MUNI ISIMU MED First aid-drowning David Kříž Learning objectives - Student will learn the causes of drowning. - Student will learn the approach of first aid for drowning (children and adults). - Student will learn about the risks to rescuer during drowning. MUNI | SIMU MED Drowning - Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. - Just 30 mm of liquid and you can drown. -360,000 people died from drowning in average every year. - Drowning is the third leading cause of unintentional injury-related death (after drink-drive accident, fire-related injury) - Drowning is the leading cause of injury death in children aged 1-4 years. - Prevention is the key. MUNI | SIMU MED Risk factors Male: Nearly 80% of people who die The most risky age in years: A 1-4. Childrens can't swim, they don't have endurance. B 18-24. Loss of inhibitions. Hazardous behavior. Alcohol intoxication. C over 55. Overestimation of swimming abilities. Chronic limiting diseases. Where: 89% swimming pool. 10% sea, ocean, river.. 1% other (transportation, toilete, bath bucket) https://encrypted-tbn0.gstatic.com/images?q=tbn%3AANd9GcScooMXritNK-fBmu5vN13mcjiDqegpLstCeA&usqp=C UNI | SIMU ED Risk factors - Transportation (migration, cheap boats fishermen, inappropriate management in an accident) - Tourists (by the sea do not know the local conditions, currents below the surface, the power of low tide, rip current) - Most people drown at the beginning of the summer season and during the big holidays (4th July) MUNI | SIMU MED SIGNS THAT A PERSON IS DROWNING: Myth Truth - Lifeguard distinguishes 4 types of people in water. 1. Swimmer (horizontal position of the body, regular breathing, progression in water) 2. Distress swimmer (horizontal position, accelerated breathing, no or minimal progression in water. Within 60 seconds they become active drowning. Ideally rescue immediately at this point. 3. Active drowning victim (vertical position, ineffective movements of the limbs, tilt of the head back. CAVE: risk of drowning of the rescuer. They are strong. They're fighting for their lives. Rescue for professionals only. 4. Passive drowning victim ( someone who is unconscious in the water) https://encrypted-tbn0.gstatic.com/images?q=tbn%3AANd9GcSxO347MkU-yDJLP8m7VSy57BAD50ezOifnqg&usqp=CAU MUNI | SIMU ED The signs of drowning https://i.pinimg.com/564x/ae/9f/38/ae9f387c577ea4c5c02d6985bbc6c0a2.jpg MUNI|SIMU MED DROWNING CHAIN OF SURVIVAL Drowning chain of survival - The safety of the rescuer is an absolute priority. ^asF w vr/ ^s__^ - If you find someone drowning. The first step is call for help bystanders and summon EMS. - Then attempt to save the victim: - 1. Throwing rescue. Throw something to keep them afloat (rescue ring, floating..) - 2. Water rescue (No diving. Always feet first and watching closely the victim. Grasp the victim ideally behind the chest and pull the victim to the nearest exit point, 2 rescuers) - The aim is to keep the airway above water level and transport the victim to the resuscitation position to the ground. II l\l T I ^ T 11 https://wwwTesearchgate.net/profile/David_Szpilman/publication/264496018_Drowning_Chain_of_Survival/data/53e13f340 MUNI|SIMU MED Basic skills on how to rescue a drowning victim If a person falls through kc, and there H mors than one person ofi solid ground, form a cham of bodies from a secure location out to the fallen person https://www.google.com/imgres?imgurl=https%3A%2F%2Flifeguardunive rsity.com data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2w MUNI I SIMU ED Hypoxic cascade-drowning - Apnoe. Voluntary stop breathing, but later C02 increases, panic, more oxygen need. Begins involuntary breathing of water. - Aspiration and swallowing of water. An uncontrollable need to breathe. The victim inhales water into his lungs and swallows. This causes a later respiratory arrest reflexively. - Respiratory arrest. Respiratory arrest leads to hypoxia. Hypoxia leads to cardiac arrest. - Irreversible changes. Begins to irreversibly die off the brain tissue. - CAVE: Cold water-brain protection. Start CPR even after 1 hour of immersion) MUNI | SIMU MED Drowning Hypoxia Cold environment better tolerancy of hypoxia Decreased rate of metabolism Start resuscitation even after 20-60 min of submersion https://encrypted-tbn0.gstatic.com/images?q=tbn%3AANd9GcQ7YIU9KgHu5lclQckdT5awBksQWXU2ipL2Kg&usqp=CAU MUNI|SIMU MED Types of drowning Symptoms of dry drowning coughing ■ white color breathing* in face or lips DRY. Water not enter lungs. Death occurs by sustained laryngeal spasm. In 10% of cases. WET. = primary drowning. Water inhaled into lungs. In 90% of cases. This is due to hypoxic cascade and the phenomenon of terminal relaxation of the muscles of the larynx, pharynx (hypercapnia, hypoxia) SECONDARY AFTER 24-48 HOURS. Respiratory distress. Aspirated fluid interferes with the pulmonary surfactant. Causes swelling of the lungs, hypersecretion of mucus, bronchospasm. CAVE: We always think about the possibility of late complications! MUNI | SIMU data:image/jpeg;base64/9j/4AAQSkZJRgABAQAAAQABAAD/2wCEAAkGBxM Drowning- Basic life support -We pulled the drowning man out of the water and he's safely on land. 1. Victim is conscious. Sitting position.Keep coughing. Can vomit. CAVE: hypothermia and secondary drowning. 2. Victim is unconscious. - Initial assement is almost identical to the other conditions. -Follow SSSABC. - Differences. CPR start with 5 breaths, then in ratio 30:2 or in children 15:2. Check availability of AED. Before AED operation-dry victims chest! MUNI I SIMU MED CPR for drowning - specifics First the respiratory arrest, then the cardiac arrest (hypoxic arrest) The restitution of spontaneous circulation is dependent on the supply of oxygen CPR start with 5 breaths (chest is rising) During CPR 90% of the victim vomits swallowed water (hypoxic cascade) If the victim vomits (we turn it to the side for better drainage, we can use a few strong back blows between the shoulder blades on the side, then immediately back to the back and continue in CPR We always check if an AED is available. Before use dry victim. data:image/jpeg;base64,/9j/4AAQSkZJRgABAQAAAQABAAD/2w MUNI | SI ED Summary -The safety of the rescuer is an absolute priority. - Prevention is the key. - Rescue the victim from water with someone. Ideally 2 rescuers. -The victim swallows water during drowning - vomits during rescue. - Dry the victim. (AED use and prevention of hypothermia) - CPR start with 5 breaths ( chest is rising). -We always think about the possibility of late complications! (secondary drowning) -Start CPR within 1 hour of immersion. - https://www.google.com/imgres?imgurl=https%3A% 11 |\| T Q T 111 MED Learning outcomes -Student is able to describe the rescue of the drowning victim. -Student can explain the difference between dry and wet drowning. -Student knows the specifics of Basic Life Support in drowning. MUNI|SIMU MED References - https://www.redcross.org/take-a-class/lifeguarding/lifeguard-preparation/lifeguard-manual - https://www.resuscitace.cz/ke-stazeni MUNI|SIMU MED MUNI ISIMU MED Simulation Centre, Faculty of Medicine, Masaryk University 2020