Drowning

Abstract

Recent epidemiologic data have shown that the burden of drowning is much greater than expected. Prevention and timely rescue are the most effective means of reducing the number of persons at risk. Early bystander cardiopulmonary resuscitation is the most important factor for survival after submersion. Cerebral damage is a serious threat when the hypoxic period is too long. In most situations, low body temperature is an indication of the severity of the drowning incident. Sometimes hypothermia that occurs during the submersion period can be brain protective. There is also new evidence to support the strategy of inducing mild hypothermia for a period of 12 to 24 hours in comatose drowning victims. In immersed patients, hypothermia should be treated. The most appropriate technique will depend on the available means in the hospital and the condition of the patient. Treatment of pulmonary complications depends on the lung injury that occurred during aspiration and the bacteria involved in aspiration. Understanding the pathophysiology of drowning may help us to understand lung injuries and ischemic brain injuries.

Sea drowning: a case report and review of the literature

“…Hemodynamic monitoring data from this case revealed hypovolemia, and preliminary analyses showed hypernatremia; these alterations were described in sea water immersion by Swann et al [11]. Some studies suggest that cardiovascular changes are secondary to hypoxia [12,13]. Pulmonary oedema is a commonly described complication; the findings of the chest x-ray, together with hypoxemia, suggested treatment with diuretics, although the hamodynamic situation and volemia of these patients is noteworthy, and these were monitored obtaining data consistent with preload dependency, initiating increased volume which resulted in increased cardiac output [14].…”

Kjøler ned barn etter hjertestans

“…Det er derfor viktig å få kjølt ned de normo-og hyperterme pasientene raskt, og helst innen seks timer, slik at den beskyttende effekten som hypotermi har gitt igangsettes (14). Barn kjøles fortere ned enn voksne fordi de har lite subkutant fett og stor kroppsoverflate i forhold til vekt (15).…”

“…Det var betydelige variasjoner i bruk av teknisk utstyr og medikamenter, samt hvor lenge barna var uten sirkulasjon. Studien sier ikke noe om hvor raskt det ble igangsatt resuscitering, til tross for at det er dokumentert å ha signifikant betydning for utkomme at hjerte-lunge-redning blir startet så raskt som mulig etter sirkulasjonsstans (10,15,16,18). I tillegg stiller vi oss spørrende til om det er mulig å sammenligne de to gruppene når det er så stor forskjell i gjennomsnittlig hjertestanstid, selv om de har justert for dette.…”

Schwere akzidentelle Hypothermie mit Kreislaufstillstand und extrakorporaler Erwärmung

“…Häufig wird die Kanülierung zum ECC-Anschluss über die Femoralgefäße vorgenommen [1,6,10,11,25,26]; allerdings erlaubt eine Sternotomie zur Kanü-lierung von Aorta und rechtem Vorhof eine direkte Defibrillation und eine ventrikuläre Dekompression durch Einlage eines Linksherzvents (Kanüle im linken Ventrikel zur Verhinderung einer Über-dehnung durch Überfüllung) sowie einen höheren Blutfluss durch die größe-ren Kanülen [4,5,24]. Deshalb wurde im vorliegenden Fall eine mediane Sternotomie durchgeführt, um das Herz bei einem während der Wiedererwärmung auftretenden Kammerflimmern und ausbleibendem Defibrillationserfolg über einen Linksherzvent entlasten zu können.…”

“…Allerdings erfordert eine deutliche Blutglukosesenkung durch intravenös verabreichtes Insulin eine engmaschige Kontrolle der Blutglukosespiegel zur Vermeidung einer Hypoglykämie [4]. Als Ursachen der Hyperglykämie kommen neben der Gabe der Pädiafusin © -Infusion durch den Notarzt eine verminderte Insulinfreisetzung durch pankreatische β-Zellen sowie eine Insulinresistenz bei Hypothermie in Betracht.…”