TSUNAMI &

DROWNING
Presented by:
Katherine June Mercado
Anjelie Dawn Mendoza
DEFINITIONS
 Drowning: Asphyxia and
death due to submersion
in liquid (usually water)
 Near Drowning: is
survival for more than 24
hours from suffocation by
submersion.
 Tsunami: Tsunamis are
ocean waves produced by
earthquakes or
underwater landslides.
SOME INTERESTING STATISTICS
 99% of all drownings occur in unsupervised
water (free flowing)
 almost half of all drownings occur in the
company of others (mostly adults)
 almost half of all drownings occur less than
two metres from safety
 highest risk category are males 18-34 years
old
 nearly 40% of all drownings involve alcohol
 over half of victims who drowned while
boating were not wearing lifejackets
 most children drown in home swimming
pools, majority of them being toddlers
 EPIDEMIOLOGY
 Drowning  Tsunamis:
 Males > Females  earthquake-induced
 In infants younger than 1 year movement of the ocean floor.
 Bathtubs and buckets of water  Landslides
 Child abuse  volcanic eruptions, and
 In children aged 1-5 years:  meteorites
 Residential swimming pools

 In young adults aged 15-19 years

 Submersion injuries usually in

ponds, lakes, rivers, oceans, and

other natural bodies of water.
 Alcohol use

 Water sports

 Cold water
 Peak ages:
 1- 2 years old
RISK FACTORS
 Intoxication with drugs/alcohol
 Venomous stings from aquatic animals
 Head/spinal injuries (Diving accidents)
 Hyperventilation syndrome (Breath
Holding) which suppresses the
physiologic response to increased CO2
 Pre-existing medical conditions:
Seizures/DM/ Syncopal episodes
 Seizures and cardiac arrhythmias
 Syncope and apnea
 Hypoglycemia
 MI/ Pre-existing cardiac disease
 Hypothermia
 Types Of Drowning
 Dry:
 15% of cases
 Small amount of H20 aspirated
 It contacts the larynx which has a natural
defense mechanism, called a laryngospasm. The
larynx expand to block the airway, thus often
preventing water from entering the lungs in.

 Wet:
 85% of cases
 Fluid and electrolyte
imbalances occur
 The laryngospasm relaxes as
the person loses consciousness,
and water enters the lungs
WET LUNG
Fresh Water Type
 Water moves from alveoli to

bloodstream
 Hemodilution occurs

 O2 carrying capacity decreases

 Water moves into red cells

 Red cells swell, rupture

 Increase Potassium resulting to
arrhythmias
 Release of hemoglobin into
bloodstream result to renal
failure
 Loss of surfactant result to
collapse of alveoli
 WET LUNG (CONT..)
Salt Water Type:
 Water moves from

bloodstream to alveoli
 Hemoconcentration

occurs resulting to shock

 Pulmonary edema occurs
 The difference in
pathophysiology of aspiration of
fresh water (hypotonic) and salt
water (hypertonic) have little
clinical significance.
 Fresh water drowning -
hemodilution & intravascular
hemolysis.
 Sea water drowning –
hemoconcentration and
hypovolemia
Classifications of Drowning
 Passive Drowning: The
victim is face-down in the
water.

 Active Drowning: The

victim is vertical in the
water, not kicking, still
breathing and usually
moving the arms in the
effort to bob out of the
water. The victim can’t
call for help.

 Do not attempt swimming
rescue without proper
training
 Throw - Tow – Row - Go
 Consider possible neck
injury:
 Diving accident
 Swimming pools
 Inadequate history
 Place patient on spineboard
in water
NEAR DROWNING
 If possible, begin
pulmonary resuscitation in
water
 Resuscitate all cold water
drowning (<72oF)
 Mammalian Diving
Reflex
 Increased Survivability
Summary of the drowning process:
1. Panic and violent struggle to return to
surface
2. Period of Calmness
3. Swallowing of fluid, followed by
vomiting
4. Terminal Gasp
5. Unconsciousness
6. Possible Seizures
7. Death
*The time that this takes is variable, but it could be as little as 12 to
20 seconds from the first panic to unconsciousness.
 Assessment of the Patient
Respiratory
Manifestations
History
 Cyanosis
 Mechanism and duration of
 Trismus
 Apnea submersion
 Tachypnea  Type and temperature of water
Signs and  Wheezing  Time to institution of CPR
Symptoms:
 Time to first spontaneous breath
 Pulmonary edema Cardiovascular
 Respiratory failure Manifestations  Time to return of spontaneous
 Shock
 Tachycardia cardiac output
 Anoxic encelopathy
 Arrhythmia
 Vomiting
 Brain edema
 Hypotension
 Shock  Likelihood of associated
 Cardiac arrest
 Cardiac Arrest trauma, other precipitants
 Hypotension (arrhythmia, MI, seizure, etc).
Pulmonary/airway:
 Ineffective breathing
 Dyspnea
 Respiratory distress
 Crackles, ronchi
 Cough with pink-frothy
sputum
 Foreign body obstruction
Other:
 Panic
 Exhaustion
 Coma
 Injuries
 Core temperature slightly
below or higher than normal
 Vomiting
MANAGEMENT ON SITE
 Get the victim out of the water.
CPR may be started while the
victim is still in the water.
 If the victim is breathing, place
him on his side. He should be
able to eject water himself but
must be carefully watched.
 If not breathing, begin CPR
and shout for help.
 Paramedics with ALS should
intubate the victim with no
heart or respiration rate.
 Establish IV line with Ringer’s
lactate (warmed if available ). Keep
open rate.
 Follow the ACLS protocol regarding
drug therapy.
 Drowning with severe hypothermia,
if heart rate is so slow do not
intubate since the victim might
develop asystole. Start rewarming
the patient.
Prehospital Management

 Assess ABC’s
 Clean airway of obstruction
 Control airway w/ chin lift or jaw
thrust. Protect C spine if trauma is
suspected.
 Begin mouth to mouth or mask
ventilation if no breathing present.
 Begin CPR if no heart rate is palpable
 Remove wet clothing and wrap in
blanket.
 For hypothermia, wrap in dry warm
blanket
Paramedics with Advance Life Support Unit
Should:

 Intubate the child if there is no HR or RR

 Establish an IV line with warm Ringer’s
lactate. An intraosseous infusion may be used
for children.

Further treatment at site includes:

 Clean the victim’s mouth with the use of finger

sweep
 Place the victims in the head down position to
allow fluid drainage from the mouth.
 Give oxygen in high concentration by
continuous positive air pressure.
 Perform Heimlich manuever if needed.
After initial stabilization,
victims who survive can
be separated into three
groups:
 Awake victims who are

neuroligically responsive and

who have signs and symptoms
of respiratory compromise.
 Those with spontaneous

respirations Glasgow Coma

scale of over 5.
 Those with Glasgow Coma

scale under 4.
DROWNED/DEAD VICTIMS
w i t h t h e h ead
 Face down
an d
hanging o b u f f ering
i es d u e t
 Head injur
m
post-morte
 Bleeding l s a nd
t h in n o s t r i
 Fine w h i t e f ro
mouth
f l a t e d l u n gs
 Over in s in
m o r rh a g e
 Occasiona
l hae
y m i d d l e ears
bon i rw a y s ( e g .,
g n m a t t e r in a
 Fore i
, s i l t , w e e ds)
sand
Labs and Diagnostics…
  No difference in
electrolytes and
hematocrit
 Average drowning victim
aspirates 3-4 ml/kg
 No electrolyte or blood

volume changes seen

until 22 ml/kg and
11ml/kg respectively
 Blood gas analysis with co-
oximetry to detect
methemoglobinemia and
carboxyhemoglobinemia
 Toxicology to determine alcohol or
illicit drug use
 Chest x-ray to look for fluid in the
lungs
 Neck x-ray to look for fractures
 Head CT to look for structural
damage to the brain
 ECG to look for irregular heart
activity
PATHOPHYSIOLOGY
D
NURSING DIAGNOSES
 Impaired Gas Exchange related factors: surfactant elimination,
Bronchospasm,Aspiration,pulmonary edema.
 Altered Cerebral Perfusion related factors: prolonged hypoxemia,impaired
gas exchange.
 Fluid Volume Excess/Deficit
 Risk for Decreased Cardiac Output
 Risk for infection
 Ineffective breathing pattern related to anxiety
 Anxiety related to hypoxemia, threat to death
 Risk for decreased cardiac output
 Risk for injury
 Hypothermia
LIFE SAVING INTERVENTIONS
Key Points of Management: Drowning

 Remove from water (effective CPR in

water is not possible)
 Start CPR
 Heimlich only for obstruction
 Move to medical facility
Interventions:
 Manage and maintain ABC’s
 Assume cervical spine injury in all drowning victims and
stabilize and/or immobilize cervical spine
 Provide 100% 02 via nonrebreather mask
 Anticipate need for intubation if gag reflex is absent
 Establish IV access with 2 large bore catheters for fluid
resuscitation and infuse warmed fluids if appropriate
 Assess for other injuries
 Remove wet clothing and cover with warm blankets
 Obtain temperature and begin rewarming if needed
 Obtain cervical spine and chest x-rays
 Insert gastric tube.
Key points of Management:
Tsunami

 First aid
 Prevent hypothermia
 Transfer to safer place in higher ground
 Decontamination
MEDS
 Mannitol (Osmitol) or Furosemide (Lasix) may
be given to decrease free water and treat cerebral
edema.
 Antibiotic prophylaxis is not indicated unless the
patient was submerged in grossly contaminated
water or sewage.
LIFE MAINTAINING INTERVENTIONS
DROWING
 Monitor ABC’s, V/S, and LOC
 Monitor O2 saturation and cardiac rhythm
 Monitor temperature and maintain normothermia
 Monitor for signs of acute respiratory failure
 Endotracheal intubation with mechanical ventilation for
respiratory failure, persistent hypotension, or impaired
airway protective reflexes.
 Nasogastric tube placement for removal of swallowed
water and debris (Use orogastric route if head or facial
trauma is suggested.)
 Urinary catheter placement for assessment of urine output
(continued)
(cont…)

 Extracorporeal membrane oxygenation (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
 Persistent hypothermia from cold-water drowning
 Bronchoscopy if needed for removal of foreign bodies,
such as aspirated debris or vomitus
 Intracranial pressure monitoring in patients with traumatic
brain injury or mass lesions (eg, hematomas)
 TSUNAMIS

 Help provide save water for

drinking
 Provide food and shelter
 Disease control
P S Y C H O S O C I A L A N D B E H AV I O R A L
I N T E RV E N T I O N S
A N D S U P P O RT I V E M A N A G E M E N T
DROWNING TSUNAMI

 Provide information  Active listening

 Educating:  Provide emotional support
 Fence all pools and spas  Give information
 Know the weather  Discourage victims from
conditions and location of
repeated exposure to the event
underwater hazards before
entering the water.  Refer patients to therapists or
 Learn and observe water and social workers and mental
boating safety rules. health care services
 Always wear life jackets
especially on open water.
 Never allow yourself or
children to swim alone or
unsupervised.
PREVENTION OF COMPLICATIONS
DROWNING
 ARDS
 Aspiration pneumonia
 Pulmonary edema
 Hypothermia TSUNAMI
 Water borne transmissions and
Interventions: infections- water purification,
 Monitoring of VS, LOC, ABC’s, O2 waste removal, removal of
saturation, human and animal remains,
 Auscultate for adventitious sounds in
and vector control
lungs or trachea.
 Observe for signs of cyanosis,
inadequate chest expansion
 Positioning

 Oxygenation

 Provide warmed blankets

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