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drowning
Etiology:
- greatest risk factor for adults & teenagers is alcohol (45% of adult victims)
- hypoxic blackout due to prolonged breath-holding [2]
Epidemiology:
1) 4th leading cause of accidental death
2) young children < 5 years of age
3) young adults 15-29 years old
4) blacks, males
5) southern states
6) 2/3 of drownings occur in fresh water
Pathology:
1) aspiration 85%
2) laryngospasm 15%
3) duration of hypoxemia is most important prognostic factor
Complications:
1) acute respiratory distress syndrome (ARDS)
2) aspiration pneumonia
3) metabolic acidosis & respiratory acidosis
4) cardiac arrhythmias
5) cerebral edema
6) shock-induced acute tubular necrosis (ATN)
7) hypothermia
Management:
- basic life support: give 2 breaths before chest compressions [3]
- American Academy of Pedicatrics Recommendations
- counsel families of children with seizures, autism, & cardiac arrhythmias about higher risk for drowning
- counsel adolescents & their parents about increased risk of drowning when alcohol or illicit drugs are used during boating or swimming
- assure rather than overestimate a child's water competency
- use the term "nonfatal drowning" rather than "near drowning"
- increase access to swimming programs
General
trauma
environmental exposure
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 764
- Boyd C et al
Fatal and Nonfatal Drowning Outcomes Related to Dangerous
Underwater Breath-Holding Behaviors - New York State,
1988-2011.
MMWR. May 22, 2015. 64(19);518-521
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6419a3.htm
- American Red Cross
- American Aceademy of Pediatrics. March 15, 2019
AAP Updates Recommendations to Prevent Drowning in Children
https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Updates-Recommendations-to-Prevent-Drowning-in-Children.aspx