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Tim Nutbeam and Clare Bosanko에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Tim Nutbeam and Clare Bosanko 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.
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Drowning

50:49
 
공유
 

Manage episode 285904904 series 165883
Tim Nutbeam and Clare Bosanko에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Tim Nutbeam and Clare Bosanko 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.

Some facts

Drowning is important: 1,000 people drown every day, 2 every 3 minutes, 41 per hour. It is the world’s 3rd leading cause of accidental death: 3.6 million people over 10 years.

Disease of youth

  • 64% < 30 years old
  • 43% < 15 years old
  • 25% < 5 years old

Male: female ratio 2:1

In 40%, alcohol is on board

4 stages of Immersion associated with particular risk in drowning

Initial Responses/Sudden Death (first 3-5 min)

  • Skin cooling

Short-Term Responses (5-30 min)

  • Superficial Nerve and Muscle Cooling

Long-Term Responses (30 min +)

  • Cooling of deep tissues

Post-immersion (during rescue)

  • Collapse of arterial pressure
  • Continued cooling

Fresh versus salt water drowning

Lethal aspiration of salt water 22ml/kg (approx 1.5 litre), fresh water 44ml/kg

Be aware that drowning can take up to 4 hours – observe and watch for 6!

Prognostication

Better outcomes:

  • Rescued and BLS commenced < 5-10 min
  • Children
  • Those who have not aspirated
  • Water temperature < 10 oC, core body temperature 33-35 oC
  • Neurologically intact on arrival at hospital
  • Minimum blood pH > 7.1, blood glucose < 11.2mmol/L
  • ROSC on scene
  • Spontaneous ventilation in ED

Worse prognosis

  • Risk of death or severe neurological impairment after hospital discharge is reported to be nearly 100% when the duration of submersion exceeds 25 min
  • Following 30 mins resuscitation, if no signs of life, resuscitation is futile -> stop

It is important to remember that casualties who have entered water sometimes have access to a “bubble” of air – particularly if they had entered the water following a boating incident or were in a car at the point they entered the water. In these circumstances it is impossible to judge the point at which submersion has occurred.

What about cold water???

This is a regular point of discussion and concern. Water temperature is a key determinant: icy versus not. In the UK sea water is very unlikely to be icy or cold enough – however, small areas of water may well be, particularly in the winter months.

References

  • Szpilman D, Bierens JJ, Handley AJ, Orlowski JP (2012) Drowning. New Engl J Med. 366: 2102–10.
  • Tipton & Golden (2011). Decision making guide for immersion incidents involving total (head under) submersion. Resuscitation. 82: 819-824.
  • Golden & Hervey, 1981
  • Oakley & Pethybridge, 1997
  • Tipton 2016
  • Bierens 2014. Handbook of Drowning.

  continue reading

48 에피소드

Artwork

Drowning

PHEMCAST

141 subscribers

published

icon공유
 
Manage episode 285904904 series 165883
Tim Nutbeam and Clare Bosanko에서 제공하는 콘텐츠입니다. 에피소드, 그래픽, 팟캐스트 설명을 포함한 모든 팟캐스트 콘텐츠는 Tim Nutbeam and Clare Bosanko 또는 해당 팟캐스트 플랫폼 파트너가 직접 업로드하고 제공합니다. 누군가가 귀하의 허락 없이 귀하의 저작물을 사용하고 있다고 생각되는 경우 여기에 설명된 절차를 따르실 수 있습니다 https://ko.player.fm/legal.

Some facts

Drowning is important: 1,000 people drown every day, 2 every 3 minutes, 41 per hour. It is the world’s 3rd leading cause of accidental death: 3.6 million people over 10 years.

Disease of youth

  • 64% < 30 years old
  • 43% < 15 years old
  • 25% < 5 years old

Male: female ratio 2:1

In 40%, alcohol is on board

4 stages of Immersion associated with particular risk in drowning

Initial Responses/Sudden Death (first 3-5 min)

  • Skin cooling

Short-Term Responses (5-30 min)

  • Superficial Nerve and Muscle Cooling

Long-Term Responses (30 min +)

  • Cooling of deep tissues

Post-immersion (during rescue)

  • Collapse of arterial pressure
  • Continued cooling

Fresh versus salt water drowning

Lethal aspiration of salt water 22ml/kg (approx 1.5 litre), fresh water 44ml/kg

Be aware that drowning can take up to 4 hours – observe and watch for 6!

Prognostication

Better outcomes:

  • Rescued and BLS commenced < 5-10 min
  • Children
  • Those who have not aspirated
  • Water temperature < 10 oC, core body temperature 33-35 oC
  • Neurologically intact on arrival at hospital
  • Minimum blood pH > 7.1, blood glucose < 11.2mmol/L
  • ROSC on scene
  • Spontaneous ventilation in ED

Worse prognosis

  • Risk of death or severe neurological impairment after hospital discharge is reported to be nearly 100% when the duration of submersion exceeds 25 min
  • Following 30 mins resuscitation, if no signs of life, resuscitation is futile -> stop

It is important to remember that casualties who have entered water sometimes have access to a “bubble” of air – particularly if they had entered the water following a boating incident or were in a car at the point they entered the water. In these circumstances it is impossible to judge the point at which submersion has occurred.

What about cold water???

This is a regular point of discussion and concern. Water temperature is a key determinant: icy versus not. In the UK sea water is very unlikely to be icy or cold enough – however, small areas of water may well be, particularly in the winter months.

References

  • Szpilman D, Bierens JJ, Handley AJ, Orlowski JP (2012) Drowning. New Engl J Med. 366: 2102–10.
  • Tipton & Golden (2011). Decision making guide for immersion incidents involving total (head under) submersion. Resuscitation. 82: 819-824.
  • Golden & Hervey, 1981
  • Oakley & Pethybridge, 1997
  • Tipton 2016
  • Bierens 2014. Handbook of Drowning.

  continue reading

48 에피소드

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