After reading this chapter, you will be able to: • List the anatomic alterations of the lungs associated with near drowning. • Describe the causes of near drowning. • List the cardiopulmonary clinical manifestations associated with near drowning. • Describe the general management of near drowning. • Describe the clinical strategies and rationales of the SOAPs presented in the case study. • Define key terms and complete self-assessment questions at the end of the chapter and on Evolve. Finally, if the victim was submerged in unclean water (e.g., swamp, pond, sewage, or mud), a number of pathogens (e.g., Pseudomonas) and solid material may be aspirated. When this happens, pneumonia may occur, and in severe cases, acute respiratory distress syndrome (ARDS) may develop. Although the theory has been controversial in the past, it is now believed that the major pathologic changes of the lungs are essentially the same in fresh water and sea water wet drownings; both result in a reduction in pulmonary surfactant, alveolar injury, atelectasis, and pulmonary edema (see Figure 40-1). The major pulmonary pathologic and structural changes associated with wet drowning are as follows: • Interstitial edema, including engorgement of the perivascular and peribronchial spaces, alveolar walls, and interstitial spaces • Decreased pulmonary surfactant with increased surface tension of alveolar fluid • Frothy, white and pink secretions throughout the tracheobronchial tree • Alveolar shrinkage and atelectasis Box 40-1 summarizes the general sequence of events that occurs in drowning or near drowning. Victims submerged in cold water generally demonstrate a much higher survival rate than victims submerged in warm water. Table 40-1 lists favorable prognostic factors in cold-water near drowning. TABLE 40-1 Favorable Prognostic Factors in Cold-Water Near Drowning
Near Drowning
Anatomic Alterations of the Lungs
Etiology and Epidemiology
Age
The younger, the better
Submersion time
The shorter, the better (60 minutes appears to be the upper limit in cold-water submersions)
Water temperature
The colder, the better (range, 27° F to 70° F)
Water quality
The cleaner, the better
Other injuries
None serious
Amount of struggle
The less struggle, the better
Cardiopulmonary resuscitation (CPR) quality
Good CPR technique increases the survival rate
Suicidal intent
Lower survival rate among victims who attempted suicide than among victims of accidental submersion