DROWNING RESUSCITATION

Disusun Oleh:
Bintari Anindhita
Pembimbing:
Dr. Erica Gilda Simanjuntak SpAn
Kepaniteraan Klinik Ilmu Anastesi Periode 15
Desember 2014 24 Januari 2015

Old Definition

Modell JH, from the Drown versus near-drown:

discussion of definitions.
Drowning:

to die from respiratory obstruction and asphyxia with or

without aspiration while submerged in a fluid medium

Near drowning:

to survive, at least temporarily, following asphyxia with

or without aspiration due to submersion in a fluid
medium

New Definition

Drowning is a process resulting in

primary respiratory impairment from
submersion/immersion in a liquid
medium
The terms wet drowning, dry
drowning, active or passive drowning,
near-drowning, secondary drowning,
and silent drowning are no longer used

Physiological Response During Drowning

Victims airway
lies below the
surface of liquid

Victim voluntarily
holds his or her
breath

Involuntary period
of laryngospasm

Oxygen and
carbon dioxide

hypercarbic,
hypoxaemic and
acidotic

stimulates
respiration

Arterial oxygen
tension drops
further

Laryngeal spasm
and obstruction
abate and the
victim actively
breathes liquid

The victims
respiratory
movements
become very
active but there is
no exchange of
air

Saltwater vs Freshwater Drowning

Freshwater Drowning

Saltwater Drowning

fresh water hypotonic and

hyponatremic relative to blood

sea water very hypertonic

relative to the blood

inducing, after inhalation, a

movementt of water from the alveoli
into the blood and movement of
sodium from the blood into the alveoli

the water movement goes from

blood into the alveoli and the
electrolytes (sodium, chloride,
magnesium) from the alveoli into
the blood.

induce haemodilution, hypervolemia,

hypnonatremia, hyperkalemia and
haemolysis

The consequences of the sea water

drowning should be
haemoconcentration, hypovolemia
and hypernatremia.

Basic Life Support

Rescue and in water resuscitation

Untrained rescuers AVOID drowning if possible,

provide help from out of the water

If conscious, the person should be brought to land, and

basic life support should be started as soon as possible

Basic Life Support

Rescue and in water resuscitation

For a person who is

unconscious, in-water
resuscitation may
increase the likelihood
of a favorable
outcome

Is possible only by
highly trained rescuer,
and it consists of
ventilation alone

Basic Life Support

Initial Resuscitation On Land

Once on land, victim should

be placed in a supine
position, with the trunk and
head at the same level

Check responsiveness and

breathing

If the person is unconscious

but breathing, the recovery
position (lateral decubitus)
should be used.
If the person is not
breathing, rescue
ventilation is essential

Basic Life Support

Initial Resuscitation On Land

Cardiac arrest AB-C not C-A-B

Maneuvers to
relieve foreign-body
airway obstruction
(FBAO) are not
recommended

Open the airway, check for breathing

No breathing
5 initial rescue breaths
Begin chest compression with 30:2
compression-ventilation ratio
Attach AED if available
Shock according to AED prompts

Advanced Life Support

Airway and breathing

High flow
oxygen with
reservoir bag

Noninvasive
ventilation /
CPAP

Early tracheal
intubation,
using rapidsequence
induction

Advanced Life Support

Circulation and defibrilation

If the victim is in cardiac arrest follow standard advanced

life support protocols.
If the victims core body temperature < 30 C :
limit

defibrillation attempts to three, and

withhold IV drugs until the core body temperature increases above
30 C

Prolonged immersion victims may become

hypovolaemic from the hydrostatic pressure of the water
on the body.

Give IV fluid to correct hypovolaemia.

After return of spontaneous circulation, use haemodynamic
monitoring to guide fluid resuscitation.

Post Resuscitation Care

Lung injury.
Victims of drowning at risk of developing
acute respiratory distress syndrome (ARDS)

protective ventilation have been shown to improve

survival in patients with ARDS

Pneumonia common after drowning.

Prophylactic antibiotics have not been shown to be

of benefit
Give broad-spectrum antibiotics if signs of
infection develop subsequently

Post Resuscitation Care

Hypothermia after drowning.

Victims of submersion may develop primary or

secondary hypothermia.
If the submersion occurs in icy water (<5 C or 41F),
hypothermia may develop rapidly and provide some
protection against hypoxia

A pragmatic approach might be to consider

rewarming until a core temperature of 3234 C is
achieved,
Taking care to avoid hyperthermia (>37 C) during
the subsequent period of intensive care

Post Resuscitation Care

Permanent neurologic damage the most

worrisome outcome in persons who have been
resuscitated after a drowning incident

Comatose victim or have neurologic deterioration

should undergo intensive assessment and care

the goals are to achieve normal values for glucose,

partial pressure of arterial oxygen, and partial
pressure of carbon dioxide, with
avoidance of any situation that increases brain
metabolism

Unusual Complication
Sepsis and
disseminated
intravascular
SIRS
coagulation
possible
complications
during the first 72
hours
Renal insufficiency
can occur as a
result of anoxia,
shock,
myoglobinuria,or
hemoglobinuria

Post mortem findings

Froth present around nostrils, mouth, upper and lower

airway in freshly drowned bodies.

Lung weights

Higher in drowning cases

Normal weights are possible in the drowning cases after
cardiac arrest reflex or vaso vagal reflex

Over-inflated lungs emphysema aquosum & marbled

appearance

Sand, silt, seashells and weeds in the airways, lungs,

stomach and duodenum of drowned victims.

If this material is found within the alveoli immersion

during life

References
Van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJLM. A new
Definition of Drowning: towards Documentation and Prevention of Global
Public Health Problem. Bull World Health Org. 2005; 83: p. 853-6.
Robert A. Berg C, Hemphill R, Abella BS, Aufderheide TP, Cave DM,
Hazinski MF, et al. 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Circulation. 2010; 122: p. S685-S705.
Szpilman D, Bierens JJLM, Handley AJ, Orlowski JP. Drowning. N Engl J Med.
2012; 366: p. 2102-10.
Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Joost J.L.M. Bierensf H, et
al. European Resuscitation Council Guidelines for Resuscitation 2010.
Resuscitation. 2010; 81: p. 1400-33.
Farrugia A, Ludes B. Diagnostic of Drowning in Forensic Medicine. In Vieira
DN, editor. Forensic Medicine - From Old Problems to New Challenge.:
Intech; 2011. p. 53-8.

THANK YOU
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