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Submersion Injuries

Submersion Injuries

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Submersion Injuries

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  1. Submersion Injuries • Mandi Stone, MD • Orlando Health Emergency Medicine

  2. No disclosures

  3. Vocabulary

  4. Vocabulary • Drowning vs near-drowning? • Wet vs dry? • Primary vs secondary?

  5. Vocabulary • Drowning vs near-drowning? • Wet vs dry? • Primary vs secondary?

  6. Vocabulary • Drowning vs near-drowning? • Wet vs dry? • Primary vs secondary?

  7. “A process resulting in primary respiratory impairment from submersion/immersion in a liquid medium.”

  8. Epidemiology • Estimated 500,000 deaths per year, worldwide

  9. Pathophysiology

  10. Submersion Breathholding Air hunger Reflex gasping Aspiration

  11. Salt vs Fresh water?

  12. Salt vs Fresh water?

  13. Surfactant washout • Atelectasis • VQ mismatch • Pulmonary edema • ARDS

  14. H+ O2

  15. Management

  16. Pre-hospital

  17. ED Management • A • B • C • D • E

  18. ED Management • Cause of drowning? • Trauma • Seizure • Hypoglycemia • Arrhythmia • Suicide attempt • Abuse or neglect

  19. Immersion syndrome • Syncope secondary to cardiac dysrhythmia due to sudden contact with cold water • ASSOCIATED WITH CONGENITAL PROLONGED QT SYNDROME • Caused by V.fib/Asystole secondary to catecholamine release in response to quick temperature change

  20. CXR

  21. Routine steroids or antibiotics NOT recommended

  22. Disposition • Symptomatic patients - admit for observation, supplemental O2 • Asymptomatic - observe for 4-8 hours

  23. Prevention • Fences around pools • Swimming lessons • Close monitoring of infants/children • Avoiding alcohol/drug use while swimming

  24. Thank you!