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Davis CA, Lareau S. Drowning. Emerg Med Clin North Am 2024; 42:541-550. [PMID: 38925773 DOI: 10.1016/j.emc.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Drowning is responsible for considerable morbidity and mortality worldwide, and it is estimated that 90% of drownings are preventable. Drowning is defined as "the process of experiencing respiratory impairment from submersion/immersion in liquid." Emergency providers should focus on airway management and rapid delivery of oxygen to interrupt the drowning process and improve patient outcomes. Patients with minimal or no symptoms do not require any specific diagnostic workup, aside from physical examination and 4 to 6 hours of observation prior to discharge. Patients with more severe symptoms may present with rales and foamy secretions, and should be managed with high-concentration oxygen and positive airway pressure.
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Affiliation(s)
- Christopher A Davis
- Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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2
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Berger S, Siekmeyer M, Petzold-Quinque S, Kiess W, Merkenschlager A. Drowning and Nonfatal Drowning in Children and Adolescents: A Subsequent Retrospective Data Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:439. [PMID: 38671656 PMCID: PMC11049416 DOI: 10.3390/children11040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Fatal and nonfatal drowning are among the leading causes of death and lifelong severe neurological impairment among children and adolescents. This study aimed to complement research from Leipzig 1994-2008 to seek trends within risk factors, treatments, and outcomes throughout the last decade. We retrospectively investigated data of 47 inpatients aged 0-18 admitted to Leipzig University Department of Pediatrics who matched ICD-10 code T75.1 from 2008 to 2020 and compared them to a preceding study at the same institution. We also examined the prognostic value of parameters regarding the patients' outcomes. There were three median incidents per annum. The median age was 2.75 years; 76% of incidents happened in males. An accumulation was seen during the summer months and weekends. Most drowning incidents occurred in private ponds or pools (48.9%). Thirty-nine children were discharged without resulting morbidity, four showed neurological impairment, and three died. Risk factors concerning age, sex, and incident characteristics were confirmed. Special supervision needs still apply to 1-3-year-old male children or children with pre-existing health conditions around private pools and ponds. Hospitalization duration shortened, and morbidity and lethality decreased since the previous study. There was structural improvement in primary care and medical documentation. Parameters suggesting good outcomes include a submersion time < 5 min, GCS > 3 points, spontaneous movement upon admission, remaining pupillary light response, the absence of cardiovascular arrest, body temperature ≥ 32 °C, pH > 7, blood glucose < 15 mmol/L, lactate < 14 mmol/L, base excess ≥ -15 mmol/L, and the absence of ARDS. Clear legislation can contribute to improved private home water safety. Further studies should include a broad in- and outpatient spectrum and standardized incident documentation presupposing Utstein-style reporting. Regular reinvestigation of consistent geographical regions facilitates process evaluations of drowning epidemiology and therapy evolution.
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Affiliation(s)
- Sebastian Berger
- Department of Women and Child Health, Hospital for Children and Adolescents, Division of Neuropediatrics, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany;
| | - Manuela Siekmeyer
- Department of Women and Child Health, Hospital for Children and Adolescents, Pediatric Intensive Care Unit, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Stefanie Petzold-Quinque
- Department of Women and Child Health, Hospital for Children and Adolescents, Pediatric Intensive Care Unit, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Andreas Merkenschlager
- Department of Women and Child Health, Hospital for Children and Adolescents, Division of Neuropediatrics, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany;
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Davis CA, Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Giesbrecht GG, Cushing TA. Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update. Wilderness Environ Med 2024; 35:94S-111S. [PMID: 38379489 DOI: 10.1177/10806032241227460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.
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Affiliation(s)
- Christopher A Davis
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | | | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ali S Arastu
- Division of Pediatric Critical Care, Stanford University School of Medicine, Palo Alto, CA
| | - Gordon G Giesbrecht
- Laboratory for Exercise and Environmental Medicine, Faculty of Kinesiology and Recreation, University of Manitoba, Winnipeg, Manitoba, Canada
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Miyamoto K, Takayasu H, Katsuki S, Maeda A, Suzuki K, Nakamura M, Hida N, Sambe T, Yagi M, Sasaki J, Hayashi M, Dohi K. Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study. J Clin Med 2024; 13:261. [PMID: 38202269 PMCID: PMC10780124 DOI: 10.3390/jcm13010261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/24/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Patients under cardiopulmonary resuscitation (CPR) are at high risk of aspirating gastric contents. Nasogastric tube insertion (NGTI) after tracheal intubation is usually performed blindly. This sometimes causes laryngopharyngeal mucosal injury (LPMI), leading to severe bleeding. This study clarified the incidence of LPMI due to blind NGTI during CPR. METHODS We retrospectively analyzed 84 patients presenting with cardiopulmonary arrest on arrival, categorized them into a Smooth group (Smooth; blind NGTI was possible within 2 min), and Difficult group (blind NGTI was not possible), and consequently performed video laryngoscope-assisted NGTI. The laryngopharyngeal mucosal condition was recorded using video laryngoscope. Success rates and insertion time for the Smooth group were calculated. Insertion number and LPMI scores were compared between the groups. Each regression line of outcome measurements was obtained using simple regression analysis. We also analyzed the causes of the Difficult group, using recorded video laryngoscope-assisted videos. RESULTS The success rate was 78.6% (66/84). NGTI time was 48.8 ± 4.0 s in the Smooth group. Insertion number and injury scores in the Smooth group were significantly lower than those in the Difficult group. The severity of LPMI increased with NGT insertion time and insertion number. CONCLUSIONS Whenever blind NGTI is difficult, switching to other methods is essential to prevent unnecessary persistence.
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Affiliation(s)
- Kazuyuki Miyamoto
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Hiromi Takayasu
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Shino Katsuki
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Atsuo Maeda
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Keisuke Suzuki
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Motoyasu Nakamura
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Noriko Hida
- Department of Clinical Pharmacy, Division of Clinical Research and Development, School of Pharmacy, Showa University, Kita-karasuyama, Setagaya-ku, Tokyo 1578577, Japan;
| | - Takehiko Sambe
- Department of Pharmacology, Clinical Pharmacology, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan;
| | - Masaharu Yagi
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Jun Sasaki
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
| | - Munetaka Hayashi
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
- Department of Emergency, Critical care and Disaster Medicine, Showa University Fujigaoka Hospital, Fujigaoka Aoba-ku, Yokohama City 2278501, Japan
| | - Kenji Dohi
- Department of Emergency, Critical care and Disaster Medicine, School of Medicine, Showa University, Hatanodai, Shinagawa-ku, Tokyo 1428666, Japan; (H.T.); (S.K.); (A.M.); (K.S.); (M.N.); (M.Y.); (J.S.); (M.H.); (K.D.)
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Pellegrino F, Raffaldi I, Rossi R, De Vito B, Pagano M, Garelli D, Bondone C. Epidemiology, clinical aspects, and management of pediatric drowning. Ital J Pediatr 2023; 49:74. [PMID: 37316902 PMCID: PMC10268379 DOI: 10.1186/s13052-023-01464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.
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Affiliation(s)
- Francesco Pellegrino
- Department of Pediatric and Public Health Sciences, Postgraduate School of Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy.
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Barbara De Vito
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Garelli
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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6-Year-Old Male Drowning Complicated by Cardiac Arrest and Ensuing Metabolic and Respiratory Acidosis: Should Presence of Pulses Lead Clinicians to Pursue Prolonged Cardiopulmonary Resuscitation? J Emerg Med 2022; 63:e67-e71. [DOI: 10.1016/j.jemermed.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/14/2022] [Accepted: 07/09/2022] [Indexed: 11/12/2022]
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Affiliation(s)
- Tracy E McCallin
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, TX
| | - Mickinzie Morgan
- Department of Pediatrics, Texas Tech Health Sciences Center, Lubbock, TX
| | | | - Shabana Yusuf
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Management for the Drowning Patient. Chest 2020; 159:1473-1483. [PMID: 33065105 DOI: 10.1016/j.chest.2020.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022] Open
Abstract
Drowning is "the process of experiencing respiratory impairment from submersion or immersion in liquid." According to the World Health Organization, drowning claims the lives of > 40 people every hour of every day. Drowning involves some physiological principles and medical interventions that are unique. It occurs in a deceptively hostile environment that involves an underestimation of the dangers or an overestimation of water competency. It has been estimated that > 90% of drownings are preventable. When water is aspirated into the airways, coughing is the initial reflex response. The acute lung injury alters the exchange of oxygen in different proportions. The combined effects of fluid in the lungs, loss of surfactant, and increased capillary-alveolar permeability result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and alveolitis, a noncardiogenic pulmonary edema. Salt and fresh water aspirations cause similar pathology. If the person is not rescued, aspiration continues, and hypoxemia leads to loss of consciousness and apnea in seconds to minutes. As a consequence, hypoxic cardiac arrest occurs. The decision to admit to an ICU should consider the patient's drowning severity and comorbid or premorbid conditions. Ventilation therapy should achieve an intrapulmonary shunt ≤ 20% or Pao2:Fio2 ≥ 250. Premature ventilatory weaning may cause the return of pulmonary edema with the need for re-intubation and an anticipation of prolonged hospital stays and further morbidity. This review includes all the essential steps from the first call to action until the best practice at the prehospital, ED, and hospitalization.
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Lawes JC, Rijksen EJT, Brander RW, Franklin RC, Daw S. Dying to help: Fatal bystander rescues in Australian coastal environments. PLoS One 2020; 15:e0238317. [PMID: 32936817 PMCID: PMC7494089 DOI: 10.1371/journal.pone.0238317] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022] Open
Abstract
Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches.
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Affiliation(s)
- Jasmin C. Lawes
- Surf Life Saving Australia, Sydney, NSW, Australia
- School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld., Australia
- * E-mail:
| | | | - Robert W. Brander
- School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld., Australia
| | - Shane Daw
- Surf Life Saving Australia, Sydney, NSW, Australia
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Childhood Drowning: Review of Patients Presenting to the Emergency Departments of 2 Large Tertiary Care Pediatric Hospitals Near and Distant From the Sea Coast. Pediatr Emerg Care 2020; 36:e258-e262. [PMID: 29406474 DOI: 10.1097/pec.0000000000001394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Drowning is a leading cause of death among infants and toddlers. Unique physiological and behavioral factors contribute to high mortality rates. Drowning incidents predominantly occur during warmer months and holidays. The aim of this study was to describe the characteristics of pediatric drowning victims who attended 2 different emergency departments (EDs), 1 near and 1 distant from the sea coast, to recognize risk factors, complications, causes of death, and the educational needs of families and caregivers. METHODS Retrospective cohort analysis of incident history, clinical presentation, treatments, and outcomes of drowning victims was performed. Data were analyzed both by age group and proximity of institution to the sea coast. RESULTS From 2005 to 2015, 70 drowning patients presented to the 2 institutions; there was no difference in incident history or outcomes based on proximity to the sea coast. Fifty-six percent of patients were younger than 6 years, the majority drowning in pools. More of the older children drowned in the sea (48% vs 23%). Half of all patients were treated and followed in the ED or ward, and the other half were treated in the pediatric intensive care unit; 12 suffered severe complications, including 5 diagnosed with brain death. Cardiopulmonary resuscitation was performed in 80% of the fatal group and 23% of the nonfatal group (P = 0.006). Seven children who experienced a cardiac arrest with hypothermia were treated before arrival in the ED, and 5 had ongoing cardiac arrest upon arrival in the ED (these were the 5 suffering brain death). DISCUSSION Most of patients younger than 6 years drowned in swimming pools, suggesting that parents are perhaps less vigilant in these circumstances, even though they may remain in close proximity. Active adult supervision entails attention, proximity, and continuity. Educational efforts should be aimed at reminding parents of this, especially in the summer months.
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Franklin RC, Peden AE, Brander RW, Leggat PA. Who rescues who? Understanding aquatic rescues in Australia using coronial data and a survey. Aust N Z J Public Health 2019; 43:477-483. [PMID: 31180612 DOI: 10.1111/1753-6405.12900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine fatal drowning associated with aquatic rescues and prior self-reported experience of undertaking an aquatic rescue in Australia. METHODS Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue-related fatal unintentional drowning between 1 January 2006 and 31 December 2015. RESULTS Twenty-three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X2 =35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X2 =13.5; p<0.001). Females were more likely to have rescued a child (0-4 years of age) (X2 =29.2; p<0.001) from a swimming pool (X2 =34.3; p<0.001). Fifty-one people drowned while performing an aquatic rescue (Males=82.4%; 25-44 years of age=53.0%; beaches=54.9%). CONCLUSIONS Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community-wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning. Implications for public health: There is a need to train people early in their life on how to undertake a safe rescue and provide resuscitation, including promoting regular updates, in particular if supervising children.
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Affiliation(s)
- Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland.,Royal Life Saving Society - Australia, Sydney, New South Wales
| | - Amy E Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland.,Royal Life Saving Society - Australia, Sydney, New South Wales
| | - Robert W Brander
- School of Biological, Earth and Environmental Sciences, UNSW, New South Wales
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland.,School of Nursing and Midwifery, Faculty of Health Sciences, Flinders University, Adelaide, South Australia
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12
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Armstrong EJ, Erskine KL. Investigation of Drowning Deaths: A Practical Review. Acad Forensic Pathol 2018; 8:8-43. [PMID: 31240023 PMCID: PMC6474464 DOI: 10.23907/2018.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/01/2017] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
Drowning, which typically involves a watery environment, remains a serious public health concern claiming an estimated 362 000 lives per year worldwide across all socioeconomic classifications and has remained under close observation by the World Health Organization and its signatories. A significant number of water-related deaths are attributed to accidental drowning, while a smaller but still significant number represent suicidal or homicidal drowning. Others involve a combination of drowning precipitated by injury, intoxication, or environmental extremes. Still others involve victims that die from injury, intoxication, or a natural disease entity of such significance as to preclude the drowning process, while near or in water. While there may be an initial presumption that all water-related deaths are accidental drownings, other possibilities must be considered in the investigation of these types of deaths, as drowning as a cause of death is a diagnosis based on the exclusion of other potential causes. The coordinated investigative efforts of multiple agencies and disciplines are required not only for the designation as drowning as the cause of death but also for death certification. The ongoing analysis and dissemination of data generated from all levels of investigation augment our understanding of the impact on public health and safety, guiding allocation of monetary and educational resources in an effort to prevent further mortality and disability.
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13
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Chan JSE, Ng MXR, Ng YY. Drowning in swimming pools: clinical features and safety recommendations based on a study of descriptive records by emergency medical services attending to 995 calls. Singapore Med J 2018; 59:44-49. [PMID: 28367581 PMCID: PMC5778258 DOI: 10.11622/smedj.2017021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study was a descriptive analysis of national ambulance case records and aimed to make practical safety recommendations in order to reduce the incidence of drowning in swimming pools. METHODS A search was performed of a national database of descriptive summaries by first-responder paramedics of all 995 calls made to the Singapore Civil Defence Force between 1 January 2012 and 31 December 2014. We included all cases of submersion in both public and private pools for which emergency medical services were activated. RESULTS The highest proportion of drowning cases occurred in the age group of 0-9 years. Males accounted for 57.0% (61/107) of cases. Bystander cardiopulmonary resuscitation (CPR) was performed in 91.3% (21/23) and 68.6% (48/70) of cases of cardiac/respiratory arrest from drowning in public and private pools, respectively; the rate of bystander CPR was higher when a lifeguard was present (88.5%, 23/26 vs. 68.7%, 46/67). The majority (72.0%, 77/107) of drowning incidents occurred in private pools, most of which had no lifeguards present. CONCLUSION To our knowledge, this study was the first in Singapore to examine data from emergency medical services. Since the majority of incidents occurred in private pools without lifeguards, it is recommended that a lifeguard be present at every pool. For pools that are too small to justify mandatory lifeguard presence, safety measures, such as guidelines for pool design and pool fencing with latched gates, may be considered. As strict enforcement may not be possible, public education and parental vigilance remain vital.
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Affiliation(s)
| | - Marie Xin Ru Ng
- Medical Department, HQ Singapore Civil Defence Force, Singapore
| | - Yih Yng Ng
- Medical Department, HQ Singapore Civil Defence Force, Singapore
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14
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Szpilman D, Orlowski JP. Sports related to drowning. Eur Respir Rev 2017; 25:348-59. [PMID: 27581833 DOI: 10.1183/16000617.0038-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
Aquatic sports are included in the top list of risky practices as the environment per se carries a possibility of death by drowning if not rescued in time. Not only are aquatic sports related to a high risk of death, but also all sports practiced on the water, over the water and on ice. Whatever the reason a person is in the water, drowning carries a higher possibility of death if the individual is unable to cope with the water situation, which may simply be caused by an inability to stay afloat and get out of the water or by an injury or disease that may lead to physical inability or unconsciousness. The competitive nature of sports is a common pathway that leads the sports person to exceed their ability to cope with the environment or simply misjudge their physical capability. Drowning involves some principles and medical interventions that are rarely found in other medical situations as it occurs in a deceptively hostile environment that may not seem dangerous. Therefore, it is essential that health professionals are aware of the complete sequence of action in drowning. This article focuses on the pulmonary injury in sports and recreational activities where drowning plays the major role.
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Affiliation(s)
- David Szpilman
- Sociedade Brasileira de Salvamento Aquatico - SOBRASA, Rio de Janeiro, Brazil
| | - James P Orlowski
- Division of Pediatrics, Dept of Pediatric Critical Care Medicine, Florida Hospital Tampa, Tampa, FL, USA Dept of Pediatrics and Critical Care Medicine, Johns Hopkins All Childrens Hospital, St Petersburg, FL, USA
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Bierens JJLM, Lunetta P, Tipton M, Warner DS. Physiology Of Drowning: A Review. Physiology (Bethesda) 2017; 31:147-66. [PMID: 26889019 DOI: 10.1152/physiol.00002.2015] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Drowning physiology relates to two different events: immersion (upper airway above water) and submersion (upper airway under water). Immersion involves integrated cardiorespiratory responses to skin and deep body temperature, including cold shock, physical incapacitation, and hypovolemia, as precursors of collapse and submersion. The physiology of submersion includes fear of drowning, diving response, autonomic conflict, upper airway reflexes, water aspiration and swallowing, emesis, and electrolyte disorders. Submersion outcome is determined by cardiac, pulmonary, and neurological injury. Knowledge of drowning physiology is scarce. Better understanding may identify methods to improve survival, particularly related to hot-water immersion, cold shock, cold-induced physical incapacitation, and fear of drowning.
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Affiliation(s)
| | - Philippe Lunetta
- Department of Pathology and Forensic Medicine, University of Turku, Turku, Finland
| | - Mike Tipton
- Department of Sport and Exercise Science, Extreme Environments Laboratory, University of Portsmouth, Portsmouth, United Kingdom; and
| | - David S Warner
- Departments of Anesthesiology, Neurobiology and Surgery, Duke University Medical Center, Durham, North Carolina
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Schober D, Schwendener N, Zech WD, Jackowski C. Post-mortem CT: Hounsfield unit profiles obtained in the lungs with respect to the cause of death assessment. Int J Legal Med 2016; 131:199-210. [PMID: 27766411 DOI: 10.1007/s00414-016-1454-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/15/2016] [Indexed: 11/26/2022]
Abstract
Segmentation of the lungs using post-mortem computed tomography (PMCT) data was so far not feasible due to post-mortem changes such as internal livores. Recently, an Osirix plug-in has been developed allowing automatically segmenting lungs also in PMCT data. The aim of this study was to investigate if the Hounsfield unit (HU) profiles obtained in PMCT data of the segmented lung tissue present with specific behaviour in relation to the cause of death. In 105 PMCT data sets of forensic cases, the entire lung volumes were segmented using the Mia Lite plug-in on Osirix. HU profiles of the lungs were generated and correlated to cause of death groups as assessed after forensic autopsy (cardiac death, fatal haemorrhage, craniocerebral injury, intoxication, drowning, hypothermia, hanging and suffocation). Especially cardiac death cases, intoxication cases, fatal haemorrhage cases and hypothermia cases showed very specific HU profiles. In drowning, the profiles showed two different behaviours representing wet and dry drowning. HU profiles rather varied in craniocerebral injury cases, hanging cases as well as in suffocation cases. HU profiles of the lungs segmented from PMCT data may support the cause of death diagnosis as they represent specific morphological changes in the lungs such as oedema, congestion or blood loss. Especially in cardiac death, intoxication, fatal haemorrhage, hypothermia and drowning cases, HU profiles may be very supportive for the forensic pathologist.
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Affiliation(s)
- Daniel Schober
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland
| | - Nicole Schwendener
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland
| | - Wolf-Dieter Zech
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland
| | - Christian Jackowski
- Institute of Forensic Medicine, University of Bern, Bühlstr. 20, CH-3012, Bern, Switzerland.
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Abstract
Determining the cause of death in animals recovered from bodies of water, swimming pools, or other water-containing vessels is challenging. Animals recovered from water may or may not have drowned. The diagnosis of drowning is usually one of exclusion, requiring information from the crime scene, recovery scene, the medical history or reliable witness accounts. While there are characteristic macroscopic and microscopic lesions of drowning, none are specific and are dependent on the volume and tonicity of the drowning medium. Beyond interpreting the postmortem findings, the court may ask pathologists to comment on the behavioral and welfare implications of drowning. This requires an understanding of the drowning process, which is a complex series of sequential, concurrent, and overlapping cardiorespiratory reflexes, electrolyte and blood gas abnormalities, aspiration, physical exhaustion, and breathlessness eventually culminating in death. This review addresses the mechanisms, lesions, and diagnostic issues associated with drowning in nonaquatic companion animals.
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Affiliation(s)
- B. J. McEwen
- Animal Health Laboratory, Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada
| | - J. Gerdin
- Antech Diagnostics, Hunt Valley, MD, USA
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Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Cushing TA, Auerbach PS. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning. Wilderness Environ Med 2016; 27:236-51. [PMID: 27061040 DOI: 10.1016/j.wem.2015.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.
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Affiliation(s)
- Andrew C Schmidt
- Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL (Dr Schmidt).
| | - Justin R Sempsrott
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston Salem, NC (Dr Sempsrott)
| | - Seth C Hawkins
- Department of Emergency Medicine, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC (Dr Hawkins)
| | - Ali S Arastu
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA (Dr Arastu)
| | - Tracy A Cushing
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, CO (Dr Cushing)
| | - Paul S Auerbach
- Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Dr Auerbach)
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He S, Lunnen JC, Zia N, Khan U, Shamim K, Hyder AA. Pattern of presenting complaints recorded as near-drowning events in emergency departments: a national surveillance study from Pakistan. BMC Emerg Med 2015; 15 Suppl 2:S4. [PMID: 26691978 PMCID: PMC4682420 DOI: 10.1186/1471-227x-15-s2-s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap. Methods Patients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization. Results A total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation. Conclusion There was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning prevention studies.
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Farr KM, Camp EA, Yusuf S, Shenoi RP. Vomiting is not associated with poor outcomes in pediatric victims of unintentional submersions. Am J Emerg Med 2015; 33:626-30. [PMID: 25701215 DOI: 10.1016/j.ajem.2015.01.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The outcome of submersion victims depends on submersion duration and the availability of timely and effective resuscitation. The prognostic implication of vomiting during resuscitation of submersion victims is unclear. The study sought to determine whether vomiting during resuscitation in children treated for unintentional submersion injuries adversely impacts outcome. METHODS This was a retrospective study of unintentional submersion victims under age 18 treated at an urban tertiary-care children's hospital from 2003-2009. Submersion and victim details were obtained from hospital, EMS, and fatality records. Outcomes studied were survival at 24 hours and condition (Favorable: good/mild impairment or Poor: death/severe disability) at hospital discharge. Descriptive comparisons between emesis groups (yes/no) and categorical covariates were analyzed. RESULTS There were 281 victims. The median age was 3 years; 66% were males. Most incidents occurred at swimming pools (77%) and bathtubs (16%). Most were hospitalized (83%). The presence or absence of emesis was documented in 246 (88%). Victims with emesis were significantly less likely to have apnea or be intubated in the ED, have a low ED GCS or die. No patient who had emesis died at 24 hours or had a poor outcome at hospital discharge. Victims who had emesis post-resuscitation were significantly more likely to have received CPR or chest compressions than rescue breaths. CONCLUSIONS Emesis in pediatric submersion victims is inversely associated with death at 24 hours or poor outcome at hospital discharge. The relationship between emesis and the adequacy of resuscitation of pediatric submersion victims needs to be further studied.
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Affiliation(s)
- Kimberley M Farr
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, Texas.
| | - Elizabeth A Camp
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, Texas.
| | - Shabana Yusuf
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, Texas.
| | - Rohit P Shenoi
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, Texas.
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Buggia M, Canham L, Tibbles C, Landry A. Near Drowning and Adult Respiratory Distress Syndrome. J Emerg Med 2014; 46:821-5. [DOI: 10.1016/j.jemermed.2014.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022]
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Caruso JL. The Forensic Pathology of Drowning and Pulmonary Overexpansion Injury. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Drowning deaths are commonly seen in most forensic pathology practices. Experienced forensic pathologists perform autopsies and assign a cause and manner of death in such cases as a matter of routine. Deaths due to pulmonary overexpansion injury and subsequent air embolism are far less common and typically involve individuals who have been breathing compressed gas at depth, generally SCUBA (self-contained underwater breathing apparatus) divers. This review outlines the pathophysiological basis of these two forensic pulmonary issues and recommends an approach to performing and interpreting the results of a forensic autopsy when faced with such cases.
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Affiliation(s)
- James L. Caruso
- Navy Flight Surgeon, and Navy Undersea Medical Officer at Navy Recruiting Command, Millington, TN
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Dyson K, Morgans A, Bray J, Matthews B, Smith K. Drowning related out-of-hospital cardiac arrests: characteristics and outcomes. Resuscitation 2013; 84:1114-8. [PMID: 23370162 DOI: 10.1016/j.resuscitation.2013.01.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/20/2012] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
Abstract
AIM There are few studies on drowning-related out-of-hospital cardiac arrest (OHCA) in which patients are followed from the scene through to hospital discharge. This study aims to describe this population and their outcomes in the state of Victoria (Australia). METHODS The Victorian Ambulance Cardiac Arrest Registry was searched for all cases of OHCA with a precipitating event of drowning attended by emergency medical services (EMS) between October 1999 and December 2011. RESULTS EMS attended 336 drowning-related OHCA during the study period. Cases frequently occurred in summer (45%) and the majority of patients were male (70%) and adult (77%). EMS resuscitation was attempted on 154 (46%) patients. Of these patients, 41 (27%) survived to hospital arrival and 12 (8%) survived to hospital discharge (5 adults [6%] and 7 [12%] children). Few patients were found in a shockable rhythm (6%), with the majority presenting in asystole (79%) or pulse-less electrical activity (13%). An initial shockable rhythm was found to positively predict survival (AOR 48.70, 95% CI: 3.80-624.86) while increased EMS response time (AOR 0.73, 95% CI: 0.54-0.98) and salt water drowning (AOR 0.69, 95% CI: 0.01-0.84) were found to negatively predict survival. CONCLUSIONS Rates of survival in OHCA caused by drowning are comparable to other OHCA causes. Patients were more likely to survive if they did not drown in salt water, had a quick EMS response and they were found in a shockable rhythm. Prevention efforts and reducing EMS response time are likely to improve survival of drowning patients.
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Affiliation(s)
- Kylie Dyson
- Operations Department, Ambulance Victoria, Victoria, Australia.
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Suominen PK, Vähätalo R. Neurologic long term outcome after drowning in children. Scand J Trauma Resusc Emerg Med 2012; 20:55. [PMID: 22894549 PMCID: PMC3493332 DOI: 10.1186/1757-7241-20-55] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/01/2012] [Indexed: 11/03/2022] Open
Abstract
Drowning is a major source of mortality and morbidity in children worldwide. Neurocognitive outcome of children after drowning incidents cannot be accurately predicted in the early course of treatment. Therefore, aggressive out-of-hospital and in-hospital treatment is emphasized. There are "miracle" cases after long submersion times that have been reported in the medical literature, which mostly concern small children. However, many of the survivors will remain severely neurologically compromised after remarkably shorter submersion times and will consequently be a great burden to their family and society for the rest of their lives. The duration of submersion, the need of advanced life support at the site of the accident, the duration of cardiopulmonary resuscitation, whether spontaneous breathing and circulation are present on arrival at the emergency room are important factors related to survival with mild neurological deficits or intact function in drowned children. Data on long-term outcome are scarce. The used outcome measurement methods and the duration of follow-up have not been optimal in most of the existing studies. Proper neurological and neurophysiological examinations for drowned children are superior to outcome scales based chart reviews. There is evidence that gross neurological examination at the time of discharge from the hospital in young children does not reveal all the possible sequelae related to hypoxic brain injury and thus long-term follow-up of drowned resuscitated children is strongly recommended.
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Affiliation(s)
- Pertti K Suominen
- Department of Anaesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Stenbäckinkatu 9, FIN-00029 HUS, Helsinki, Finland.
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Affiliation(s)
- David Szpilman
- Adult Intensive Care Unit, Hospital Municipal Miguel Couto, and Corpo de Bombeiros Militar, Rio de Janeiro, Brazil.
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Tourigny PD, Hall C. Diagnosis and management of environmental thoracic emergencies. Emerg Med Clin North Am 2011; 30:501-28, x. [PMID: 22487116 DOI: 10.1016/j.emc.2011.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Physiologic sequelae from increasing ambient pressure in underwater activities, decreasing ambient pressure while at altitude, or the consequences of drowning present a unique set of challenges to emergency physicians. In addition, several environmental toxins cause significant respiratory morbidity, whether they be pulmonary irritants, simple asphyxiants, or systemic toxins. It is important for emergency physicians to understand the pathophysiology of these illnesses as well as to apply this knowledge to the clinical arena either in the prehospital setting or in the emergency department. Current treatment paradigms and controversies within these regimens are discussed.
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Affiliation(s)
- Paul D Tourigny
- Division of Emergency Medicine, Foothills Medical Centre, University of Calgary, 1403-29 Street Northwest, Calgary, Alberta, Canada.
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Abstract
INTRODUCTION Drowning is a leading preventable cause of unintentional morbidity and mortality. The dominant pathophysiological mechanism of drowning includes the development of acute hypoxia. FIRST AID The rescue procedure of a drowning person includes careful pulling the victim out of the water, examination, maintenance of the airways passable and urgent transfer to hospital. BASIC LIFE SUPPORT The first and most important treatment option of a drowning victim is the provision of ventilation which increases the chances of survival. As soon as the unresponsive victim is removed from the water, the lay rescuer should immediately begin chest compressions and provide cycles of ventilations and compressions. Some recent investigations have revealed that exterior compression of the chest is a necessary measure even in a situation when bystanders cannot provide airway. It is recommended to train bystanders to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early as possible. ADVANCED LIFE SUPPORT In drowning, the victim with cardiac arrest requires advanced life support, including an early intubation. Extended medical measures, which are primarily provided by medical professionals, include cervical spine immobilization in case a spinal injury is suspected, or, establishment of the ventilation with oxygen, emergency transport, application of reanimation and advanced vital support measures.
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Franklin RC, Pearn JH. Drowning for love: the aquatic victim-instead-of-rescuer syndrome: drowning fatalities involving those attempting to rescue a child. J Paediatr Child Health 2011; 47:44-7. [PMID: 20973865 DOI: 10.1111/j.1440-1754.2010.01889.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Non-intentional child drowning remains a leading cause of child mortality. A related and secondary syndrome is composed of those who drown in impulsive, altruistic attempts to go to the aid of a drowning child. Such 'rescuers' who attempt to save a drowning child may themselves drown, a tragic event we term the AVIR syndrome or aquatic victim-instead-of-rescuer. METHODS This study is composed of a five-year (1 July 2002 to 30 June 2007) total population Australian survey, using the National Coroners Information System to identify cases and an analysis of every immersion rescuer-victim dyad where the primary 'victim' was a child and where the 'rescuer' drowned. RESULTS In Australia (2002-2007), 17 rescuers drowned in 15 incidents in which the primary victim was a drowning child. In 93% of the incidents, the primary 'child-victim' survived, 82% of the victims were unfamiliar with the aquatic location (i.e. were a visitor) and 76% of the victims were a male parent, partner of first-degree relative. Alcohol was not generally involved. CONCLUSION We define the AVIR syndrome as one that typically involves the following: a male, parent, partner or relative; an unfamiliar water hazard; a 'rescuer' who is a tourist; alcohol is not usually involved; and the primary victim usually survives. We posit that an increased awareness of such risks, the promotion of rudimentary rescue skills (e.g. being able to throw a lifeline) and increased advocacy for parents to learn the simple and basic life-saving skills of non-contact rescue will help reduce these drowning tragedies.
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Affiliation(s)
- Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.
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Childhood drowning in Matlab, Bangladesh: An in-depth exploration of community perceptions and practices. Soc Sci Med 2009; 68:1720-7. [DOI: 10.1016/j.socscimed.2009.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Indexed: 11/19/2022]
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Grmec S, Strnad M, Podgorsek D. Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest. Int J Emerg Med 2009; 2:7-12. [PMID: 19390911 PMCID: PMC2672980 DOI: 10.1007/s12245-009-0084-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 01/02/2009] [Indexed: 12/04/2022] Open
Abstract
Background In 2003, the International Liaison Committee on Resuscitation (ILCOR) published the Recommended Guidelines for Uniform Reporting of Data from Drowning: the “Utstein style” (“Utstein Style for Drowning,” USFD) to improve the understanding of epidemiology, treatment, and outcome prediction after drowning. Aims The aim of this study was to compare the characteristics and outcome between patients suffering from out-of-hospital primary cardiac arrest (OHPCA) and drowning victims in cardiac arrest (DCA) by analysis of variables based on the USFD. Methods All cases of OHPCA and DCA from February 1998 to February 2007 were included in the research and analysis. Data on OHPCA and DCA patients were collected using the Utstein method. Data on DCA patients were then compared with data of OHPCA patients. Results During the study period 788 cardiac arrests with resuscitation attempts were identified: 528 of them were OHPCA (67%) and 32 (4%) were DCA. The differences between DCA and OHPCA patients were: the DCA patients were younger (46.5 ± 21.4 vs 62.5 ± 15.8; p = 0.01), suffered a witnessed cardiac arrest less frequently (9/32 vs 343/528; p = 0.03), were more often found in a nonshockable rhythm (29/32 vs 297/528; p < 0.0001), had a prolonged ambulance response time (11 vs 6 min; p = 0.001), had a relatively better (but not statistically significant) return of spontaneous circulation (ROSC) in the field [22/32 (65%) vs 301/528 (57%); p = 0.33], more of them were admitted to hospital [19/32 (60%) vs 253/528 (48%); p = 0.27], and also had a significantly higher survival rate (discharge from hospital) [14/32 (44%) vs 116/528 (22%); p = 0.01]. DCA patients had higher values of initial PETCO2 (53.2 ± 16.8 vs 15.8 ± 8.3 mmHg; p < 0.0001) and average PETCO2 (43.5 ± 13.8 vs 23.5 ± 8.2; p = 0.002). These values of PETCO2 suggest an asphyxial mechanism of cardiac arrest. The analysis showed that DCA patients who survived were younger, had more bystander cardiopulmonary resuscitation (CPR), shorter call-arrival interval, higher values of PETCO2 after 1 min of CPR, higher average and final values of PETCO2, lower value of initial serum K+, and more of them received vasopressin (p < 0.05) in comparison with DCA patients who did not survive. Conclusion DCA patients had a better survival rate (discharge from hospital), higher initial and average PETCO2 values, and more of them had nonshockable initial rhythm. Survival (discharge from hospital) in DCA patients is associated with the PETCO2 values, initial serum K+ values, administration of vasopressin, and ambulance response time.
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Affiliation(s)
- Stefek Grmec
- Center for Emergency Medicine Maribor, Maribor, Slovenia.
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Gregorakos L, Markou N, Psalida V, Kanakaki M, Alexopoulou A, Sotiriou E, Damianos A, Myrianthefs P. Near-Drowning: Clinical Course of Lung Injury in Adults. Lung 2009; 187:93-7. [DOI: 10.1007/s00408-008-9132-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
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Hyder AA, Borse NN, Blum L, Khan R, El Arifeen S, Baqui AH. Childhood drowning in low- and middle-income countries: Urgent need for intervention trials. J Paediatr Child Health 2008; 44:221-7. [PMID: 18377369 DOI: 10.1111/j.1440-1754.2007.01273.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Data available for low- and middle-income countries (LMICs) indicate that the burden of drowning in children is significant and becoming a leading public health problem. At the same time, interventions for drowning are not well documented in LMICs. The overall purpose of this paper is to make the case for research investments in conducting intervention trials to prevent child drowning in LMICs. In high-income countries (HICs), existing drowning prevention interventions include among others: pool fencing, supervision, lifeguards and water safety training at a young age. However, these measures may not be the most relevant in curtailing the number of drowning deaths in LMICs. There are differences with regard to geographical, social, cultural and behavioural factors associated with drowning between HICs and LMICs, often making it inappropriate to apply existing interventions directly in LMIC settings. This paper focuses on drowning from LMICs and reveals a dearth of data on incidence rates and risk factors; absence of public health interventions; lack of research on intervention effectiveness and cost-effectiveness; and paucity of national drowning prevention programs. Based on this evidence, this paper calls for immediate attention to drowning prevention by increasing research investments. This paper specifically discusses Bangladesh as a case study and proposes a drowning intervention study focusing on children less than 5 years in LMICs as an example of appropriate research investment.
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Affiliation(s)
- Adnan A Hyder
- Department of International Health and Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Near-drowning and clinical laboratory changes. Leg Med (Tokyo) 2008; 10:1-5. [DOI: 10.1016/j.legalmed.2007.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 05/02/2007] [Accepted: 05/24/2007] [Indexed: 11/21/2022]
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Abstract
Sudden and unexpected natural deaths and nonnatural deaths may result from various pulmonary conditions. Additionally, several nonpulmonary conditions of forensic significance may be complicated by the development of respiratory lesions. Certain situations with pulmonary pathology are particularly likely to be critically scrutinized and may form the basis of allegations of medical negligence, other personal injury liability, or wrongful death.1
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Pendergrast JM, Hladunewich MA, Richardson RMA. Hemolysis due to inadvertent hemodialysis against distilled water: Perils of bedside dialysate preparation. Crit Care Med 2006; 34:2666-73. [PMID: 16915116 DOI: 10.1097/01.ccm.0000240230.10343.3e] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the physiologic consequences of dialysis against distilled water and to provide recommendations by which other institutions may avoid similar errors in dialysate preparation. DATA SOURCE Four cases of dialysis against distilled water are described, occurring at three teaching hospitals within a 2-yr period. In addition, an in vitro experiment of banked whole blood exposure to distilled water dialysate was performed. DATA EXTRACTION Because all four cases occurred within a critical care setting, intensive monitoring of clinical, biochemical, and hematologic abnormalities was possible. DATA SYNTHESIS Serum sodium decreased by an average of 22 mmol/L, followed by a decrease in hemoglobin averaging 32 g/L. Additional investigations and the in vitro experiment provided evidence that hemolysis occurred primarily via clearance of damaged erythrocytes within the patient's reticuloendothelial system. Physiologic derangements secondary to dialysis against distilled water likely contributed to a stroke suffered by one patient and the death of at least one other patient. CONCLUSIONS Accidental dialysis against distilled water is a potentially serious but preventable complication of bedside dialysate preparation.
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Affiliation(s)
- Jacob M Pendergrast
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network, Toronto, Canada
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Azparren JE, Perucha E, Martínez P, Muñoz R, Vallejo G. Factors affecting strontium absorption in drownings. Forensic Sci Int 2006; 168:138-42. [PMID: 16901667 DOI: 10.1016/j.forsciint.2006.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 06/29/2006] [Accepted: 07/02/2006] [Indexed: 11/23/2022]
Abstract
This study examines the effects of age, gender, a cold water medium versus warm water medium, and salinity on strontium levels determined in left ventricular blood in drownings. Significant differences in the amount of strontium absorbed into the bloodstream (p<0.001) were detected between individuals who drowned in fresh water versus those drowning in seawater, and between those drowning in cold water versus warm water (p=0.030). However, no significant differences were noted in the strontium concentrations of left ventricular blood according to gender or age.
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Affiliation(s)
- J E Azparren
- Instituto Nacional de Toxicología y Ciencias Forenses, Ministerio de Justicia, C/Luis Cabrera 9, 28002 Madrid, Spain.
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Affiliation(s)
- Robyn J Meyer
- The University of Arizona Steele Memorial Children's Research Center, Tucson, Arizona, USA
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Byard RW, Cains G, Simpson E, Eitzen D, Tsokos M. Drowning, haemodilution, haemolysis and staining of the intima of the aortic root – preliminary observations. ACTA ACUST UNITED AC 2006; 13:121-4. [PMID: 16488651 DOI: 10.1016/j.jcfm.2006.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 01/01/2006] [Accepted: 01/01/2006] [Indexed: 11/27/2022]
Abstract
In order to demonstrate that hyponatraemia due to haemodilution occurs within the left ventricle following freshwater drowning, and to determine whether lysed blood resulting from left ventricular haemodilution may cause staining of the aortic intima, the following studies were undertaken. Measurements of left ventricular sodium levels were performed in 74 consecutive coronial cases where death was attributed to drowning, consisting of 44 and 30 deceased who were believed to be victims of freshwater and saltwater drowning, respectively. Left ventricular sodium levels differed significantly between the two groups (p<0.001), with a range of 93-147 mmol/L in freshwater drowning (mean=117+/-14.2 mmol/L) and 123-183 in saltwater drowning (mean=153+/-14.4 mmol/L). In addition, the mean sodium level of 117 mmol/L in freshwater drowning was significantly lower than the standard range of 137-145 mmol/L. In a second study, portions of aorta and pulmonary trunk from a euthanised pig were soaked in lysed blood resulting in marked haemolytic staining of the intima of both vessels after 20 min. Water and a mixture of blood and water were then injected into the left ventricles in two further pig carcasses, respectively, resulting in haemolytic staining of the intima of the aortic roots, with no staining of the pulmonary trunks. These studies have confirmed that significant hyponatraemia secondary to haemodilution may occur within the left ventricle in freshwater drowning, and that haemolysed blood is capable of causing staining of the aortic root in an animal model. These results provide further data to support haemolytic staining of the aortic root intima as a possible manifestation of freshwater drowning.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA, 21 Divett Place, Adelaide, SA 5000, Australia.
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Papa L, Hoelle R, Idris A. Systematic review of definitions for drowning incidents. Resuscitation 2005; 65:255-64. [PMID: 15919561 DOI: 10.1016/j.resuscitation.2004.11.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Revised: 11/30/2004] [Accepted: 11/30/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In preparation for the World Congress on Drowning uniform reporting consensus document of drowning incidents we reviewed systematically the medical literature for the terms and definitions used to describe drowning incidents to assess the uniformity of these terms in the medical literature. METHODS The search strategy included a literature search of PubMed, MEDLINE and the Cochrane Database from 1966 to April 2002, as well as a review of reference lists of identified studies and a hand search of relevant textbooks and reference works. Search terms used included drowning, near-drowning, submersion, immersion, suffocation, asphyxiation, water injuries, and aspiration. Any article with drowning as a primary focus and containing a definition of drowning was included. Study designs included experimental studies, observational studies, case control studies, reviews, letters, and editorials. RESULTS The search identified approximately 6000 articles. Of these 650 were reviewed and 43 articles addressing the definition of drowning were identified. We found a total of 33 different definitions to describe drowning incidents, 20 for drowning and 13 for near-drowning; along with another 13 related terms. There were at least 20 different outcome measures for drowning incidents reported. CONCLUSIONS A review of existing drowning literature demonstrates a lack of a standard definition of drowning and a lack of agreement on measures of outcome. This variability in definitions and outcomes makes it very difficult to assess and analyze studies both individually and as a whole and draw conclusions that will influence practice. These objective findings support the need for the drowning Utstein focus on one definition of drowning and validated measures of functional and neurological outcome.
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Affiliation(s)
- Linda Papa
- Department of Emergency Medicine, University of Florida, 1329 SW 16th Street (Suite 2204), Gainesville, FL 32608, USA.
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Salomez F, Vincent JL. Drowning: a review of epidemiology, pathophysiology, treatment and prevention. Resuscitation 2005; 63:261-8. [PMID: 15582760 DOI: 10.1016/j.resuscitation.2004.06.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Revised: 04/29/2004] [Accepted: 06/11/2004] [Indexed: 11/29/2022]
Abstract
Although often preventable, drowning remains a leading cause of accidental death, especially in children. New definitions classify drowning as the process of experiencing respiratory impairment from submersion or immersion in a liquid. The key pathophysiological feature in drowning is hypoxia. Accurate neurological prognosis cannot be predicted from the initial clinical presentation, laboratory, radiological, or electrophysiological examinations. Prompt and aggressive resuscitation attempts are crucial for optimal survival. This article reviews the epidemiology, pathophysiology, treatment, and prevention of drowning.
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Affiliation(s)
- Frédéric Salomez
- Department of Intensive Care, Erasme University Hospital, Route de Lennik, 808, Free University of Brussels, 1070 Brussels, Belgium
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Zuckerbraun NS, Saladino RA. Pediatric Drowning: Current Management Strategies for Immediate Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2005. [DOI: 10.1016/j.cpem.2004.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lunetta P, Modell JH, Sajantila A. What Is the Incidence and Significance of “Dry-Lungs” in Bodies Found in Water? Am J Forensic Med Pathol 2004; 25:291-301. [PMID: 15577518 DOI: 10.1097/01.paf.0000146240.92905.7e] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drowning without aspiration of liquid, generally attributed to death from asphyxia while submerged and in laryngospasm, has been reported to occur in approximately 10% to 15% of drowning victims. OBJECTIVES The occurrence of "dry-drowning" recently has been questioned and the hypothesis developed that "dry-lungs" in bodies found dead in the water could conceal more natural deaths than previously recognized. METHODS Based on 578 selected adult victims who presumably drowned, we analyzed the correlation between the cases with a low combined lung/pleura liquid weight (< 1000 g and < 750 g) and a wide set of individual, circumstantial, and postmortem (PM) variables, using multivariate logistic regression analysis. Victims with lung weight < 1000 g were screened for long-QT syndrome (LQTS) founder mutations in KCNQ1 and KCNH2 genes. RESULTS Of the 578 victims, 120 (20.7%) had a lung weight of < 1000 g, and 22 of these (3.8%) of < 750 g. Multivariate analysis showed a significant correlation for women (P < 0.001), for women aged 65 years or older (P < 0.001), and for men with prolonged PM submersion time (P < 0.001). "Normal" lungs were found in only 8 (1.4%) victims. Low-weight (< 1000 g), overdistended lungs with no sign of liquid penetration were seen in 11 (1.9%). No LQTS founder mutations were detected. CONCLUSIONS The actual incidence of death of persons found in water who have normal lungs or do not have penetration of liquid into their airways, based on our study, is much lower (below 2%) than currently assumed.
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Affiliation(s)
- Philippe Lunetta
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
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