Drowning

Drowning

When drowning, pronounced hypoxemia, respiratory failure, hypercapnia due to aspiration of water and reflex spasm of the larynx are noted. Aspiration of fluid and solids is the root cause of pneumonitis, damage to alveolar endothelial cells, atelectasis, and impaired surfactant secretion. Even without aspiration of water, reflex spasm of the larynx can cause asphyxia. Loss of surfactant, atelectasis, hypoxemia are more pronounced with significant fluid aspiration. Tissue hypoxia can cause metabolic acidosis. Hypoxemia and tissue hypoxia are common causes of pulmonary and cerebral edema. The severity of changes in the electrolyte composition and BCC depends on the type and volume of the aspirated fluid. With aspiration of sea water: an increase in the content of sodium and chlorine in plasma, which does not pose a danger to life. When aspirating fresh water: a pronounced violation of the electrolyte balance, an increase in blood volume, hemolysis, leading to asphyxia, ventricular fibrillation, cardiac arrest. In cold water, the oxygen demand of tissues is reduced, and the duration of survival increases due to the diving reflex.

Risk factors

• • Alcohol intoxication
  • Convulsive conditions
  • Inability to swim
  • Inadequate parental supervision of children
  • Cardiovascular diseases.

Clinical picture

• • Changes in level of consciousness or coma
  • Thready pulse or lack thereof
  • Tachypnea or agonal breathing
  • Cyanosis
  • Difficulty breathing, wheezing
  • Hypothermia
  • Poor reaction of pupils to light or their dilation.

Treatment:

• • Tactics of conducting
  • Start of resuscitation at the scene
  • Shocks on the abdominal wall should be avoided in the presence of airway obstruction.
  • Control of blood pH and electrolytes, cardiac activity (ECG)
  • Prophylactic antibiotic use should be avoided.
  • With hypothermia, due to the diving reflex, resuscitation may be successful (especially in infants) even after being underwater for 1 hour or more.
  • Urgent hospitalization – no concussions or sudden movements (high chance of developing ventricular arrhythmia)
  • Rapid warming: immersion in a bath of water at a temperature of 45-48 ° C, the use of warming heaters, in extremely severe cases – peritoneal dialysis with warm 0.9% solution of NaCI.
  • If the victim is not breathing, the contractions of the heart and the pulse on the carotid arteries are not determined – mouth-to-mouth artificial respiration and closed heart massage.
  • When drowning in fresh water, the removal of water from the lungs is not carried out (hypotonic fluid is quickly absorbed into the blood). When drowning in sea water, it will be necessary to drain the lungs (this is facilitated by the Trendelenburg position).
  • Mandatory hospitalization. Resuscitation measures are carried out regardless of the condition of the victim, tk. return-

consciousness does not mean that the person survived (lethal outcome due to hypoxia may follow later).

• • With safe spontaneous breathing – an oxygen mask, with respiratory arrest and acute respiratory distress syndrome – mechanical ventilation after tracheal intubation.
  • Intravenous administration of sodium bicarbonate 1 mmol/kg.
  • With bronchospasm – an aerosol of salbutamol.
  • In aspiration pneumonia – glucocorticoids and antibiotics.
  • With a pronounced violation of the water and electrolyte balance – infusion therapy.
  • In case of aspiration of sea water – compensation of the BCC. It is not recommended to limit fluid intake.
  • With severe hemolysis – the introduction of erythrocyte mass (to increase the oxygen capacity of the blood) and forced diuresis (to accelerate the excretion of free Hb plasma).

Prevention. Before bathing, it is not recommended to consume food, alcoholic beverages and large amounts of water. On the beach, within the pond or pool, you can not leave kids unattended. You can only swim in the area of ​​the rescue station. Children and non-swimmers must wear inflatable life jackets when in a boat or when playing in water. Children should be taught to swim as early as possible, and adults and children over 12 years of age should know the basic techniques of artificial respiration. Swimming pools must be fenced (the height of the fence is not less than 120 cm). Children, the disabled and the elderly must not be left unattended in the bath. See also Adult ICD Respiratory Distress Syndrome. W65-W74 Accidental drowning and immersion in water