(Tödliches drowning; Non serious drowning)
Drowning breathing by immersion in a liquid is made impossible. This can be fatal or non-fatal. Drowning leads to hypoxia, which may be several organs, including the lungs and brain damage. Treatment is supportive and directed at the cardiac and respiratory arrest, hypoxia, hypoventilation and hypothermia.
Drowning is one of the most important accidental causes of death worldwide, especially in children and adolescents <19 years. From 2005-2009 had children aged 1-4 years in the US, the highest death rates from drowning, and drowning was the second leading cause of death (after congenital anomalies). Drowning was the second leading cause of death by injury in children aged 5-9 years and the third leading cause of children <1 year, and in the age group of 10-19 years. Other groups that are at higher risk of death by drowning, are the following:
Drowning breathing by immersion in a liquid is made impossible. This can be fatal or non-fatal. Drowning leads to hypoxia, which may be several organs, including the lungs and brain damage. Treatment is supportive and directed at the cardiac and respiratory arrest, hypoxia, hypoventilation and hypothermia. Drowning is one of the most important accidental causes of death worldwide, especially in children and adolescents <19 years. From 2005-2009 had children aged 1-4 years in the US, the highest death rates from drowning, and drowning was the second leading cause of death (after congenital anomalies). Drowning was the second leading cause of death by injury in children aged 5-9 years and the third leading cause of children <1 year, and in the age group of 10-19 years. Other groups that are at higher risk of death by drowning are the following: children of African-Americans, immigrants or impoverished families men people alcohol or sedatives taken people with conditions that cause temporary incapacitation have such. B. seizure, hypoglycemia, stroke, myocardial infarction, cardiac arrhythmias people with long QT syndrome (swimming can trigger cardiac arrhythmias that can lead to drowning in people with this syndrome, especially LQT1 syndrome) people suffering from dangerous underwater Atemanhalten- behavior (Dubbs) involved drowning often occurs in swimming pools, hot tubs and natural bodies of water and - in infants and young children - in toilets, bathtubs, buckets with water or cleaning fluids. 4 times as many people will be admitted to the hospital because they are almost drowned. Pathophysiology Hypoxia Hypoxia caused the Beinaheertrinken the main damage to the brain, heart and other tissues; may cause respiratory arrest followed by cardiac arrest. Cerebral hypoxia can lead to cerebral edema and occasionally have permanent neurological consequences. A generalized tissue hypoxia can cause metabolic acidosis. The immediate hypoxia resulting from the aspiration of fluid or gastric contents, (formerly called dry drowning) an acute reflex laryngospasm, or both. Lung injury resulting from the aspiration or hypoxia itself, can cause a delayed hypoxia (previously referred to as the secondary drowning). The aspiration, particularly of particles or chemicals, can cause a chemical pneumonitis or secondary bacterial pneumonia and may affect the alveolar surfactant secretion, resulting in a patchy atelectasis. Extensive atelectasis can cause the affected areas of the lungs become stiff, compliance and the ventilation can be reduced, which can cause respiratory failure with hypercapnia and respiratory acidosis. The perfusion of poorly ventilated areas of the lung (mismatch of ventilation and perfusion, V / Q mismatch) worsens hypoxia. Alveolar hypoxia may be a pulmonary edema nichtkardiogenes verursachen.Unterkühlung Exposure to cold water induces a systemic hypothermia, which can be a significant problem. However, hypothermia can also be protective by triggering the diving reflex, slows the heartbeat and narrowed peripheral arteries, increasing oxygenated blood is diverted away from the extremities to the heart and the gut and brain. Hypothermia also reduces the O2 demand of the tissue, which may improve the chances of survival and the beginning of hypoxic tissue damage is delayed. The diving reflex and all clinically protective effects of cold water are usually in young children most ausgeprägt.Aspiration liquids A laryngospasm often limits the amount of aspirated fluid; nevertheless the Beinaheertrinken large amounts of water are aspirated occasionally. Sea water can increase the sodium and chloride levels slightly. In contrast, large amounts of fresh water can reduce the electrolyte concentration significantly increase the blood volume and cause hemolysis. Inhalation can cause pneumonia, sometimes with anaerobic Erregern.Gefährliches underwater breath-holding behavior (Dubbs) Hazardous underwater breath-holding behavior (Dubbs) are mostly of healthy young men practiced (often good swimmers) who are trying to extend to stay under water their capacity. There are three types of DUBB Intentional hyperventilation-blowing CO2 before swimming underwater described, thereby delaying central hypercarbic ventilatory responses Hypoxic Training Expansion of capacities for distance swimming under water or breath holding static apnea dive holding the breath for as long as possible while is submerged and motionless, as a game in DUBB while one is under water, occurs hypoxia on first, followed by loss of consciousness (hypoxic blackout, "breath-hold blackout) and then Ertrinken.Assoziierte violations skeletal, soft tissue, head and internal injuries can occur, especially with surfers, water skiers, sailors, but also for flood victims and occupants of submerged vehicles. people who jump into shallow water, can neck and other spinal injuries suffered (what the reason for the drowning may be s). In rare cases, drowning occurs when people have a carbon monoxide poisoning when they swim close to the stern of a boat. Just a few breaths can result in unconsciousness. While symptoms and complaints of drowning occurs panic and the urgent need for air. Children who can not swim, dive under in less than a minute, so more quickly than adults. After the rescue, often anxiety, vomiting, wheezing and changes in consciousness occur. In the patients of acute respiratory failure can occur together with tachypnea, intermediate retractions or cyanosis. Sometimes the respiratory symptoms delayed up to several hours after the immersion. Patients may have symptoms of injury or exacerbation of underlying disease. Tips and risks Sometimes enter the respiratory symptoms and hypoxia on delayed up to several hours after the immersion. Diagnosis Clinical Investigation for associated injuries are indexed imaging tests, as required pulse oximetry and if the results are abnormal or if respiratory symptoms are present, blood gas analysis and chest X-ray measurement of core temperature to the exclusion of hypothermia. A clarification on causal or contributing to that purpose diseases (eg. As hypoglycemia, myocardial infarction, poisoning, injuries) Ongoing monitoring as for delayed respiratory complications common Most people will find it in the water or in the vicinity, which makes the diagnosis clinically clear. Resuscitation must, if it is necessary to use before the complete diagnostic evaluation. If one starts from cervical spine injuries, the spine is immobilized, eg. As if the patients have altered consciousness or has a jump into the water or trauma to the mechanism of injury. Secondary head injuries and circumstances that may have contributed to drowning (z. B. hypoglycemia, stroke, myocardial infarction, arrhythmia) are examined. In all patients, oxygenation is determined by oximetry or there will be a determination of arterial blood gases and chest radiograph performed if the results are normal or if respiratory symptoms or corresponding signs are present. Because respiratory symptoms may occur later, even asymptomatic patients to be hospitalized and monitored for several hours. In patients with corresponding symptoms or patients who were submerged long, the core body temperature is measured, an ECG taken, and serum electrolytes determined; In addition, continuous monitoring by oximetry and cardiac monitoring take place. In cases of suspected cervical spine injury patients are subjected to an imaging method for assessing the cervical spine. In patients with impaired consciousness, a CT scan is done. Any other suspected predisposing or associated conditions shall be clarified with reference to corresponding tests (z. B. fingertips test for glucose for hypoglycemia, ECG for myocardial infarction, cardiac monitoring of cardiac arrhythmia, investigation on intoxication). Patients who are drowning without obvious risk factors are examined for the Long QT syndrome and ventricular torsades de point tachycardia. In patients having pulmonary infiltrates, the sputum is a distinction between bacterial pneumonia and chemical pneumonitis by blood culture, Gram stain and culture. If indicated (eg. As when a bacterial pneumonia is suspected, but the pathogen can not be identified), a bronchial lavage for review may be useful, including a culture. Anaerobic pathogens should be considered. Clinical Calculator: QT interval correction (ECG) prognostic factors that increase the likelihood of survival without permanent injuries in immersion: short duration of immersion Cold water temperature Young age No pre-existing conditions, secondary trauma or aspiration of fine dust or chemicals Rapid induction of Resuscitation (most importantly) a survival may be possible to an hour in cold water after a submersion up, especially in children; therefore patients are resuscitated vigorously with longer-term submersion. Treatment resuscitation correction of O2 and CO2 levels and other physiological abnormalities Intensive respiratory support Treatment aims to improve cardiac arrest, hypoxia, hypoventilation, hypothermia and other pathophysiological findings. Resuscitation from drowning When apnea is started immediately with the emergency resuscitation - if possible in the water. When the immobilization of the spinal column is necessary, it is carried out in a neutral position, and the ventilation is carried out without tilting the head or to raise the chin by advancing the mandible angle of the jaw (jaw thrust). The ambulance service is called. If the patient does not respond to the ventilator attempts beginning with chest compressions, followed by Advanced Cardiac Life Support. Although the guidelines for resuscitation of the American Heart Association in 2010 recommend chest compressions as the first step in the resuscitation of patients in cardiac arrest, is drowning an exception to this recommendation. Attempts to remove water from the lungs, should be avoided because they delay the ventilation and increase the risk of vomiting. Oxygenation, intubation, or both, should be made as soon as possible. Patients with hypothermia are warmed up as soon as possible. Immediate treatment measures are the removal of clothes drying and isolation. Tips and risks attempts to remove water from the lungs should be avoided, because they delay the ventilator and increase the risk of vomiting. Hospital care for drowning patients (patients drowning) All patients with hypoxia or moderate symptoms to be hospitalized. At the hospital, the supportive treatment is continued in order to achieve acceptable arterial O2 and CO2 levels. Mechanical ventilation may be necessary. It is administered 100% O2; the concentration is down-regulated on the basis of the blood gas values. A positive end-expiratory pressure (PEEP) may be necessary to promote the development of alveoli for adequate oxygenation or maintain. Pulmonary support may be needed over hours and days. When sufficient oxygen supply is impossible despite maximizing the ventilator settings that extracorporeal membrane can be considered. Inhaled ?2-adrenergic agonists may help reduce bronchospasm and wheezing. Patients with bacterial pneumonia are treated with antibiotics, which target identified in the sputum or blood culture or potential pathogens. Corticosteroids are not used. The body temperature is controlled and treated hypothermia. Volume or electrolyte replacement are required infrequently to compensate for significant electrolyte derailment. A fluid restriction is rarely indicated, unless pulmonary or cerebral edema occur. Simultaneous injuries and diseases (eg. As head or neck injury, carbon monoxide poisoning) often have to be observed for several hours also treated werden.Entlastung of drowning patients (Discharge of drowning patients) patients with mild symptoms, clear lungs and normal oxygenation can , If the symptoms disappear and the investigation and oxygenation remains normal, patients can be discharged the symptoms with the note if it occurs again come back immediately. Prevention drugs, alcohol and drowning alcohol or drugs, which are among the greatest risk factors should, before and should during the swim, boat trips and during the supervision of children werden.Sicherheit avoided the water while swimming float to use their common sense and previously inform the weather and water conditions. Swimmers should be accompanied by an experienced swimmer or swim only in supervised areas. Swimming should be terminated if it is apparent that the person freezes or feels very cold, because hypothermia can impair judgment. People swimming in the sea should learn to escape flows with train out to sea by parallel swim to the beach, instead of trying to swim straight to shore. Swimmers should be discouraged from Dubbs. If they exercise it, they should be monitored and should be aware of its dangers. Swimmers should avoid swimming near a boat tail, as this can lead to carbon monoxide poisoning. Public swimming areas should be patrolled by lifeguards who are trained in rescue techniques and resuscitation. Life jackets, life jackets and a shepherd's staff should be present near a swimming pool. An emergency resuscitation equipment, automated external defibrillators (AED) and an emergency telephone on site should allow access to emergency services. Comprehensive public prevention programs should address high-risk groups, teach children as early as possible to swim and so many young people and adults to teach as possible in cardiopulmonary resuscitation. Owners of private swimming pools should also install an emergency telephone with connection to a rescue service and in techniques of resuscitation for drowning auskennen.Wassersicherheit for children must wear approved flotation devices in the water or in its vicinity. Air-filled swimming aids and foam toy (water wings, swimming noodles, etc.) are not designed to save swimmers from drowning and should not be used as a substitute for approved flotation devices. Children must be constantly supervised by an adult when they are playing the water, eg. As at the seaside, at swimming pools or ponds. Infants and young children should also be monitored, ideally within an arm's length when are close to toilets, bathtubs or water accumulation. Studies in the United States and China have shown that routine swimming lessons can reduce the risk of fatal drowning among children aged 1-4; however, children who have learned how to swim must be constantly monitored when they are near water. Adults should remove water from containers such as buckets and buckets immediately after use. Swimming pools should be surrounded by a locked fence of ? 1.5m sein.Sicherheit on the water Before departure should create approved life jackets boaters and learn about weather and water conditions. Non-swimmers and small children in a boat should wear all the time approved life jackets. Since alcohol increases the consumption of any amount the risk of drowning, the crew and passengers were on pleasure boats generally can the consumption of alcohol vermeiden.Besondere groups of people at risk of drowning Weakened, the elderly and people with seizure disorders or other diseases that lead to changes in consciousness who need special supervision while swimming, boat trips and in the bathtub. People with a personal or family history of unexplained drowning, which is not due to alcohol consumption, drug use, or seizure disorder, should be checked for the long QT syndrome. Summary Patients should be investigated for suspected certain causes (eg. As in Halswirbelsäulemveletzungen, head injuries, carbon monoxide poisoning, arrhythmias, hypoglycemia) and for injury or consequences of drowning (z. B. injury to the head or cervical spine, aspiration). In cold water drowned should be revived vigorously, even if the immersion lasted longer. A survival is possible after 1 h immersion. Resuscitation begins with respiration, not with chest compressions. Preventive measures (eg. As swimming lessons, child care, use of certified flotation devices or life jackets, avoiding alcohol, fast access to qualified lifeguards and emergency services) can bring substantial benefits for public health.