Submersion injury 8.9 Flashcards Preview

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Flashcards in Submersion injury 8.9 Deck (9)
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Shallow water blackout

hyperventilation-->decreased CO2 upon submersion-->O2 metabolized to CO2 but its not high enough to trigger breath-->swimmer loses consciousness


Pre-hospital care

Immediate CPR, ventilation first with 2 rescue breaths. NO maneuvers to remove water, high flow oxygen and intubate apneic patients


ED care

resuscitative efforts in hypothermic patients until 35C, in non-hypothermic resuscitative efforts no more than 30 mins. high flow O2, inhaled beta-adrenergic agonists, CPAP/BiPAP, rewarming, glucose, opioid intoxication-->naloxone, monitor cardiac telemetry, continous and end tidal CO2, vital signs, neuro checks


ED indications for Orogastric intubation

inability to protect airway/neurologic deterioration, PaO2 50mmHg


ED diagnostic tests

ECG, chest radiograph, Serum electrolytes, BUN/Cr, EtOH/drug screen, CBC, PT/PTT, ABG/VBG, cardiac markers as indicated, imaging studies as indicated


Pulmonary drowning complications

bronchospasm, pneumonia, ARDS


Neurologic considerations

elevate head of bed, cautious use of diuretics if hypervolemic, tight seizure control with non-sedating anti-convulsants, avoid neuromuscular blocking agents, tight glycemic control, avoid hyperthermia,


Asymptomatic patients

observe for 8hrs, if all vitals, clinical state and CXR are normal may discharge


Poor Prognosis

submersion > 5mins, delay to BLS >10 mins, duration of resuscitation >25 mins, age >14 yrs, Glasgow coma Scale