Near Drowning

Pathophysiology of the drowning

Drowning is divided into four stages:

Breath-hold under voluntary control until the impulse
to breathe because of hypercapnia becomes
overwhelming
The liquid is consumed and/or aspirated into the
airways
Cerebral anoxia stops breathing and aspiration
Cerebral injury because of anoxia becomes irreversible
In the early stages of drowning, a person holds their
breath to prevent water from penetrating their lungs.
When this is no longer possible, a small amount of
water penetrating the trachea causes a muscular spasm
that seals the airway and prevents other passage of
water. If the process is not interrupted, loss of
consciousness because of hypoxia is followed by
cardiac arrest.
ABCDE method for drowning

Airway (clearing the airways): If the patient

responds in a normal voice, then the airway is clear.
The airway block should be partial or complete.
Signals of a partly blocked airway involve a changed
voice, noisy breathing like stridor, and a raised
breathing effort. With a completely blocked airway,
there is no respiration against great efforts like paradox
respiration or the “see-saw” sign.
Breathing (ensuring respiration): it is possible to
specify the respiratory rate, check movements of the
thoracic wall for balance and use of auxiliary respiratory
muscles, and percussion the chest for unilateral dullness or
resonance. Cyanosis, swollen neck veins and lateral shift
of the trachea should be specified. If the stethoscope is
available, lung auscultation should be conducted and, if
possible, a pulse oximeter should also be used. Tension in
the pneumothorax should be reduced instantly by inserting
a cannula where the second intercostal space crosses the
midclavicular line needle thoracocentesis. Bronchospasms
should be treated with inspiration
Circulation (internal bleeding): The capillary refill
time and pulse rate should be estimated in any setting.
Examination of the skin provides hints of circulatory
problems. Color changes, sweating, and a decreased
level of consciousness should be signs of reduced
perfusion. If a stethoscope is available, heart
auscultation should be examined. Electrocardiography
monitoring and blood pressure measurements should
also be conducted as soon as possible.
Mouth-to-mouth resuscitation is a form of artificial
ventilation that is the act of helping or producing
respiration in which a rescuer squeezes their mouth
against that of the person and blows air into the
person’s lungs. Artificial respiration brings many
forms but commonly requires supplying air for a
person who is not breathing or is not making a
satisfactory respiratory effort on their own airways. It
is utilized on a patient with a beating heart or as a
component of cardiopulmonary resuscitation to gain
internal respiration.
Oxygen for the drowning
The effectiveness of artificial respiration should be
largely raised by the simultaneous use of oxygen
therapy. The amount of oxygen available to the patient
in mouth-to-mouth breathing should be approximately
16 percent. If this is done via the pocket mask method
an oxygen flow should increase to 40 percent oxygen.
If either a bag valve mask or a mechanical ventilator is
utilized with an oxygen supply, increases to 99 percent
oxygen. The greater the oxygen attention, the more
efficient the gaseous exchange will be in the lungs.
cardiopulmonary rehabilitation for the drowning

cardiopulmonary resuscitation is an emergency

approach containing chest compressions usually
combined with artificial ventilation in an effort to
manually maintain entire brain function until other
measures should take to regain spontaneous blood
circulation and breathing in a person who is in cardiac
arrest due to drowning. It is suggested for those who
are unresponsive with no breathing or abnormal
breathing,
Positive end-expiratory pressure for the drowning
Positive end-expiratory pressure (PEEP) is the
pressure in the lungs alveolar pressure beyond
atmospheric pressure the pressure outside of the body
that exists at the end of exhalation The two types of
Positive end-expiratory pressure are extrinsic Positive
end-expiratory pressure (PEEP applied by a ventilator)
and intrinsic Positive end-expiratory pressure (PEEP
caused by an incomplete exhalation). The pressure that
is applied or raised during inspiration is termed
pressure support.
Thank you