DROWNING

AKSHATA HINGE
AISHWARYA PRADHAN
 What is drowning?

 Drowning  is a type of suffocation  induced by the submersion of the mouth and nose in a liquid. Most instances of
fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or
unable to offer assistance.
 After successful resuscitation , drowning victims may experience breathing problems, vomiting , confusion,
or unconsciousness. Occasionally, victims may not begin experiencing these symptoms until several hours after
they are rescued. An incident of drowning can also cause further complications for victims due to low body
temperature, aspiration of vomit, or acute respiratory distress syndrome (respiratory failure from lung
inflammation).
 Drowning occurs when a person spends too much time with their nose and mouth submerged in a liquid to the
point of being unable to breathe. If this is not followed by an exit to the surface, low oxygen levels and excess
carbon dioxide in the blood trigger a neurological state of breathing emergency, which results in increased
physical distress and occasional contractions of the vocal folds. Significant amounts of water usually only enter
the lungs later in the process.
 Pathophysiology

 Drowning is split into four stages

1. Breath-hold under voluntary control until the urge to breathe due to hypercapnia becomes overwhelming
2. Fluid is swallowed and/or aspirated into the airways
3. Cerebral anoxia stops breathing and aspiration
4. Cerebral injury due to anoxia becomes irreversible
 A person can struggle on the surface of the water for only 20 to 60 seconds before being submerged. In
the early stages of drowning, a person holds their breath to prevent water from entering their lungs .
When this is no longer possible, a small amount of water entering the trachea causes a muscular spasm
that seals the airway and prevents further passage of water. If the process is not interrupted, loss of
consciousness due to hypoxia is followed by cardiac arrest.
 Medical management

 Asses the patient :- look for alertness (GCS)

 listen to the heart sounds
 feel the movement of air through the nostrils
 if no pulse and no respiration :- CPR
 if patient is breathing but has difficulties:- maintain ABC and manage injuries
Maintain Airway Patency: • left lateral position • clear secretions, foreign bodies • Don’t insert anything in mouth
( example:- spoon) • Head tilt, chin lift , jaw thrust to prevent tongue fall • Loosen tie, clothing around the neck •
Remove artificial dentures if possible
Remove excess water from lungs and abdomen: • By turning upside down • Or pressing over the abdomen
Reassure the patient Immediately transfer to hospital
ICU management

 . Initially provide all drowning victims with 100% oxygen, yet be cognizant of the goal to avoid
or treat hypoxemia while minimizing hyperoxemia.

 Early use of intubation and PEEP, or CPAP/bilevel positive airway pressure (BiPAP) in the
awake, cooperative, and less hypoxic individual, is warranted if hypoxia or dyspnea persists
despite 100% oxygen.

 Endotracheal intubation and mechanical ventilation may be indicated in awake individuals who
are unable to maintain adequate oxygenation on oxygen by mask or via CPAP or in whom
airway protection is warranted.
 parameters

 Endotracheal intubation
 Intubation may be required in order to provide adequate oxygenation in a patient unable to maintain a PO 2 of
greater than 60-70 mm Hg (>80 mm Hg in children) on 100% oxygen by facemask. In the alert, cooperative
patient, use a trial of BiPAP/CPAP, if available, to provide adequate oxygenation before intubation is performed.
 Other criteria for endotracheal intubation include the following:
• Altered level of consciousness and inability to protect airway or handle secretions
• High alveolar-arterial (A-a) gradient: PaO2 of 60-80 mm Hg or less on 15 L oxygen nonrebreathing mask
• Respiratory failure: PaCO2 greater than 45 mm Hg
 Parameters
 Positive end-expiratory pressure
 Intubated victims of submersion injury may require PEEP with mechanical ventilation to maintain adequate oxygenation. PEEP has
been shown to improve ventilation patterns in the noncompliant lung in several ways, including the following:
• Provides distending pressure to improve volume of gas at the end of exhalation (increases functional residual capacity)
• Minimizes atelectasis or alveolar collapse by maintaining pressure above which the lungs collapse (closing pressure)
• Decreases intrapulmonary shunting of blood and improves arterial oxygenation
• Increases intrathoracic pressure, which transmits the applied PEEP to transmural capillary pressure (results in minimizing
interstitial lung water)
• Increases the diameter of both small and large airways to improve distribution of ventilation
 Extracorporeal membrane oxygenation
 Extracorporeal membrane oxygenation (ECMO) has been shown to be beneficial in selected patients.  ECMO may be considered in
the following circumstances:
• Respiratory compromise resulting from lack of response to conventional mechanical ventilation or high-frequency ventilation
• A reasonable probability of the patient recovering neurologic function
Physiotherapy Mx

 RESCUE
 CPR
 AIRWAY PATENCY :- ET SUCTIONING , POSITIONING in initial stages
 NEB :- TO RELIVE BRONCHO AND LARYNGOSPASM
 ONCE PATIENT IS STABLE MAINTAIN MOBLITY :- to prevent vascular
complication
 to maintain properties of muscle fibre:- passive movement , stretching etc
THANK YOU