Trauma Week Day 3

Every year, drowning accounts for at least 500,000 deaths worldwide, including approximately 4000 fatalities in the United States. Statistics for nonfatal drowning are more difficult to obtain, but nonfatal drowning events may occur several hundred times as frequently as reported drowning deaths. Multiple definitions of drowning, nonfatal drowning, and emergent injury have been proposed in the medical literature, creating confusing situations and underlining the need for more consistent approach to reporting and studying these incidents. In the United States, drowning is a major cause of accidental death among persons under the age of 45 years and leading cause in children under five years of age in states where swimming pools or beaches are more accessible, such as California, Arizona, and Florida. Behind incidence of drowning occurs among males, African-Americans, children between the ages of one and five years old, persons with law socioeconomic status, and among residents of southern states. Drowning is much more common during the summer months. The age distribution of submersion injuries is bimodal. The first peak occurs among children less than five years of age who are in adequately supervised in swimming pools, bathtubs, or other liquid filled containers; approximately 7% of these incidents appear related to child abuse or neglect. The second HP KeSean among males between 15 and 25 years old and these episodes tend to occur at rivers, lakes, and beaches. In adequate adult supervision, and inability to swim or over estimation of swimming capabilities, risk-taking behavior, use of alcohol and illicit drugs (more than 50% of adult drowning deaths are believed to be alcohol related), Hypothermia, which can lead to rabbit exhaustion or cardiac arrhythmias, concomitant trauma, stroke, or myocardial infarction. Fatal and vital drowning typically begins with a period of panic, low of the normal breathing pattern, breath holding, air hunger, and a struggle by the victim to stay above the water. Reflex inspiratory effort eventually occurs leading to hypoxemia by means of either aspiration or reflex laryngospasm That occurs when water contacts the lower respiratory tract. Hypoxemia in turns affects every organ system, with the component of morbidity and mortality being related to cerebral hypoxia. Hypoxemia ultimately produces tissue hypoxia, which affects virtually all tissues and organs within the body. Pulmonary fluid aspirations result in varying degrees of hypoxemia. Both saltwater and freshwater washout surfactant, often producing noncardiogenic pulmonary edema in the acute respiratory distress syndrome. Pulmonary insufficiency can develop insidiously or rapidly; signs and symptoms include shortness of breath, crackles, and wheezing. The chest radiograph or CT scan at presentation can vary from normal to localized, perihilar, or diffuse pulmonary edema. Neurologic hypoxemia and ischemia cause neuronal damage, which can produce cerebral Adema and elevations in intracranial pressure. Some others consider the progressive rise in intracranial pressure that is sometimes observed approximately 24 hours after injury to reflect the severity of the neurologic insult rather than its cause. Approximately 20% of nonfatal drowning victims sustained neurologic damage, limiting functional recovery despite successful cardiopulmonary resuscitation. Renal failure rarely can occur after submergence, it is usually due to an acute tubular necrosis resulting from hypoxemia, shock, hemoglobinuria, or myoglobinuria. Seizure activity which increases cerebral oxygen consumption and blood flow, should be aggressively controlled. Neuromuscular blocking agents should be avoided if possible, because they can mask neurologic signs. Both hypoglycemia and hyperglycemia may be harmful to the brain, and euglycemic should be meticulously maintained.