Drowning and Diving Emergencies

Near Drowning: drowning is death by asphyxiation during an immersion episode, so near drowning is when the process is interrupted and reversed. Drugs and alcohol are involved in 35-75% of drownings. Lakes, ponds and backyard pools. Males 5-8x more likely, also older, younger and African American are higher risks.

Assessment: Signs and symptoms:
Progressive dyspnea
Chest pain
Mental confusion
Coma, resp. or cardiac arrest
Mouth to mouth can begin in the water
Stabilize neck if nec.
ECG monitoring
IV of normal saline or LR at TKO

Three types of drowning:
Dry drowning: 10-20% laryngeal spasm cuts off the air
Wet drowning: 80-90% fluid fills the lungs
Secondary drowning: reoccurrence of fluid in lungs (PE or Asp. Pneu) after successful recovery, few minutes up to four days.

Seawater causes an influx of hypotonic serum. Blood can’t exchange O2 and CO2 Freshwater causes a washout of surfactant and lung loses elasticity.

Diving Accidents: Pressure increases about 1 pound per square inch (PSI) with each 2 feet in depth. Divers must take pressurized air in scuba gear so the lungs will not collapse

Air Embolism: Divers must exhale on the way up or the volume of gas “trapped” in the lungs will expand. Also it is easier to hold your breath underwater, because the O2 is under pressure and more gets to the cells. But never hold your breath under water, or upon ascent, the drop in pressure ceases to feed the tissues at the same rate and you could black out.

Signs and Symptoms: frothy pink sputum, shortness of breath, vertigo, seizures.

Treatment: High-flow O2, watch for tension pneumothorax, Trendelenberg, left side lateral trap air in heart. Recompression in hyperbaric chamber

Nitrogen Narcosis: apathetic, slightly euphoric state

Decompression Sickness: the “bends”. Nitrogen dissolves into the tissues under high pressure and is released into the bloodstream in the form of bubbles upon a too-rapid ascent. Most cases due to repetitive diving (more than 1 in a 12-hour period).

Signs and Symptoms: blotchy red rash, pain in joints, dizziness, paralysis, shortness of breath

Treatment: High-flow O2, IV normal saline TKO, Trendelenberg, left side lateral trap air in heart. Recompression in hyperbaric chamber

Squeeze Symptoms: severe pain in the ears, sinuses, lungs, airways, teeth, other air spaces, gut, Gradual ascent watch the eardrums.
Assessment for all diving emergencies:
Did you breathe compressed air underwater? Number of dives, bottom time
Type of equipment
Diver’s activities
Type of water, environmental factors, water entry
Gas mix
In-water recompression
Flew or ran before symptoms

High Altitude Sickness
Acute Mt. Sickness (AMS) unacclimatized people in excess of 8,000 feet.
Dizziness. Headache, irritability, breathlessness, euphoria

High Altitude Pulmonary Edema (HAPE) increased pulmonary artery pressures in response to hypoxia. Shortness of breath, tachypnea, cyanosis
High Altitude Cerebral Edema (HACE) Increased intracranial pressure. Most severe form. Progression from AMS to HACE takes 1-3 days

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