Wilderness and Rescue Medicine 8th Edition

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Section V: Environmental Medicine

PPV, begin chest compressions and if available, apply an AED and shock if indicated. Once the patient is breathing, consider an urgent evacuation with the anticipated problem of respiratory failure from pulmonary edema, and elevated ICP from hypoxia. Water inhala- tion causes irritation of the alveoli in the lungs. Hypoxia causes brain injury. In all but the warm- est water, hypothermia can also become an issue.

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 significant complications, especially if crackles are detected on auscultation of the lungs. 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 howdramatic and scary the event was. These patients may be uncomfortable and scared, but they are not in trouble from water inhalation or hypoxia. You should be most concerned about the patient who lost consciousness and had to be rescued and resuscitated. Nevertheless, don’t forget to look for other injuries that may have occurred during the event and rescue. Treatment of Drowning Injury If the primary assessment problem is respiratory arrest, then the immediate treatment is positive pressure ventilation (PPV). The treatment does not differ between salt and fresh water submer- sions. There is no need to drain water from the lungs and foamy sputum does not need to be con- tinually suctioned or cleared unless it interferes with PPV. If the effort is initiated within a few minutes of submersion, the patient may recover spontaneous respiration quickly. After starting

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

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

© 2018 WMA

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