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We are now going to have a look at cardiac arrest in the drowned patient. We have to remember that when somebody gets submerged in water, the first thing that starts to happen is, they start to panic. Their heart starts to run faster, their blood pressure starts to increase and they start to become hypothermic very quickly. It is where we lose a lot of young adults in lakes and quarries during the summer when their body temperature is warm and they plummet into cold water, their body temperature drops at such a degree so fast, their body goes into shock and quite often they do not even submerse from going into the water in the first place. Their airway is open, and they literally go to the bottom of the pond. A few hours later, maybe a few minutes later, because their body is full of air, that they have actually taken on board and their lungs are full of oxygen, they will float back up again and then they tend to sink at a later point.

So what we have got to remember is temperature changes when somebody goes into... Plummets into cold water, their body really does react very, very fast and their temperature starts to drop very quickly. We also get a thing called mammalian diving reflex which is basically where a patient goes underwater and their system pauses or stops or freezes. This does not tend to happen in the UK because the water temperatures does not get cold enough but in areas like Canada, people have actually been under the ice in Canada for up to 45 minutes and still survived without any major complications. So a patient who comes out of a drowning situation again is hypothermic. So they are not dead until they are warm and dead. So resuscitation must start as soon as the patient comes out of the water that they are submersed in. Onto the hard surface of the bank, it's very difficult to do resuscitation, whilst in a boat, especially a rubber rib, we need a hard surface to be able to get CPR to work and be effective.

So the patient needs to be got out of the water as fast as possible. But remember, your safety always comes first. We do not go diving into pools because statistics prove that quite often the patient that is in distress gets out and the rescuer gets lost. So at all times, we must make sure our safety comes first. Use branches, throwing ropes, the rescuer hoops and all this type of stuff to try and get to the patient before we actually commit to water. Our safety comes number one, we are no use to anybody if we are the next casualty. When the patient comes to the bank or comes onto the boat, we then start resuscitation as we would with any normal casualty, same positioning, same rates, same oxygen flow, but we also have to remember, there are a couple of other oddities that happen with drowning. One is dry drowning or secondary drowning both are very, very similar.

Secondary drowning tends to happen more with children than it does with adults. Anybody that has been rescued from the water and even if that is the bath that they are bathing in, if water gets taken into their lungs from being underwater for a few seconds where they take a gasp and breathe it into the lungs, that water can have up to 24 hours later, a knock-on effect to their actual survivability and we can lose the patient up to 24 hours later from the effects of inhaling that water. Vapour can do the same. So it is not just literally the head going underwater. It can be in a splash or vapour environment where they are taking on board fluids. Another complication that we get with the dry drowning is that the vocal cords can swell, the airway itself can swell and consequently, we occlude the flow of air going into the lungs. So we can get water in the lungs, we can get swelling of the throat and the vocal cords and all are complications that come with drowning.

At all times remember. Resuscitation is the same, the sooner we start the better and when the patient is warm, that is the point when we make the decisions whether the patient is survivable or not. So remember again, as, in hypothermia, the patient is not dead until they are warm and dead. And finally remember, with drowning, always take the patient or get the patient seen by medical assistance. Call an ambulance or take the patient to the hospital yourself, because the effects of dry drowning and secondary drowning in particularly with the kids can be a sad consequence of inhalation of water. So always seek medical attention.

  • IPOSi Unit two LO1.2, 1.3, 1.4, 2.1, 2.2 & 2.3