Submersion injury: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*[[CXR]] | *[[CXR]] (on arrival and after 4 hours) | ||
*ABG | *ABG | ||
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==Management== | ==Management== | ||
*Supportive care based on presentation is cornerstone of management. | |||
* | |||
==Disposition== | ==Disposition== | ||
*Discharge after 4-6 hours of observation if: | *Discharge after 4-6 hours of observation if: | ||
**Normal mental status, SpO2 >95% on room air, normal respiratory exam | **Normal mental status, SpO2 >95% on room air, normal CXR and respiratory exam | ||
*Admit all others | *Admit all others | ||
==See Also== | ==See Also== | ||
Revision as of 05:10, 2 February 2017
Background
- Definition: "The process of experiencing respiratory impairment from submersion/immersion in liquid"[1]
- Term "near-drowning" no longer used
- Three possible outcomes = death, survival with morbidity, survival without morbidity
- Consider secondary causes such as intoxication, syncope, cardiac arrhythmia, ACS, non-accidental trauma, etc.
Pathophysiology
- Submersion → voluntary breath holding → aspiration → coughing/laryngospasm → aspiration continues → hypoxia → death[2]
- Aspiration destroys surfactant which → alveolar collapse, atelectasis, non-cardiogenic pulmonary edema, and V-Q mismatch.
Clinical Features
Differential Diagnosis
- Hypothermia
- Immersion pulmonary edema
- Marine toxins, envenomations, and bites
- Scuba diving emergencies
- Submersion injury (drowning and near-drowning)
Evaluation
- CXR (on arrival and after 4 hours)
- ABG
- Other work-up generally not needed unless specifically indicated by history or exam[2], but may consider:
- Labs, EKG
- CT head/C-spine (if history of trauma) - C-spine injury extremely unlikely without evidence or history of trauma (<0.5% in large cohort study)[3]
Management
- Supportive care based on presentation is cornerstone of management.
Disposition
- Discharge after 4-6 hours of observation if:
- Normal mental status, SpO2 >95% on room air, normal CXR and respiratory exam
- Admit all others
See Also
Video
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References
- ↑ World Health Organization (WHO) "Global Report on Drowning". http://www.who.int/violence_injury_prevention/global_report_drowning/Final_report_full_web.pdf (Accessed 02/01/2017)
- ↑ 2.0 2.1 Szpilman, D., Bierens, J. J., Handley, A. J., & Orlowski, J. P. (2012). Drowning. N Engl J Med, 366(22), 2102-2110. doi: 10.1056/NEJMra1013317
- ↑ Watson RS, Cummings P, Quan L, et al. Cervical Spine Injuries Among Submersion victims. J Trauma 2001; 51:658.