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Nursing Care for Near


Drowning patient
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Drowning: Key Facts

Drowning is the 3rd leading cause of
unintentional injury death worldwide, accounting
for 7% of all injury related deaths.
Low- and middle-income countries account for
95% of unintentional drowning deaths
Children, males and individuals with increased
access to water are most at risk of drowning.
Children under 5 years of age have the
highest drowning mortality rates worldwide

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Drowning: Risk Factors


Age: Children under 5 years of age have the highest drowning
mortality rates worldwide
Gender: Males twice as likely than females to be hospitalized than
females for non-fatal drowning.
Access to water: Occupations involving water (fishing), children
who live near open water sources
Other risk factors:
lower socioeconomic status, lack of higher education, ethnic minority,
rural population
infants left unsupervised or alone with another child around water;
unsafe or overcrowded transportation vessels lacking flotation devices;
alcohol use
medical conditions, such as epilepsy;
tourists unfamiliar with local water risks and features;
floods and other cataclysmic events like tsunamis.

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Pre-Hospital Care

Optimal pre-hospital care is a significant
determinant of outcome.
Victim should be removed from the water at the earliest
opportunity
Bystanders should call for emergency help immediately.
Transport patient to hospital quickly
Start rescue breaths (while still in water)
Ensuring adequacy of the airway, breathing, and circulation
(ABCs).
C-spine precautions

Why are C-spine precautions important for drowning victims?
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Emergency Department Care

Initial management of near drowning should place
emphasis on immediate resuscitation and treatment
of respiratory failure.
Manage airway
Supplemental oxygen, 100% by mask as soon as
available. Monitor oxygen saturation (SpO2)
If the patient remains dyspneic on 100% oxygen or has a
low oxygen saturation, use continuous positive airway
pressure (CPAP) if available
Frequent neurologic assessment should occur: the
Glasgow Coma Scale is one modality that has been
effectively used
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Treatment of Volume Depletion
and Acidosis

Intravascular volume depletion is common
secondary to pulmonary edema and intracompartmental fluid
shifts, regardless of the type of fluid aspirated.
Rapid volume expansion may be indicated using
isotonic crystalloid (20 mL/kg) or colloid.
Inotropic support may be required using dopamine
and/or dobutamine.
Most acidosis is restored after correction of volume
depletion and oxygenation.
Hypothermia may also be present and exacerbate
bradycardia, acidosis, and hypoxemia.
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Other Interventions

Nasogastric tube placement can be used for removal of
swallowed water and debris. Use the orogastric route if
head or facial trauma is suggested.
Bronchoscopy may be needed to remove foreign
material, such as aspirated debris or vomitus plugs from
the airway.
Appropriate management of hypoglycemia and other
electrolyte imbalances, seizures, bronchospasm and
cold-induced bronchorrhea, dysrhythmias, and
hypotension may be necessary in the drowning patient.
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Patient Discharge

Patients can be safely discharged from the ED after 6-8 hours of
observation if they meet the following criteria:
Able to relay a good history of minor immersion injury
No evidence of significant injury
No change in mental status or behavior
No evidence of bronchospasm or tachypnea/dyspnea
No evidence of inadequate oxygenation (by ABG analysis and
pulse oximetry)
Tell discharged patients to return immediately if they develop
dyspnea, cough, and/or fever.

Observe victims for a more prolonged period of time if they
experienced mild to moderately severe submersion and only have
mild symptoms that improve during observation and have no
abnormalities on ABG analysis or pulse oximetry and chest
radiograph


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Complications to watch for

Look for evidence of:
acute respiratory distress syndrome (ARDS)
multiple organ system failure
nosocomial infection, especially pneumonia;
hyperglycemia
[
gastric stress ulceration.

Begin aggressive rehabilitation early (as soon as
tolerated) to prevent disuse injury and promote functional
improvement.



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Emergencies and other
complications


Inform provider immediately if patients exhibit signs of any of the following:
Acute Respiratory Distress Syndrome (ARDS)
Significant hypoxia that requires intubation
Worsening dyspnea with the potential for intubation
Evidence of hypoxic cerebral injury
Evidence of renal insufficiency
Evidence of hemolysis
Severe hypothermia requiring cardiopulmonary bypass

Notes to Nurses: The patients must be monitored for any of these
symptoms, as early detection and treatment improves chances for
survival

Also, consider:
nosocomial infection, especially pneumonia
Begin aggressive rehabilitation early (as soon as tolerated) to prevent
disuse injury and promote functional improvement.




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Prevention

Drowning prevention strategies start with
community education:
Increase individual, family and community
awareness of risk and to aid in response if a
drowning occurs

What are some things nurses can do to educate
communities about preventing drowning?
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Prevention

Other community level efforts to prevent
drowning:
Engineering methods to remove the hazard
Legislation to enforce prevention and assure
decreased exposure
Research and public health initiatives to further
define the burden of drowning worldwide and
explore prevention interventions.

Where can nurses go to to learn about best
practices and research for nursing care?
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Nursing care: Teamwork

It takes excellent teamwork to provide care for patients
experiencing near-drowning
Nurses, doctors, laboratory, public health, hospital
administrators, the community, etc. all must come
together.
Good communication between the team members is
essential
For those with less experience, the team should
support that person, and provide guidance as needed
The patients deserve the best, and that can only be
provided with a team effort.
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Summary
Drowning incidences are a serious problem
worldwide, especially for children.
Prevention is one strategy to address, but
unfortunately, this is not always possible
Effective management of near-drowning patients
requires a good working health care team.
Nurses are important members of the health care
team

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Terima kasih! Mahalo! Thank you!
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