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• Submersion injury:
Survival after more than 24 hr is termed
regardless the victim later dies or recovers
Epidemiology
Age
1-toddler age<5 yr
2-in 15-19 years old.
• Male predominant in All ages .
• Male/ Female
• 2:1 in toddlers 10:1 in teenager
• The site of drowning ,most
common depending on age.
Relevant factors:
• Water Tonicity
• Time submersion
• water Temperature
• symptoms associated injuries .
• Undetected primary cardiac
arrhythmia( long QT)
• response to initial CPR
Drowning begin with:
2. laryngospasm (10-20%)
until cardic arrest
)dry drowning)
Anoxic-ischemic injury
• CNS injury
(ICP ,cerebral edema)
The most frequent cause of
mortality and long- term morbidity
Anoxic-ischemic injury
• Pulmonary:
wash out surfactant
Pulmonary edema, ARDS
• Cardiovascular:
Arrhythmia( hypothermia ,hypoxemia)
• Acid-base
• Electrolytes
Anoxic-ischemic injury
• Renal
ATN (hypoxemia,shock,
hemoglobinuria)
• Gasterointestinal
hepatic trasaminases and serum
pancratic enzymes are often acutely
elevated
Aspiration and pulmonary injury
• Below T 32:
(sever hypothermia) shivering ceases and
cellular metabolic rate decreases
• ABG
• CBC ,Electrolytes ,U/A
• Chet x Ray - cervical spine X Ray
If pulses presented :
• Chest compression withhold
Sinus bradicardia and atrial
fibrillation require no immediate
treatment
Treatment
• Initial resuscitation:
• CPR
• air way should be clear
• Chest X RAY
Emergency unit management
• significant injury
• bronchospasm
• tachypnea
• inadequate oxigenation
hospitalized Children
• Supplement O2
• NaHCO3
• diuretic for pulmonary edema .
• broncodilators for brochospasme .
• Antibiotic for contaminated water.
• Anticonvolsion treatment for seizure
Treatment
• NG tube
• ECG monitoring for diagnosis and
treatment of arrhythmia.
• Hypothermia treatment
passive,active
• If a child is hypoglycemic 0/5-
1g/kg dextrose
ETT is needed if…
1. apnea ,cyanosis .
2. hypoventilation.
3. hemodynamic istability.
4. protect air way in patient with
depressed Mental
Treatment (con)
• A few patients develop require mechanical
ventilation.
for at least 24-48 hours.