.

1. NEAR DROWNING
RAHUL. A.P
Asst Proff;LIAHS
BPT,MPT MIAP
(CRD &ICU CARE)

2. Definition
 "Near drowning" means a person almost died from
not being able to breathe (suffocating) under water.
 A process resulting in primary respiratory
impairment from submersion in a liquid medium

3. • The majority of near-drowning cases are attributed to
accidents that occur near or in the water. The most
common causes of near-drowning include:
• an inability to swim
• panic in the water
• leaving children unattended near bodies of water
• falling through thin ice
• alcohol consumption while swimming or on a boat
• concussion, seizure, or heart attack while in water
• suicide attempt etc…

4. • Infant drownings: 55% in bathtubs
• Age 1-4 years, 56% in artificial pools and 26% in
otherbodies of freshwater
• Children 63% of drownings werein natural
bodies of freshwater

5. Signs & symptoms
• cold or bluish skin
• abdominal swelling
• chest pain
• cough
• shortness or lack of breath
• Vomiting

6. • Rales and Rhonchi An abnormal lung sound that can
be heard through a stethoscope.
• Rales may be sibilant (whistling), dry (crackling), or
wet (sloshy), depending on the amount and density
of fluid refluxing back and forth in the air passages.
• Rhonchi are continuous low pitched, rattling lung
sounds that often resemble snoring. Obstruction or
secretions in larger airways are frequent causes of
rhonchi.
• Signs of associated trauma to the head and neck
should be sought

7. PATHOPHYSIOLOGY
1. Involuntary submersion
 Voluntary apnea, hypoxia, hypercarbia
2. Involuntary inspiration
 Triggered by hypercarbia and hypoxia
 arterial hypoxemia, tissue hypoxia, tissue acidosis, and
tachycardia
3. Water enters lungs
 Increased peripheral airway resistance, pulmonary
vessel vasoconstriction/hypertension, decreased lung
compliance, decreased surfactant

8. 4. Decompensation
-gasping with further inhalation
-swallowing with emesis
-loss of consciousness
5. Neuronal dysfunction
-blood brain barrier breaks down
6. Cardiac dysfunction
-bradycardia, arrhythmias, asystole
7. Brain Death

9. Dry Drowning
• 10-20% of patients experience a laryngospasm that
prevents aspiration of fluid into the lungs
• Tight spasm often persists until cardiac arrest
• Lungs remain dry
• Large volumes of fluid ingested into stomach
• Major cause for electrolyte abnormalities in children
(hyponatremia from fresh water, hypernatremia from salt
water)

10. Wet Drowning
 1-3 mL/kg water aspirated hinders gas exchange
 When fluid is in the lungs, vagus nerve stimulates
vasoconstriction of pulmonary vessels and pulmonary
hypertension
 Freshwater diffuses rapidly across alveolar-capillary
membrane and saltwater damages the membrane
 Surfactant is denatured by freshwater and washed away
by salt water
 In both salt water and freshwater aspiration,
compliance is decreased

11. WORKUP-Laboratory Studies
• The following studies are indicated in near
drowning:
• Blood gas analysis with co-oximetry (A CO-oximeter
is a device that measures the oxygen carrying state
of hemoglobin in a blood specimen, including
oxygen-carrying hemoglobin (O2Hb), non-oxygen-
carrying but normal hemoglobin (HHb)to detect
methemoglobinemia and carboxyhemoglobinemia

12. Methemoglobin- a stable oxidized form of
haemoglobin which is unable to release oxygen to
the tissues
Carboxyhemoglobin- is a stable complex of carbon
monoxide and hemoglobin (Hb) that forms in red
blood cells upon contact with carbon monoxide
(CO).
• CBC count, prothrombin time and partial
thromboplastin time,

13. • Serum electrolytes (with glucose)
• Liver enzymes
• Renal function tests
• Drug screen and ethanol level (consider)
• Continuous pulse oximetry and cardiorespiratory
monitoring (may be needed)

14. Imaging Studies
• Chest radiography
• Head CT and cervical spine imaging if trauma
suspected
• Extremity, abdominal, pelvic imaging if
clinically indicated
• Echocardiography if myocardial dysfunction
present

15. Other Tests
• Consider electrocardiography if the patient
has arrhythmias. Monitor the patient if
rewarming is necessary, because dysrhythmias
are common when rewarming patients who
suffer cold-water immersion injuries.

16. • Swan-Ganz catheter for monitoring cardiac
output and related hemodynamic parameters
may be useful in patients with unstable
cardiovascular status

17. Arrival to the hospital
• General Assessment:
• Appearance
• Work of Breathing
• Circulation
• Primary Assessment:
• Airway
• Breathing
• Circulation
• Disability
• Exposure

18. Management
• ET intubation if unconscious
• 100% O2 by face mask
• Treat hypothermia, hypoglycaemia, seizures, hypovolaemia
and hypotension, if they occur
• If the patient is awake and alert, observe for at least six
hours. Pulmonary oedema may develop late

19. • continuous positive airway pressure (CPAP),
intubation and mechanical ventilation with high
positive end expiratory pressure (PEEP), or even
extracorporeal membrane oxygenation (ECMO) for
severe pulmonary oedema.
• Rewarming by extracorporeal circulation provides
efficient rewarming and full circulatory support

20.  Broncoscopy
Removal of vomit, debris in lungs
• Nasogastric tube +/- urinary catheter.
 Albuterol
For bronchospasm

21. Thank you….