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Flashcards in Environmental Emergencies Deck (101)
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31

Near Drowning Risk Factors

Inability to swim
Overestimation of swimming capabilities
Risk-taking behaviors
ETOH or drugs
Inadequate supervision
Hypothermia
Concomitant trauma, CV, MI
Hyperventilation

32

Pathophysiology of Drowning

Period of panic
Loss of normal breathing pattern
Reflex inspiratory efforts
Aspiration
Reflex laryngospasm

33

Pathophysiology of Dry Drowning

Laryngospasm
Hypoxia
LOC

34

Pathophysiology of Wet Drowning

Aspiration of water
Dilution and washout of surfactant
Diminished gas transfer
Atelectasis
V/Q mismatch

35

Pathophysiology of Fresh Water Drowning

Transient hemodilution
Blood cells swell and burst

36

Pathophysiology of Salt Water Drowning

Draws blood out of blood stream
Build up of sodium in alveoli
Decreased/stopping of oxygen from reaching blood

37

Pulmonary End Organ Effects of Drowning

Fluid aspiration
Wash out of surfactant
Non-cardiogenic edema
Acute respiratory distress
S/S of ARDS

38

Neurologic End Organ Effects of Drowning

Neuronal damage
Cerebral edema
Elevated ICP

39

CV End Organ Effects of Drowning

Arrhythmias
Sinus bradycardia
Fibrillation

40

Acid-Base and Electrolyte Effects of Drowning

Metabolic and/or respiratory acidosis
No significant electrolyte imbalances

41

Prehospital Drowning Management

CPR
Neck in neutral position
Rescue breathing
Rewarming

42

ER Management of Drowning

Prehospital efforts continued
Seek out head and spinal cord injuries
Re-warming initiated

43

Re-warming Efforts in Drowning

Blankets
Bair hugger
Overhead warmers
Resuscitative efforts until 32-35C

44

Drowning Victims with CGS 13+ Management

O2
Observation 4-6 hours
Possible discharge home with someone
Reassess/admit

45

Drowning Victims with GCS Less than 13 Management

O2
CXR
Labs

46

Labs in Drowning Victims

ABGs
CBC
CMP
PT/PTT
UA
CK
Urine myoglobin
Urine drug screen

47

Inpatient Management of Neurologic Issues in Drowning Victims

Duration of LOC
Neuro state at presentation
Prevent secondary injury

48

Secondary Neurologic Injuries in Drowning Victims

Cerebral edema
Hypoxemia
Fluid and electrolyte imbalances
Acidosis
Seizure activity

49

Inpatient Management of Pulmonary Issues in Drowning Victims

Intubation for PEEP delivery
CXR when indicated
Bronchospasm: beta agonists

50

Factors Associated with a Poor Prognosis in Drowning

Duration of submersion (10+ minutes)
Time to effective BLS (10+ minutes)
Resuscitation duration (25+ minutes)
Hypothermia with core temp less than 33C
GCS of 5
Less than 3 years
Persistent apnea and CPR in ER
Arterial pH less than 7.1
Water temp 50+ F

51

Define Hypothermia

Core temperature less than 35C or 95F

52

Core Temperature of Mild Hypothermia

90-95F

53

Core Temperature of Moderate Hypothermia

82-90F

54

Core Temperature of Severe Hypothermia

Less than 82F

55

Individuals at Risk for Hypothermia

Elderly
Neonates
Individuals with altered sensorium

56

How is heat loss from the body?

Evaporation
Radiation
Conduction
Convection

57

How is heat preserved by the body?

Peripheral vasoconstriction
Shivering
Increase in metabolic rate

58

Presentation of Mild Hypothermia

Tachypnea
Tachycardia
Hyperventilation
Ataxia
Dysarthria
Impaired judgement
Shivering
"Cold diuresis"

59

Presentation of Moderate Hypothermia

Reduction in pulse and CO
Hypoventilation
A-fib
CNS depression
Hyporeflexia
Decreased renal flow
Loss of shivering
Paradoxical undressing

60

Presentation of Severe Hypothermia

Pulmonary edema
Oliguria
Areflexia
Coma
Hypotension
Bradycardia
Ventricular arrhythmias
Asystole