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SUBMERSION INJURY
Signs and Symptoms History (Complications)
• Unresponsive • Head Injury
• Change in Mental Status • Intoxication
• Hypoxia • Arterial gas embolism (medical/trauma)
• Cyanosis • Scuba diving (see DECOMPRESSION
• Hypothermia SICKNESS PROTOCOL)
• Vomiting
• Coughing
Treatment
• If initiating a water rescue
Utilize flotation devices and tow/hoist the patient to safety. Rescuing someone from water is a
˚ last resort.
Administer 5 rescue breaths only if there is a delay in water extrication
• ˚ Once on land/in an aircraft
˚ Airway
Assess patency of airway; remove sand, seaweed, etc if visible.
■
■ Consider early intubation for obtunded patients
˚ Breathing
If unconscious and not breathing, immediately perform 5 rescue breaths
■
■ If spontaneous breathing, immediately apply O at 15LPM via NRB
2
■ Support ventilation with BVM, PEEP, oxygen, etc., to a goal O saturation of 92–96%
2
■ Place the patient in the recovery position as soon as able to reduce the risk of aspiration
˚ Circulation
If no pulses, focus on quality CPR. Move to ADULT CARDIAC ARREST PROTOCOL/
■
PEDIATRIC CARDIAC ARREST PROTOCOL
■ Obtain IV access when able. See IV/IO PROTOCOL
■ Consider warmed IV fluids in hypotensive or hypothermic patients
˚ Disability/Environment
Assess GCS
■
■ Maintain glucose 80–140mg/dL. See HYPERGLYCEMIA/HYPOGLYCEMIA PROTOCOL
■ If the event is unwitnessed and there is persistent LOC, consider other etiologies besides
hypoxemia
■ Dry and insulate the patient. Treat hypothermia, move to HOT/COLD WEATHER INJURY
PROTOCOL
■ Consider placement of NG/OG tube
• Terminating resuscitation efforts
In a non-hypothermic patient, stop efforts after 30min of CPR without ROSC
˚ In a hypothermic patient, continue until the patient is rewarmed to 30°–34º C (86°–93º F), then
˚ continue CPR. Stop efforts if the patient remains asystolic for >20min
Notes, Warnings, Cautions
• No inwater routine cspine precautions or chest compressions
• Rescue breaths and CPR represent a significant risk of emesis in drowning victims
• Due to the increased pulmonary airway pressures required for ventilating drowning patients, the use of
supraglottic airways is discouraged
• Head-down positioning or abdominal thrusts increase the risk of aspiration. Heimlich maneuver is NOT
recommended for drowning
• The initial 5 rescue breaths are used as a recruitment maneuver. Drowning patients without circulatory
arrest will often respond to rescue breaths alone
• Many ALS interventions are ineffective with low core body temperature. Withhold antiarrhythmics for
core temp <30ºC (86ºF)
Reference: CPG ID #64 (Drowning Management)
44 • MEDICAL