Anyone from the ages 2 days- 19 years old go to her in the ICU
NONFATAL OR SUBERMISON INJURIES
NonFatal Drowning
Nonfatal drowning is generally defined as survival (temporary or long term)
Epidemiology
In the United States, drowning is a major cause of accidental death among persons under the age of 45. Drowning is more common in the southern states and in the summer months. The age distribution of submersion injury is bimodal.
- a frequency curve characterized by two peaks
Risk Factors
Some risk factors for a submersion injury are:
inadequate adult supervision
inability to swim
risk-taking behavior
use of alcohol/drugs
hypothermia
trama
Medical Risks
seizure disorder
cardiac arrhythmia
hyperventilation
Seizure disorders and cardiac arrhythmias are more common than hyperventilation. This can all lead to hypoxemia.
- lack of oxygen
Hypoxemia affects all organs.
Organ Affects
Hypoxemia will produce tissue hypoxemia. The most severe organs will be the brain and heart, specifically the brain. There are also ones that are less severe and more likely to recover: cardiovascular, acid-base & electrolytes, renal, and coagulation (cold).
Management
Management in the ICU can be divided into three phases; prehospital care, ED care, and inpatient care.
Prehospital care and acute intervention
- Rescue and immediate resuscitation by bystanders improves the outcome of
drowning victims.
Ventilation
- Ventilation is considered one of the most important treatments for submersion injury patients.
Inpatient care
- Neurological injuries
- There is not a set recovery for brain injuries
- The patient is more likely to survive if there was a pule at the scene
- The major determinants of neurologic outcome are the duration of
consciousness and the neurologic state of the patient upon presentation.
- The goal is to prevent secondary neurological injury
TREATMENTS
30-45 degree head elevation
try to keep the spine up and down
take diuretics to avoid hyperolimia
- to fluid manage
We are attempting to control fluid, brain, and blood.
Attempt to control carbon dioxide level with hyperventilation
- low -> shirk/decrease blood flow
- high -> dialte/increase blood flow
- only for short term, long term low carbon dioxide levels lecaad to stroke.
- Attempt to keep carbon Dioxide levels normal, 35-38
regulate PH and sodium levels.
- Increase sodium levels
Keep a constant watch for seizures when using neuromuscular blocking agents. Neuromuscular agents can lead to paralyzation, therefore no signs of seizures.
Outcome
When a pulse is found at the scene the outcomes depend upon:
duration of submersion>5 minutes (most children)
time to effective basic life support>10 minutes
resuscitation duration>25 minutes
age >14 years
glasgow coma scale<5 (ie, comatose)
persistent apnea & requirement of cardiopulmonary resuscitation in the emergency department
arterial blood PH<7.1 upon presentation
Comments