1 / 16

Environmental Emergency “A Swimmer Disappears ”

Environmental Emergency “A Swimmer Disappears ”. 1. Learning Objectives. Discuss potential complications of near-drowning, which may cause cardiopulmonary arrest or a prearrest condition

lenci
Télécharger la présentation

Environmental Emergency “A Swimmer Disappears ”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Environmental Emergency “A Swimmer Disappears” • 1

  2. Learning Objectives • Discuss potential complications of near-drowning, which may cause cardiopulmonary arrest or a prearrest condition • Manage a case scenario describing the resuscitation and stabilization (ACLS)appropriate for a near-drowning victim After completing this discussion we should be able to:

  3. The case: 24-year-old victim • 24-year-old man disappeared after diving into water from a platform near the edge of Klineline Pond • He was submerged for several minutes before being found by friends and pulled to shore • At the scene he was unresponsive, without respiratory effort, and pulseless • Bystander CPR begun, 911 activated

  4. Pond Depths Swim Area

  5. Drowning/Near-Drowning Definition and Classification • Drowning: submersion resulting in immediate death or death within 24hours • Near-drowning: submersion, no immediate death or death within 24 hours • Submersion liquid: contamination and chemical irritants more relevant than salt vs fresh water • Note: Duration of hypoxia, rather than submersion liquid, affects outcome

  6. Near-DrowningPathophysiology • Hypoxemia is the major insult; duration determines outcome • Rule out associated conditions: trauma, alcohol intoxication, hypothermia • Potential neurologic insults: hypoxia, trauma • Potential pulmonary insults: pulmonary edema, intrapulmonary shunting, surfactant inactivation, ARDS, aspiration

  7. Near-DrowningBLS at Scene • Treat as traumatic event; immobilize cervical spine • Immediate BLS required • Hypoxia leads to respiratory and cardiac arrest (bradycardia or VT/VF) • Begin conventional BLS (airway, breathing, circulation) • Routine use of maneuvers to relieve foreign-body airway obstruction NOT recommended

  8. Near-Drowning VictimOn Medic Arrival • Call-to-scene interval: 8 minutes • On Fire arrival: victim out of water; unresponsive, apneic, and pulseless • CPR is producing chest rise, good pulse What should ACLS providers do first?

  9. Primary ABCD Survey C: Circulation — Assess breathing as you approach. Check for pulse, if no pulse, turn “on” LP12 and begin chest compressions A:Open the airway • Always use c-spine precautions B: Breathing • Not breathing (CPR continues) • Ventilate with 100% O2 via BVM D: Defibrillation • Dry victim’s chest • Apply “FAST” patches = asystole

  10. Secondary ABCD Survey Is advanced support needed? A = Airway: intubate at once if indicated • Intubation indicated to protect airway(8.0-mm tube successfully placed) • Vomiting occurs frequently: prepare suction B = Breathing: Is advanced support needed? Is support effective? • Verify tube placement • Monitor chest expansion, breath sounds, oxygenation

  11. Secondary ABCD Survey C = Circulation, advanced support • Check pulse frequently; continue CPR if needed • Insert two 14- to 16-gauge IVs; infuse 500 mL 0.9% NaCl or normal saline • Check rhythm: follow ACLS asystole protocol D = Differential Diagnosis • Asphyxia (including cerebral ischemia) • Trauma to cervical spine, head • Seizure or other cause of fall into water • Aspiration pneumonia • Hypothermia from submersion and heat loss

  12. Third Quadrad O2–IV–Monitor–Fluids Oxygen • Continue to deliver oxygen • Ensure effective oxygenation and ventilation • Verify proper tube placement and patency IV • Insert 2 large-bore catheters Monitor • Determine rhythm (asystole) • Verify ETT placement, evaluate temperature Fluids • Infuse NS (warm if the patient is cold)

  13. Case ProgressionResponse to EMS Treatment • Airway and breathing: 8-mm ETT in place, bilateral chest expansion, lungs compliant • Circulation: epinephrine administered, pulses return • Vital signs: HR = 139 bpm, BP = 94/74 mm Hg, RR = 14/min (hand ventilation), temp = 35°C (95°F) axillaries • Transport: Spine immobilized with cervical collar

  14. Case Progression Arrival in ED • Airway and breathing: spontaneous respiratory efforts detected • Circulation: normal sinus rhythm (88/min), good perfusion, BP = 110/68 mm Hg • Neurologic evaluation: pupils equal and reactive, no spontaneous movement What actual or potential problems may exist?

  15. Summary: ACLS Managementof Near-Drowning • Near-drowning creates severe hypoxic insult • Must restore oxygenation and ventilation • Key: drowning is trauma; immobilize cervical spine • Perform Primary and Secondary ABCD Surveys (consider factors that may complicate submersion)

More Related