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Agreed terminology is essential to describe the problem and to allow effective comparisons of drowning trends. Thus, this definition of drowning adopted by the World Congress on Drowning should be widely used.
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The WHO Global report on drowning: preventing a leading killer , published in , highlights that , people drown worldwide each year. Drowning is among the ten leading causes of death for children and young people in every region of the world. The report sets out the evidence showing a range of effective drowning prevention strategies, and makes a number of recommendations for concrete measures to be taken by national and local governments. Hypoxaemia combines with increased demands on the myocardium increased cardiac output combined with increased systemic vascular resistance due to peripheral vasoconstriction.
Volume and electrolyte disturbances may further contribute to cardiovascular instability. Pneumonia is a common complication in drowning victims, resulting from aspiration of water and contaminants during submersion, or secondary infection during recovery. These patients are often infected with unusual bacteria, such as Aeromonas spp , Burkholderia pseudomalaei , Chromobacterium spp , Pseudomonas species and Leptospirosis. Rapid onset hypothermia is protective. Several case reports show survival despite prolonged periods of submersion in ice cold water over one hour.
Hypothermia slows metabolism and reduces oxygen consumption; helping to reduce the inflammatory response. However, unless the onset of hypothermia is rapid, significant injury may develop before the body cools. Asphyxia and aspiration cause hypoxaemia, while cardiovascular instability results in hypoperfusion of vital organs. This combination of hypoxia and hypoperfusion ischaemia results in metabolic acidosis and cell death. Neurological damage is usually the main problem in patients that survive drowning. However, damage is not limited to the brain.belgacar.com/components/gsm-espion/logiciel-de-golocalisation-photo.php
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Myocardial infarction, rhabdomyolysis, acute tubular necrosis and DIC are common complications of drowning. There is a high incidence of associated injuries in victims of drowning.
Head and cervical spine injuries are particularly common in patients rescued from shallow water. Initial assessment should aim to identify respiratory compromise and other end-organ damage.
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Symptoms and signs of aspiration include dyspnoea, cough, retrosternal discomfort, tachypnoea and audible crackles on chest auscultation. Look for evidence of any precipitating causes eg seizure, arrhythmias, myocardial infarction, stroke and associated injuries e.
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Several attempts have been made to identify reliable prognostic indicators for victims of drowning. The aim is to distinguish, at presentation, patients who survive with little long-term disability from those who have established brain injury, or who are unlikely to survive. Unfortunately, none are reliable enough to influence management decisions when these patients present3. There are no prognostic features that reliably predict a poor outcome after drowning. Spinal injury should be considered in all cases of drowning, especially in patients recovered from shallow water or those with evidence of head injury.
Appropriate spinal precautions should be taken. Patients should be lifted out of the water in a horizontal position to prevent venous pooling and sudden cardiovascular collapse. Early, effective maintenance of airway and ventilation prevents cardiac arrest and improves neurological outcome. Attempting to drain water from the lungs is ineffective.
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Significant hypoxia may develop without dyspnoea. High flow oxygen should be administered to all patients. Bronchospasm may be treated with nebulised bronchodilators. Patients with significant respiratory compromise or altered GCS need early intubation and mechanical ventilation. Patients who are asymptomatic and have no evidence of respiratory compromise no CXR changes or hypoxia on ABG after six hours can be safely discharged home. All symptomatic patients should be admitted for observation.