Upload
sudheera-rachamalla
View
225
Download
0
Embed Size (px)
Citation preview
7/30/2019 Drowning Presentation
1/49
Advocacy Project:
Drowning Prevention
Lindsay M. Stewart, MD
July 26, 2012University of Nevada School of Medicine
7/30/2019 Drowning Presentation
2/49
Disclosures
No current research
No financial investments
7/30/2019 Drowning Presentation
3/49
Objectives
1. MEDICAL KNOWLEDGE2. PATIENT CARE
3. INTERPERSONAL & COMMUNICATIONSKILLS4. PRACTICE-BASED LEARNING &
IMPROVEMENT
5. SYSTEMS-BASED PRACTICE6. PROFESSIONALISM
7/30/2019 Drowning Presentation
4/49
7/30/2019 Drowning Presentation
5/49
In the Community
July 11, 2012
7/30/2019 Drowning Presentation
6/49
1. MEDICAL KNOWLEDGE
Learn what constitutes a drowning
Understand the pathophysiology Review findings at autopsy
7/30/2019 Drowning Presentation
7/49
Drowning
the process ofexperiencing respiratory
impairment fromsubmersion/immersion inliquid
Can be any kind of fluid
Peden M, McGee K, Sharma K. The injury chart book: a graphical overview of theglobal health burden of injuries. Geneva: World Health Organization, 2002.
7/30/2019 Drowning Presentation
8/49
Terminology
1. Nonfatal drowning- if the person is rescued atany time; the process of drowning is
interrupted2. Fatal drowning- if the person dies at any timeas a result of drowning
3. Water rescue- any submersion or immersionwithout evidence of respiratory impairment
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl JMed2012;366:2102-10.
7/30/2019 Drowning Presentation
9/49
Phases of Drowning
1. Submersion2. Struggle
3. Exhaustion4. Drowning5. Loss of consciousness6. Death
7/30/2019 Drowning Presentation
10/49
Pathophysiology
Fresh water - water passes from lungs toblood- hemodilution; denaturation of surfactant ->alveolar collapse -> decr lung compliance -> severe V-Qmismatch -> hypoxia -> neuro damage
Electrolyte shifts -> Cardiac arrhythmias
(0.6% NaCl)
Blood Lung Tissue Blood Lung Tissue
7/30/2019 Drowning Presentation
11/49
Pathophysiology
Sea water - water passes fromblood into lung tissue- hemoconcentration
Na incr -> severe pulm edema
(3% NaCl)
Blood Lung Tissue
7/30/2019 Drowning Presentation
12/49
Histology
Pulmonary edema Plant material in bronchus
7/30/2019 Drowning Presentation
13/49
Findings on Autopsy
Fine white froth in the mouth,
nose, lungs and air passages Water-logged lungs Venous congestion and fluid
blood
Water in the stomach andintestines
7/30/2019 Drowning Presentation
14/49
Findings on Autopsy
Middle ear hemorrhages
7/30/2019 Drowning Presentation
15/49
2. PATIENT CARE
Identify patients at risk
Perform accurate H&P Develop appropriate treatment plan
7/30/2019 Drowning Presentation
16/49
More at Risk?
OR
Centers for Disease Control and Prevention, National Center for Injury Prevention andControl. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. [cited
2011 Apr 6]. Available from URL: http://www.cdc.gov/injury/wisqars
Males: ~80% Females: ~20%
7/30/2019 Drowning Presentation
17/49
More at Risk?
OR
1-4 yo 5-8 yo
Centers for Disease Control and Prevention, National Center for Injury Prevention andControl. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. [cited
2011 Apr 6]. Available from: URL: http://www.cdc.gov/injury/wisqars
Children ages 1 to 4
7/30/2019 Drowning Presentation
18/49
More at Risk?
OR
Centers for Disease Control and Prevention, National Center for Injury Prevention andControl. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. [cited
2011 Apr 6]. Available from: URL: http://www.cdc.gov/injury/wisqars
Minorities: AA 1.3x W; NA & Alaskan 1.7x W
OR
7/30/2019 Drowning Presentation
19/49
More at Risk?
OR
7/30/2019 Drowning Presentation
20/49
Others at RiskLow income, neglected Poor education
Aquatic exposure Alcohol use, risky behavior
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J Med2012;366:2102-10.
7/30/2019 Drowning Presentation
21/49
Also at Risk
Risk of drowning is
15-19 times higherthan those withoutepilepsy!!!
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl JMed2012;366:2102-10.
Epilepsy pts
7/30/2019 Drowning Presentation
22/49
Also at Risk
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J
Med2012;366:2102-10.
7/30/2019 Drowning Presentation
23/49
H&P for Well Child Check
What questions shouldyou ask?
When should you askthem?
What should you look for
on physical exam?
7/30/2019 Drowning Presentation
24/49
Initial Resuscitation
CPR Resp? -> rescue
breathing only
Cardiac? -> ABC 5 rescue breaths 30 compressions 2 rescue breaths 30 compressions
Aspiration risk
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J
Med2012;366:2102-10.
7/30/2019 Drowning Presentation
25/49
Pre-Hospital Care
BLS until PALS available O2 by face mask at 15L
Early intubation & mech ventilation Peripheral IV or IO Correct hypotension with crystalloids
If CPR does not result in cardiac activity,epi or norepi may be considered
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J
Med2012;366:2102-10.
7/30/2019 Drowning Presentation
26/49
ED
Secure airway Insert NG tube Thermal insulation
Find out if precipitatedby injury or medicalcondition
Phys exam, CXR, ABG
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J
Med2012;366:2102-10.
7/30/2019 Drowning Presentation
27/49
PICU
Follow guidelines for ARDS Keep on vent at least 24 hrs even if gas
exchange appears to be adequate
Little evidence supporting glucocorticoid use Pneumonia often misdiagnosed No evidence supporting use of specific fluid
therapy, diuretics or water restrictions
Induced hypothermia (32-34C) for 24 hrs maybe neuroprotective
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J
Med2012;366:2102-10.
7/30/2019 Drowning Presentation
28/49
Complications
SIRS Sepsis & DIC possible in first 72 hrs after
resuscitation
Renal insufficiency or failure (rare)
Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts: Drowning. N Engl J
Med2012;366:2102-10.
7/30/2019 Drowning Presentation
29/49
3. INTERPERSONAL &COMMUNICATION SKILLS
Apply skills to different cultural
backgrounds, SES, developmental levels Develop rapport Use a team approach
7/30/2019 Drowning Presentation
30/49
Counseling
Dont lecture Dont talk down to or belittle Do ask questions Do offer suggestions
Do assess for understanding
7/30/2019 Drowning Presentation
31/49
How do you develop rapport?
7/30/2019 Drowning Presentation
32/49
Drowning Prevention
Formal swimming lessons Designated supervision Buddy system Seizure disorder safety
Learn CPR Use personal flotation
devices
Barriers such as fences Lock up pool toys No holding breath contests Obey beach warnings
Watch for signs of ripcurrents
Avoid alcohol
7/30/2019 Drowning Presentation
33/49
7/30/2019 Drowning Presentation
34/49
4. PRACTICE-BASED LEARNING &IMPROVEMENT
Acknowledge barriers
Analyze your skills & practice them Evaluate the effectiveness of your
encounter
Identify ways to improve compliance
7/30/2019 Drowning Presentation
35/49
Possible Barriers?
7/30/2019 Drowning Presentation
36/49
Evaluate Your Encounter
Did you have good rapport? What did you do well?
What can you improve on?
7/30/2019 Drowning Presentation
37/49
Ways to Improve Compliance
Handouts
Videos Make it relevant Repetition
Follow up on it
7/30/2019 Drowning Presentation
38/49
5. SYSTEMS-BASED PRACTICE
Review incidence rates
Understand cultural norms & healthbeliefs Invest in the health literacy & awareness
in your community
7/30/2019 Drowning Presentation
39/49
Incidence
In 2007 there were ~4,000 fatal unintentionaldrownings in the U.S.
~3,500 non-boating related
~500 boating-related incidents > 1 in 5 people who die from drowning are
children 14 and younger
2nd leading cause of unintentional injury-relateddeath for children ages 1 to 14 years
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-basedInjury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 July 23]. Available from URL:
http://www.cdc.gov/injury/wisqars
7/30/2019 Drowning Presentation
40/49
Statistics
19% of drowning deaths in children occur inpublic pools with certified lifeguards present
Of all preschoolers who drown, 70% are in thecare of one or both parents at the time of thedrowning and 75% are missing from sight for 5min or less
92% of children who survive are discovered
within 2 min following submersion, and 86% ofchildren who die are found after 10 min
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-basedInjury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 July 23]. Available from URL:
http://www.cdc.gov/injury/wisqars
7/30/2019 Drowning Presentation
41/49
Statistics
Among children 1-4 yo, most drowningsoccur in residential swimming pools, and11% occur in portable pools
>50% of drownings among infants occurin bathtubs, buckets or toilets
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-basedInjury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 July 23]. Available from URL:http://www.cdc.gov/injury/wisqars
7/30/2019 Drowning Presentation
42/49
Southern NV Health District
Southern Nevada Health District [online]. Drowning and Near Drowning Statistics. [cited 2012 July 20].Available from URL: http://www.southernnevadahealthdistrict.org/stats-reports/drowning-statistics.php
7/30/2019 Drowning Presentation
43/49
Myths About Swimming
1. You shouldnt swim right after eating.2. Clear pool water means clean pool water.3. I only need to take a shower before swimming
if I havent bathed that day.
4. As long as a child is wearing a diaper in thepool, theres no chance for contamination ofthe water.
5. When I smell the strong odor of poolchemicals, it means the water is very clean.
Water Quality and Health Council [online]. [cited 2012 July 20]. Available from URL:http://www.healthypools.org/resources/swimming-pools-myths-facts/
7/30/2019 Drowning Presentation
44/49
Support In Our Community
Swim Lessons: Clark County Parks & Recreation- Free
Swim Squad- 1st Assessment $20YMCA- 4 lessons $50
Bubble Swim School- $15, one day/wk x5
Private lessons- $22.50 Group swim- $15
7/30/2019 Drowning Presentation
45/49
Support In Our Community
CPR Lessons: UMC- Free ($10 deposit required & refunded)
UNLV & Amer Red Cross- Free
Safe Sitter Courses (ages 11-13):
UMC- Free, monthly
7/30/2019 Drowning Presentation
46/49
Support In Our Community
Life Jackets: Walmart: $6.96 $13.96 $16.00
Recommend checking local Goodwill etc.
Amazon: ~$5 -Ebay: ~$12
http://www.walmart.com/ip/Sterns-Puddle-Jumpers-Life-Vest/20567536http://www.walmart.com/ip/Stearns-Adult-Boating-Vest-Universal/138487917/30/2019 Drowning Presentation
47/49
6. PROFESSIONALISM
Demonstrate cultural competency
Emphasize medical ethics Reflect on professional impact
7/30/2019 Drowning Presentation
48/49
Professional Impact
7/30/2019 Drowning Presentation
49/49
References
1. Peden M, McGee K, Sharma K. The injury chart book: a graphicaloverview of the global health burden of injuries. Geneva: WorldHealth Organization, 2002.
2. Centers for Disease Control and Prevention, National Center forInjury Prevention and Control. Web-based Injury Statistics Query
and Reporting System (WISQARS) [online]. [cited 2012 July 23].Available from: http://www.cdc.gov/injury/wisqars3. Szpilman D, Bierens J, Handley A, Orlowski J. Current Concepts:
Drowning. N Engl J Med 2012;366:2102-10.4. Southern Nevada Health District [online]. Drowning and Near
Drowning Statistics. [cited 2012 July 20]. Available from URL:http://www.southernnevadahealthdistrict.org/stats-reports/drowning-statistics.php
5. Water Quality and Health Council [online]. [cited 2012 July 20].Available from URL: http://www.healthypools.org/resources/swimming-pools-myths-facts/