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DROWNING RESUSCITATION
Disusun Oleh: Bintari Anindhita Pembimbing: Dr. Erica Gilda Simanjuntak SpAn Kepaniteraan Klinik Ilmu Anastesi Periode 15 Desember 2014 24 Januari 2015
Old Definition
Modell JH, from the Drown versus near-drown:
discussion of definitions. Drowning:
to die from respiratory obstruction and asphyxia with or
without aspiration while submerged in a fluid medium
Near drowning:
to survive, at least temporarily, following asphyxia with
or without aspiration due to submersion in a fluid medium
New Definition
Drowning is a process resulting in
primary respiratory impairment from submersion/immersion in a liquid medium The terms wet drowning, dry drowning, active or passive drowning, near-drowning, secondary drowning, and silent drowning are no longer used
Physiological Response During Drowning
Victims airway lies below the surface of liquid
Victim voluntarily holds his or her breath
Involuntary period of laryngospasm
Oxygen and carbon dioxide
hypercarbic, hypoxaemic and acidotic
stimulates respiration
Arterial oxygen tension drops further
Laryngeal spasm and obstruction abate and the victim actively breathes liquid
The victims respiratory movements become very active but there is no exchange of air
Saltwater vs Freshwater Drowning
Freshwater Drowning
Saltwater Drowning
fresh water hypotonic and
hyponatremic relative to blood
sea water very hypertonic
relative to the blood
inducing, after inhalation, a
movementt of water from the alveoli into the blood and movement of sodium from the blood into the alveoli
the water movement goes from
blood into the alveoli and the electrolytes (sodium, chloride, magnesium) from the alveoli into the blood.
induce haemodilution, hypervolemia,
hypnonatremia, hyperkalemia and haemolysis
The consequences of the sea water
drowning should be haemoconcentration, hypovolemia and hypernatremia.
Basic Life Support
Rescue and in water resuscitation
Untrained rescuers AVOID drowning if possible,
provide help from out of the water
If conscious, the person should be brought to land, and
basic life support should be started as soon as possible
Basic Life Support
Rescue and in water resuscitation
For a person who is
unconscious, in-water resuscitation may increase the likelihood of a favorable outcome
Is possible only by highly trained rescuer, and it consists of ventilation alone
Basic Life Support
Initial Resuscitation On Land
Once on land, victim should
be placed in a supine position, with the trunk and head at the same level
Check responsiveness and
breathing
If the person is unconscious
but breathing, the recovery position (lateral decubitus) should be used. If the person is not breathing, rescue ventilation is essential
Basic Life Support
Initial Resuscitation On Land
Cardiac arrest AB-C not C-A-B
Maneuvers to relieve foreign-body airway obstruction (FBAO) are not recommended
Open the airway, check for breathing
No breathing 5 initial rescue breaths Begin chest compression with 30:2 compression-ventilation ratio Attach AED if available Shock according to AED prompts
Advanced Life Support
Airway and breathing
High flow oxygen with reservoir bag
Noninvasive ventilation / CPAP
Early tracheal intubation, using rapidsequence induction
Advanced Life Support
Circulation and defibrilation
If the victim is in cardiac arrest follow standard advanced
life support protocols. If the victims core body temperature < 30 C : limit
defibrillation attempts to three, and
withhold IV drugs until the core body temperature increases above 30 C
Prolonged immersion victims may become
hypovolaemic from the hydrostatic pressure of the water on the body.
Give IV fluid to correct hypovolaemia.
After return of spontaneous circulation, use haemodynamic monitoring to guide fluid resuscitation.
Post Resuscitation Care
Lung injury. Victims of drowning at risk of developing acute respiratory distress syndrome (ARDS)
protective ventilation have been shown to improve
survival in patients with ARDS
Pneumonia common after drowning.
Prophylactic antibiotics have not been shown to be
of benefit Give broad-spectrum antibiotics if signs of infection develop subsequently
Post Resuscitation Care
Hypothermia after drowning.
Victims of submersion may develop primary or
secondary hypothermia. If the submersion occurs in icy water (<5 C or 41F), hypothermia may develop rapidly and provide some protection against hypoxia
A pragmatic approach might be to consider
rewarming until a core temperature of 3234 C is achieved, Taking care to avoid hyperthermia (>37 C) during the subsequent period of intensive care
Post Resuscitation Care
Permanent neurologic damage the most
worrisome outcome in persons who have been resuscitated after a drowning incident
Comatose victim or have neurologic deterioration
should undergo intensive assessment and care
the goals are to achieve normal values for glucose,
partial pressure of arterial oxygen, and partial pressure of carbon dioxide, with avoidance of any situation that increases brain metabolism
Unusual Complication Sepsis and disseminated intravascular SIRS coagulation possible complications during the first 72 hours Renal insufficiency can occur as a result of anoxia, shock, myoglobinuria,or hemoglobinuria
Post mortem findings
Froth present around nostrils, mouth, upper and lower
airway in freshly drowned bodies.
Lung weights
Higher in drowning cases
Normal weights are possible in the drowning cases after cardiac arrest reflex or vaso vagal reflex
Over-inflated lungs emphysema aquosum & marbled
appearance
Sand, silt, seashells and weeds in the airways, lungs,
stomach and duodenum of drowned victims.
If this material is found within the alveoli immersion
during life
References Van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJLM. A new Definition of Drowning: towards Documentation and Prevention of Global Public Health Problem. Bull World Health Org. 2005; 83: p. 853-6. Robert A. Berg C, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, et al. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122: p. S685-S705. Szpilman D, Bierens JJLM, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012; 366: p. 2102-10. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Joost J.L.M. Bierensf H, et al. European Resuscitation Council Guidelines for Resuscitation 2010. Resuscitation. 2010; 81: p. 1400-33. Farrugia A, Ludes B. Diagnostic of Drowning in Forensic Medicine. In Vieira DN, editor. Forensic Medicine - From Old Problems to New Challenge.: Intech; 2011. p. 53-8.
