Near-drownings

Near drowning is defined as almost dying from suffocating under water. It is common in children under the age of four and teenagers. Near drowning can cause lung damage and hypoxia; and it may lead to hypoxic encephalopathy. Serious complications include volume shift, electrolyte abnormalities, circulation compromise, hemolysis, rhabdomyolysis, renal failure, and DIC.



Physical examination:

· Monitor vital signs closely, especially for hypotension and hypothermia
· Lungs: RALES (indicates ARDS or pulmonary edema) and DECREASED BREATH SOUNDS (pneumothorax)
· CVS: murmurs, arrhythmia, raised JVP (CHF or pneumothorax)
· Assess for C spine injuries
· Neuro: GCS or AVPU, pupils, focal deficits

Investigations:

· Oxygen saturation
· Bloods: CBC, electrolytes, ABG, creatinine/BUN
· Urinalysis
· ECG
· CXR and cervical spine X-ray

Management:
· DRABC
     o Secure airway and intubate—high flow O2/BiPAP/CPAP ventilation may be adequate but some        may need mechanical ventilation with Positive End-Expiratory Pressure. Pulmonary toilet may be necessary.
     o Always initiate CPR even if patient is hypothermic
     o IV replacement of fluids if hypotension
· Treat underlying trauma, shock, hypothermia
· Control symptoms
    o Bronchodilators for bronchospasms
    o Dysrhythmia usually goes away after correcting hypoxemia, hypothermia, and acidosis
    o O2 or diazepam for convulsions
    o NG tube/suction to avoid aspiration in vomiting

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