILCOR : Submersion or near-drowning. Circulation 2000; 102: pp. I-233</ref>		*Continue resuscitation efforts in hypothermic patients until core temperature rises to at least 30 C (not dead until warm and dead) <ref>American Heart Association; ILCOR : Submersion or near-drowning. Circulation 2000; 102: pp. I-233</ref>
	*Routine antibiotics in ED are not necessary, but broad spectrum coverage may be indicated for submersion in heavily contaminated water		*Routine antibiotics in ED are not necessary, but broad spectrum coverage may be indicated for submersion in heavily contaminated water