Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Wilderness and Rescue Medicine

the warmest water, hypothermia can also become an issue. If evacuation is not an option, careful moni- toring of respiratory status should be part of the plan, with PPV and oxygen being the anticipated treatment if respiratory failure develops. Patients who remain clear of symptoms for at least 8 hours can be considered at very low risk for further complications.

General Principles

Drowning with Injury

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Problems: • Respiratory arrest A’: cardiac arrest • Water inhalation lung injury A’: pulmonary edema • Hypoxic brain injury A’: Increased ICP

A person’s ability to swim has little to do with their ability to drown. Survival efforts are often ham- pered by bulky clothing and equipment, cold water, and current. Cases where a patient is rescued and resusci- tated are considered to be drowning with injury. The respiratory system and brain are at risk for sig- nificant complications. Respiratory distress and increased ICP are on the anticipated problem list. By contrast, the swimmer who did not lose consciousness or experience respiratory distress during the event will not develop drowning injury regardless of how dramatic and scary the event was. These patients may be uncomfortable and scared, but they are not in trouble. You should be most concerned about the patient who lost con- sciousness and had to be rescued and resuscitated. Treatment of Drowning Injury If the primary assessment problem is respiratory arrest, then the immediate treatment is positive pressure ventilation (PPV). There is no need to drain water from the lungs, and there is no dif- ference in field treatment between salt and fresh water. If the effort is initiated within a fewminutes of submersion, the patient may recover spontane- ous respiration quickly. Once the patient is breathing, consider an urgent evacuation with the anticipated problem of respiratory failure from pulmonary edema, and elevated intracranial pressure (ICP) from hypoxia. Water inhalation causes irritation of the alveoli in the lungs. Hypoxia causes brain injury. In all but

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“The initial assessment problem is respiratory arrest and the immediate treatment is positive pressure ventilation.”

©2018WMA

A successful resuscitation is far less likely if the patient was submerged long enough to go into cardiac arrest. Nevertheless, there are some pro- longed submersion survival stories and aggressive resuscitation is warranted if it will not put rescu- ers at risk. Some research has suggested that there is benefit from the effects of very cold water where rapid cooling of the brain may delay the damage caused by hypoxia. Other studies show that the temperature of the water makes little or no differ- ence. In any case, the best chance for survival rest with early rescue, aggressive resuscitation, and early access to sophisticated medical care.

General Principles

Cardiac Arrest

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WILDERNESS PROTOCOL

Treatment: • Attempt resuscitation with CPR if submersion is less than one hour • Urban – immediate ALS and hospital transfer • Remote – follow CPR wilderness protocols

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©2018WMA