Komplikasi dan Prognosis

Complications

Neurologic injuryPulmonary edema and ARDSSecondary pulmonary infectionMultiple organ system failureAcute tubular necrosis (secondary to hypoxemia)MyoglobinuriaHemoglobinuria

Prognosis

Patients who are alert or mildly obtunded at presentation have an excellent chance for full recovery.Patients who are comatose, those receiving CPR at presentation to the ED, or those who have fixed and dilated pupils and no spontaneous respirations have a poor prognosis. In a number of studies, 35-60% of individuals needing continued CPR on arrival to the ED die, and 60-100% of survivors in this group experience long-term neurologic sequelae. Pediatric studies indicate that children who require specialized treatment for drowning in the pediatric intensive care unit (PICU) experience at least a 30% mortality rate and an

additional 10-30% experience severe brain damage.

What are the complications of drowning?

Hypoxemia causing brain damage is the major complication in drowning victims who do not die.

Direct lung tissue damage because of water aspirated into the lung can also occur and lead to pneumonia and acute respiratory distress syndrome (ARDS).

If the drowning occurs in colder water risks include hypothermia or a drop in body temperature. (If the body temperature drops below 95F (35C) get medical attention immediately.)

Cervical spine fractures may occur in diving injuries associated with drowning.

Does the type of drowning matter?

There have been a variety of theories reported regarding the potential responses of the body to different drowning situations. Most discuss dry vs. wet drowning and salt vs. fresh water drowning.

Wet vs. Dry Drowning

Most drownings are unwitnessed, and the victim is found floating. While only a small amount of aspirated water is required to cause significant problems with lung function, it is the prolonged submersion time and lack of breathing that causes morbidity due to hypoxemia.

Approximately 10%-20% of drowning victims have dry drowning, but even most wet drowning victims have less than 4cc/kg of water found in their lungs. For a 50 pound child, this amounts to less than 3 ounces.

Salt vs. Fresh Water Drowning

In the lung, the breathing tubes (trachea, bronchi, bronchioles) branch into smaller and smaller segments until they end in an air pocket called an alveolus (plural alveoli). This is the part of the lung where air and red blood cells in capillary blood vessels come near enough to allow the transfer of oxygen and carbon dioxide between the two. Alveoli are covered with a chemical called surfactant that allows the air pocket to open and close easily when breathing occurs.

When fresh water enters an alveolus, it destroys the surfactant and causes the alveoli to collapse, unable to open with breathing. A ventilation-perfusion mismatch occurs in which the body sends blood to parts of the lung that lack oxygen, resulting in a decrease in the concentration of oxygen in the blood.

Salt water doesn't destroy surfactant, rather it washes it away and damages the membrane between the alveolus and the capillary blood vessel. One again, the body sends blood flow to areas of the lung that aren't able to provide it

oxygen, and hypoxemia occurs.