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Breindahl N, Bierens JLM, Wiberg S, Barcala-Furelos R, Maschmann C. Prehospital guidelines on in-water traumatic spinal injuries for lifeguards and prehospital emergency medical services: an international Delphi consensus study. Scand J Trauma Resusc Emerg Med 2024; 32:76. [PMID: 39180135 PMCID: PMC11344453 DOI: 10.1186/s13049-024-01249-3] [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] [Received: 03/05/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed. METHODS An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75-85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2. RESULTS Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90-95%). The integral flowchart received strong consensus (93%). CONCLUSIONS This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.
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Affiliation(s)
- Niklas Breindahl
- Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark.
- Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- International Life Saving Federation, Leuven, Belgium.
- International Drowning Researchers' Alliance, Kuna, ID, USA.
| | - Joost L M Bierens
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, ID, USA
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Sebastian Wiberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Roberto Barcala-Furelos
- International Life Saving Federation, Leuven, Belgium
- International Drowning Researchers' Alliance, Kuna, ID, USA
- REMOSS Research Group, Faculty of Education and Sports Sciences, Universidade de Vigo, Pontevedra, Spain
| | - Christian Maschmann
- Department of Emergency Medicine NFZ, Cantonal Hospital St. Gallen, Gallen, Switzerland
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Kemal S, Ramgopal S, Macy ML. Traumatic Injuries and Radiographic Study Utilization Among Children With Drowning Presenting to U.S. Pediatric Hospitals. Acad Pediatr 2024; 24:677-685. [PMID: 37743013 DOI: 10.1016/j.acap.2023.09.009] [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: 04/08/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The role of traumatic injuries in fatal and nonfatal drownings is poorly described. We sought to characterize the incidence of traumatic injuries and diagnostic imaging performed among children who received pediatric hospital care for drowning. METHODS We conducted a retrospective study of children (≤18 years) with drowning encounters at 45 pediatric hospitals, October 2015 through December 2020. We described the presence of clinically important traumatic injuries to the following body regions: brain, spinal cord, thoracic and intra-abdominal organs, axial skeleton, pelvis, and long bones, and major vessels. We described patient characteristics and radiographic testing. We compared patients with and without traumatic injuries using the Fisher's exact and Wilcoxon signed rank tests. RESULTS We identified 10,397 children with a drowning encounter. Most (83.4%) were treated in the emergency department and 52.8% were admitted. There were 238 (2.3%) encounters with clinically important traumatic injuries. Intracranial injury was the most common (1.0%) with other traumatic injuries occurring in ≤0.5%. Less than 2% of children had a moderate or severe injury severity score and approximately half of these children had a clinically important traumatic injury. Among children with traumatic injuries, a higher proportion were 10 to 14 or 15 to 18 years old and from ZIP codes with lower median household income. Computerized tomography imaging was performed in the following proportions: brain (11.4%), cervical spine (3.7%), abdomen/pelvis (1.2%), chest (0.5%) and face/orbits (0.2%). CONCLUSIONS Clinically important traumatic injuries in children with drowning are rare. Further studies are needed to guide the optimal utilization of radiographic studies in this population.
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Affiliation(s)
- Samaa Kemal
- Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Sriram Ramgopal
- Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (S Ramgopal and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Michelle L Macy
- Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (S Ramgopal and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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3
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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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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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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin R. Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine. Emerg Med Australas 2023; 35:18-24. [PMID: 35878883 PMCID: PMC10087421 DOI: 10.1111/1742-6723.14036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor. METHODS Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition. RESULTS Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging. CONCLUSIONS The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Surf Life Saving Queensland, Brisbane, Queensland, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Amy E Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Life Saving Society Australia, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Life Saving Society Australia, Sydney, New South Wales, Australia
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6
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Just the facts: drowning. CAN J EMERG MED 2022; 24:263-265. [PMID: 35129831 DOI: 10.1007/s43678-022-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/17/2022] [Indexed: 11/02/2022]
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Minasian B, Hope N. Surfing on the world stage: a narrative review of acute and overuse injuries and preventative measures for the competitive and recreational surfer. Br J Sports Med 2021; 56:51-60. [PMID: 34862173 DOI: 10.1136/bjsports-2021-104307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/03/2022]
Abstract
Surfing has rapidly grown in popularity as the sport made its debut at the Tokyo 2020 Olympic Games. Surfing injuries are becoming more relevant with the globalisation and increasing risks of the sport, but despite this, little is known about surfing injuries or prevention strategies in either the competitive or recreational surfer. Prior research demonstrates that surfers are injured at a frequency of 0.74-1.79 injuries per 1000 hours of surfing. We reviewed the literature for the incidence, anatomical distribution, type and underlying mechanism of acute and overuse injuries, and discuss current preventative measures. This review finds that skin injuries represent the highest proportion of total injuries. Acute injuries most frequently affect the head, neck and face, followed by the lower limbs. Being struck by one's own board is the most common mechanism of injury. Non-contact acute ligament injuries have increased as surfing manoeuvres have become more acrobatic and overuse musculoskeletal injuries are highly correlated with paddling. However, there is a paucity of research for surfing injuries, and studies on overuse musculoskeletal injuries and prevention are disproportionally under-represented. Most of the prior studies are limited by small sample sizes, poor data collection methodology and geographical constraints. Further research is needed to establish preventative measures for both acute and overuse surfing injuries and to ensure the increasing popularity of surfing is met with an improved understanding of sport risks and safety. Specifically, we recommend research be prioritised regarding the efficacy of training programmes to prevent surfing-related overuse musculoskeletal injuries.
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Affiliation(s)
- Bayan Minasian
- Westmead Hospital, Westmead, NSW, Australia .,Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
| | - Nigel Hope
- University of Notre Dame, Darlinghurst, NSW, Australia
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8
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Ching CK, Leong BSH, Nair P, Chan KC, Seow E, Lee F, Heng K, Sewa DW, Lim TW, Chong DTT, Yeo KK, Fong WK, Anantharaman V, Lim SH. Singapore Advanced Cardiac Life Support Guidelines 2021. Singapore Med J 2021; 62:390-403. [PMID: 35001112 PMCID: PMC8804484 DOI: 10.11622/smedj.2021109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy- and bradydysrhythmias that may deteriorate further.
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Affiliation(s)
- Chi Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | - Praseetha Nair
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Kim Chai Chan
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Eillyne Seow
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Francis Lee
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore
| | - Kenneth Heng
- Emergency Medicine Department, Tan Tock Seng Hospital, Singapore
| | - Duu Wen Sewa
- Department of Respiratory Medicine, Singapore General Hospital, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Hospital, Singapore
| | | | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Wee Kim Fong
- Department of Anaesthesia, Tan Tock Seng Hospital, Singapore
| | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Ryan KM, Dugas J, Pina T, Maksimenko Y, Liu J. Drowning injuries in the United States: Patient characteristics, mortality risk, and associated primary diagnoses. Injury 2020; 51:2560-2564. [PMID: 32798037 DOI: 10.1016/j.injury.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine patient demographics, associated primary diagnoses, mortality risk, and inpatient mortality of admitted drowning patients in the U.S. METHODS Retrospective cross-sectional study using 2016 National Inpatient Sample Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality dataset. External cause codes were used to identify drowning records, excluding self-inflicted/suicides. ICD-10 diagnosis and procedure codes, patient demographics, and admission-related data were collected. RESULTS Of the 4,355 admissions in 2016, 68.3% were male (95% CI 65.3-71.3%) and 70.3% were white (95% CI 66.9-73.6%) with mean length of stay of 5.5 days (95% CI 4.9-6.2) and mean total charge of $81,624 (95% CI $70926-$92321). 8.2% of admissions resulted in inpatient death. Those that died were significantly younger than those that did not die (χ2=5.9, p=0.02). There was a statistically significant association between primary payer and inpatient mortality (χ2=10.5, p=0.02). CONCLUSION Younger, male, and white patients accounted for the majority of drowning admissions and deaths. A significantly larger proportion of Medicaid patients died compared to inpatient mortality of those with other insurance. Recognizing those most impacted by drowning could help better tailor prevention efforts.
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Affiliation(s)
- Kevin M Ryan
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States.
| | - Julianne Dugas
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - Tyler Pina
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - Yevgeniy Maksimenko
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
| | - James Liu
- Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, BCD Building, Boston, MA, 02118, United States
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Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, Kudenchuk PJ, Kurz MC, Lavonas EJ, Morley PT, O’Neil BJ, Peberdy MA, Rittenberger JC, Rodriguez AJ, Sawyer KN, Berg KM, Arafeh J, Benoit JL, Chase M, Fernandez A, de Paiva EF, Fischberg BL, Flores GE, Fromm P, Gazmuri R, Gibson BC, Hoadley T, Hsu CH, Issa M, Kessler A, Link MS, Magid DJ, Marrill K, Nicholson T, Ornato JP, Pacheco G, Parr M, Pawar R, Jaxton J, Perman SM, Pribble J, Robinett D, Rolston D, Sasson C, Satyapriya SV, Sharkey T, Soar J, Torman D, Von Schweinitz B, Uzendu A, Zelop CM, Magid DJ. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S366-S468. [DOI: 10.1161/cir.0000000000000916] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Strapazzon G, Reisten O, Argenone F, Zafren K, Zen-Ruffinen G, Larsen GL, Soteras I. International Commission for Mountain Emergency Medicine Consensus Guidelines for On-Site Management and Transport of Patients in Canyoning Incidents. Wilderness Environ Med 2018; 29:252-265. [PMID: 29422373 DOI: 10.1016/j.wem.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/23/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
Canyoning is a recreational activity that has increased in popularity in the last decade in Europe and North America, resulting in up to 40% of the total search and rescue costs in some geographic locations. The International Commission for Mountain Emergency Medicine convened an expert panel to develop recommendations for on-site management and transport of patients in canyoning incidents. The goal of the current review is to provide guidance to healthcare providers and canyoning rescue professionals about best practices for rescue and medical treatment through the evaluation of the existing best evidence, focusing on the unique combination of remoteness, water exposure, limited on-site patient management options, and technically challenging terrain. Recommendations are graded on the basis of quality of supporting evidence according to the classification scheme of the American College of Chest Physicians.
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Affiliation(s)
- Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy (Dr Strapazzon); International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras).
| | - Oliver Reisten
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Air Zermatt Air and Mountain Rescue, Alpine Rescue Center, Zermatt, Switzerland; Rescue Service, Solothurn Hospital, Solothurn, Switzerland (Dr Reisten)
| | - Fabien Argenone
- Helicopter Emergency Medical Service 04, ICU, Centre Hospitalier de Digne, Digne les Bains, France; French Mountain Rescue Association (ANMSM Medcom), Grenoble, France (Dr Argenone)
| | - Ken Zafren
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK (Dr Zafren)
| | - Greg Zen-Ruffinen
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Air Glaciers SA et GRIMM, Sion, Switzerland (Dr Zen-Ruffinen)
| | - Gordon L Larsen
- Department of Emergency Medicine, Dixie Regional Medical Centre, St. George, UT; Search and Rescue Service, Zion National Park, Springdale, UT (Dr Larsen)
| | - Inigo Soteras
- International Commission of Mountain Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland (Drs Strapazzon, Reisten, Zafren, Zen-Ruffinen, and Soteras); Cerdanya Hospital, Puigcerdà, Spain; Faculty of Medicine, Girona University, Girona, Spain (Dr Soteras)
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Tadros A, Sharon M, Hoffman SM, Davis SM. Emergency department visits coded for swimming pool diving injuries. Int J Inj Contr Saf Promot 2018; 25:347-351. [PMID: 29400126 DOI: 10.1080/17457300.2018.1431935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite legislative efforts to enhance safety in public swimming pools, diving injuries are still common. This study investigated the characteristics of emergency departments (EDs) visits for diving accidents. This study utilized 2006-2014 data from the Nationwide Emergency Department Sample and examined visits for accidents due to diving or jumping into water (swimming pool). Data were stratified by age categories. Over 83,000 ED visits were found and the majority of visits were by males. Significantly more patients were in the 15-24 age category. The majority of patients were discharged and were covered by private insurance. Total charges for the six-year period approached $620 million. Spinal cord injuries were more common in those over age 25, whereas intracranial injuries occurred more frequently in younger patients. This study provides a profile of patients presenting to US EDs for diving-related injuries.
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Affiliation(s)
- Allison Tadros
- a Department of Emergency Medicine , West Virginia University , Morgantown , WV , United States
| | - Melinda Sharon
- a Department of Emergency Medicine , West Virginia University , Morgantown , WV , United States
| | - Shelley M Hoffman
- a Department of Emergency Medicine , West Virginia University , Morgantown , WV , United States
| | - Stephen M Davis
- a Department of Emergency Medicine , West Virginia University , Morgantown , WV , United States
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13
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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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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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16
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 537] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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17
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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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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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Heming N, Serve E, Weiss N, Imbert A, Ducharne G, Diehl JL, Guérot E, Fagon JY, Tadié JM. Drowning after falling from a medium-height bridge: multiple trauma victims. PREHOSP EMERG CARE 2012; 16:356-60. [PMID: 22494150 DOI: 10.3109/10903127.2012.670691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Drowning following a fall from a bridge can lead to cardiac arrest caused by hypoxia, hypothermia, or severe traumatic injury. Every year patients are brought to our hospital who have nearly drowned in the local river after a jump from a bridge (approximate height 16-22 meters). We report traumatic injuries in patients admitted to our hospital for out-of-hospital cardiac arrest due to drowning. METHODS We retrospectively reviewed the charts of all patients admitted to the intensive care units of our hospital for out-of-hospital cardiac arrest due to drowning after a jump from a bridge in the Seine River between 2002 and 2010. All clinical or radiologic evidence of trauma was recorded. RESULTS A total of 37 patients where admitted to our hospital for out-of-hospital cardiac arrest due to drowning. Fourteen patients had radiologic examinations. Five of these examinations showed evidence of severe trauma. In one case, clinical examination showed evidence of severe peripheral neurologic trauma. Seven of these patients (19%) were discharged from the hospital alive. CONCLUSIONS Patients found nearly drowned in a river spanned by a medium-height bridge should undergo spinal immobilization and complete radiologic examination as soon as possible.
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Affiliation(s)
- Nicholas Heming
- Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, 20-40, rue Leblanc, 75908 Paris cedex 15, France
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23
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Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJLM, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2011; 81:1400-33. [PMID: 20956045 DOI: 10.1016/j.resuscitation.2010.08.015] [Citation(s) in RCA: 362] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
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Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S829-61. [PMID: 20956228 DOI: 10.1161/circulationaha.110.971069] [Citation(s) in RCA: 392] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Soar J, Perkins G, Abbas G, Alfonzo A, Barelli A, Bierens J, Brugger H, Deakin C, Dunning J, Georgiou M, Handley A, Lockey D, Paal P, Sandroni C, Thies KC, Zideman D, Nolan J. Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1374-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA. Part 5: Adult Basic Life Support. Circulation 2010; 122:S685-705. [PMID: 20956221 DOI: 10.1161/circulationaha.110.970939] [Citation(s) in RCA: 480] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
CONTEXT The diagnosis of the cause and the establishment of the manner of death in submersion cases are routine challenge for forensic pathologists as it presents considerable diagnostic difficulties. OBJECTIVE To concisely review the main questions during a submersion death investigation and to give the respective documented answers. DATA SOURCES The search strategy included a literature search of PubMed, Medline and Google Scholar databases, as well as a review of the cited references by the identified studies and a hand search of relevant textbooks and reference works. CONCLUSIONS A complete autopsy, histopathological examination and full toxicological screening are important to determine whether death indeed followed submersion in the water, or to see whether any natural disease or substance use have contributed or caused death. In ambiguous situations, the co-estimation of circumstantial evidence may be of invaluable importance toward the conclusion concerning the cause and the manner of death. The thorough forensic investigation of the submersion deaths not only serves the justice administration, but it also presents considerable benefits for the public health.
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Affiliation(s)
- S A Papadodima
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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29
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Borius PY, Gouader I, Bousquet P, Draper L, Roux FE. Cervical spine injuries resulting from diving accidents in swimming pools: outcome of 34 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:552-7. [PMID: 19956985 DOI: 10.1007/s00586-009-1230-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/27/2009] [Accepted: 11/15/2009] [Indexed: 11/28/2022]
Abstract
Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5-C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem.
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Affiliation(s)
- Pierre-Yves Borius
- Pôle Neuroscience (Neurochirurgie), Centres Hospitalo-Universitaires, Université Paul-Sabatier, 31059 Toulouse, France.
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Kikuike K, Uemura S, Miyamoto K, Horiya Y, Shimizu K. Upper lumbar burst fracture due to recreational high jumping into a river: report of five cases. Arch Orthop Trauma Surg 2009; 129:87-90. [PMID: 18648825 DOI: 10.1007/s00402-008-0698-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Spinal injuries resulting from entering into water usually occur in the cervical region, with few reported in the thoracolumbar region. Although the mechanism of cervical spine injury caused by diving is known, less is known regarding the mechanism of upper lumbar spine injury. MATERIALS AND METHODS The study subjects were five patients (mean age, 32.8 years), inexperienced in diving from heights, who were referred for burst fractures (Denis type B) at L1 caused while jumping into a river from a 12-m-high bridge between 2004 and 2005. Three patients were treated surgically and two were treated conservatively. Their clinical outcomes were reviewed and the mechanism of upper lumbar spine injury was discussed. RESULTS No patient experienced neurological deficit or low back pain after treatment, and all returned to their previous activities within 1 year. Impact with the surface of the river with back and hip flexed may be a major cause of upper lumbar spine injury. CONCLUSIONS To minimize the incidence of upper lumbar burst fracture during recreational high jumping into water, it is important that jumpers, especially inexperienced jumpers, should be instructed to jump with their backs and hips straight.
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Affiliation(s)
- Kenta Kikuike
- Department of Orthopaedic Surgery, Gifu University School of Medicine, Gujo City Hospital, Gifu, Japan.
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31
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Piepho T, Muth C, Schröder S. Wasserunfälle. Notf Rett Med 2008. [DOI: 10.1007/s10049-007-0989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Muth CM, Piepho T, Schröder S. [Water rescue. A unique area of emergency medicine with many facets]. Anaesthesist 2008; 56:1047-57. [PMID: 17603775 DOI: 10.1007/s00101-007-1224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Emergencies on or in water are relatively rare in the rescue service. For this reason, water accident treatment and management does not receive much attention in the training of emergency medicine physicians. Consequently doctors working in emergency medicine often have minimal knowledge in this area. On the other hand, the number of fatal accidents on and in water has increased in recent years. In Germany the number of non-swimmers is also increasing, so it can be assumed that the number of water-related accidents will continue to rise. Drowning accidents and near drowning are important in this context and will be discussed in detail in this review as well as hypothermia (a frequent problem), accompanying injuries and diving accidents.
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Affiliation(s)
- C-M Muth
- Sektion Spezielle Anästhesie, Universitätsklinik für Anästhesiologie, Universitätsklinikum Ulm, Ulm.
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Abstract
PURPOSE OF REVIEW To summarize current knowledge on pathophysiology and treatment of drowning accidents. Studies and case reports were searched using the keywords drowning, near-drowning, asphyxia, hypoxia and hypothermia in conjunction with organ systems and specific treatment options. RECENT FINDINGS Drowning is defined as death by suffocation in a liquid. In contrast, near-drowning is defined as survival beyond 24 h after a drowning accident. Drowning is a frequent preventable accident with a significant morbidity and mortality in a mostly healthy population. In the majority of patients the primary injury is pulmonary, resulting in severe arterial hypoxemia and secondary damage to other organs. Damage to the central nervous system is most critical in terms of patient survival and subsequent quality of life. Therefore, prompt resuscitation and aggressive respiratory and cardiovascular treatment are crucial for optimal survival. Immediate interruption of hypoxia, aggressive treatment of hypothermia and cardiovascular failure are the cornerstones of correct medical treatment. Unfortunately, accurate neurologic prognosis cannot be predicted from initial clinical presentation, laboratory, radiological or electrophysiological examinations. SUMMARY Several case studies have convincingly demonstrated that drowning victims may survive neurologically intact even after prolonged submersion times, in particular in cold water. Therefore, aggressive initial therapeutic efforts are indicated in most near-drowning victims.
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Affiliation(s)
- Walter R Hasibeder
- Division of General and Surgical Intensive Care Medicine, Department of Anaesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Innsbruck, Austria.
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Oral R, Rahhal R, Elshershari H, Menezes AH. Intentional avulsion fracture of the second cervical vertebra in a hypotonic child. Pediatr Emerg Care 2006; 22:352-4. [PMID: 16714964 DOI: 10.1097/01.pec.0000215370.71729.cd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children uncommonly present with cervical fractures due to high-impact injuries. A 4-year-old child with developmental delay and chronic hypotonia presented to the hospital with acute onset of irritability and transient difficulty in walking. Lateral neck x-rays showed avulsion fracture of the second cervical vertebra. Neck magnetic resonance imaging study showed injury to the interspinal ligaments between the first and second cervical vertebrae in addition to confirming the acute avulsion fracture of C-2. The child was injured after he was thrown onto a bed from a distance of 1 to 2 ft according to his babysitter's admission. This is the first reported pediatric case presenting this type of inflicted fracture in a hypotonic child, although hypotonia may not have played a causal role.
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Abstract
Abstract
OBJECTIVE:
Spine injuries can occur secondary to several aquatic recreational activities. A series of cases of patients who experienced cervical spine injuries secondary to ocean waves accidents is presented. A description and analysis of this kind of injury is performed.
METHODS:
Sixteen patients were treated from January 1999 to May 2005. The mechanism of accident, mechanism of injury, neurological status, radiographic findings, associated injuries, and treatment were analyzed.
RESULTS:
These injuries are common among older patients. More severe and devastating injuries occurred in young patients. The most common mechanism of injury is hyperextension associated to spondylosis, which usually caused central cord syndrome.
CONCLUSION:
Wave-related accidents in ocean bathers are secondary to lack of experience of swimming in the ocean and underestimating the danger of waves. Although different types of mechanism of injury occurred, hyperextension was the most common. High-risk patients are older people with preexisting cervical spondylosis.
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Affiliation(s)
- Luis A Robles
- Section of Neurosurgery, Hospital Ameri-med, Puerto Vallarta, Jalisco, México, CP 48310.
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36
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Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K. European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances. Resuscitation 2006; 67 Suppl 1:S135-70. [PMID: 16321711 DOI: 10.1016/j.resuscitation.2005.10.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4: Advanced life support. Resuscitation 2006; 67:213-47. [PMID: 16324990 DOI: 10.1016/j.resuscitation.2005.09.018] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kreislaufstillstand unter besonderen Umständen. Notf Rett Med 2006. [DOI: 10.1007/s10049-006-0798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- S R Lord
- Southern General Hospital, Glasgow G51 4TF.
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40
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Robles LA, Curiel A. Posttraumatic cervical disc herniation: an unusual cause of near drowning. Am J Emerg Med 2005; 23:905-7. [PMID: 16291453 DOI: 10.1016/j.ajem.2005.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2005] [Accepted: 07/18/2005] [Indexed: 10/25/2022] Open
Affiliation(s)
- Luis A Robles
- Hospital Ameri-med, Puerto Vallarta Jalisco, CP 48310, Mexico.
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41
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2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 2: Adult basic life support. Resuscitation 2005; 67:187-201. [PMID: 16324988 PMCID: PMC7144408 DOI: 10.1016/j.resuscitation.2005.09.016] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Burford AE, Ryan LM, Stone BJ, Hirshon JM, Klein BL. Drowning and near-drowning in children and adolescents: a succinct review for emergency physicians and nurses. Pediatr Emerg Care 2005; 21:610-6; quiz 617-9. [PMID: 16160669 DOI: 10.1097/01.pec.0000177204.21774.35] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amy E Burford
- Emergency Physician, Riverside Regional Medical Center, Newport News, VA, USA
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43
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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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44
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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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Abstract
Many thousands of individuals are submersion victims each year in the United States. The majority of victims are young, previously healthy people. There have been no recent breakthroughs in medical technology or treatment modalities that have improved survival rates for submersion victims. The key to their successful outcome and return to productive, full lives is aggressive resuscitation by emergency physicians and prehospital care providers. Most submersion incidents should never take place. Emergency physicians can take the lead in public education and prevention.
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Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM, Gabrielli A, Graves SA, Handley AJ, Hoelle R, Morley PT, Papa L, Pepe PE, Quan L, Szpilman D, Wigginton JG, Modell JH. Recommended guidelines for uniform reporting of data from drowning: the "Utstein style". Resuscitation 2004; 59:45-57. [PMID: 14580734 DOI: 10.1016/j.resuscitation.2003.09.003] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A H Idris
- Emergency Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8579, USA
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47
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Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM, Gabrielli A, Graves SA, Handley AJ, Hoelle R, Morley PT, Papa L, Pepe PE, Quan L, Szpilman D, Wigginton JG, Modell JH. Recommended guidelines for uniform reporting of data from drowning: the "Utstein style". Circulation 2003; 108:2565-74. [PMID: 14623794 DOI: 10.1161/01.cir.0000099581.70012.68] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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48
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Abstract
Drowning and other asphyxial injuries are important causes of childhood morbidity and mortality. In this review, the epidemiology, pathophysiology, and treatments applied to near-drowning victims are discussed, with an emphasis on the difficulties encountered attempting to predict outcome using current methods.
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Affiliation(s)
- Laura M Ibsen
- Department of Pediatrics, Division of Critical Care, Oregon Health and Sciences University, Portland, OR, USA
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