NEAR-DROWNING group 6[1]

NEAR-DROWNING
NUR 323
GROUP 6
OBJECTIVES.
 Define near-drowning and distinguish it from drowning.
 Types of near-drowning
 Describe the risk factors and causes of near-drowning.
 Recognize the signs and symptoms of near-drowning.
 Pathophysiology of near drowning
 Understand the immediate actions to take in a near-drowning situation, including basic
life support (CPR) and rescue techniques.
 Explain the importance of early medical intervention for near-drowning victims.
 Identify long-term complications that may arise from near-drowning.
 Discuss prevention strategies to reduce the risk of near-drowning, such as swimming
lessons, adult supervision, and pool safety measures.
 Develop an understanding of the psychological impact of near-drowning on survivors
and their families.
DEFINITION.
Near-drowning is a life-threatening event where a person survives
a submersion or immersion in liquid, typically water, that causes
breathing difficulties.
It's crucial to understand that near-drowning can occur in any body
of water, from bathtubs to oceans, and even in as little as an inch of
water for small children.
The process can happen rapidly, with brain damage potentially
occurring within minutes of oxygen deprivation.
CAUSES:
 Accidental Falls: Slipping or falling into pools, bodies of water, or
other water sources.
 Diving Accidents: Striking the bottom or other objects underwater.
 Boating Accidents: Falling overboard or being ejected from a boat.
 Swimming in Unsafe Areas: Entering water in areas with strong
currents, poor visibility, or other hazards.
•Intentional Self-Harm or Homicide: Deliberate acts of submersion
or immersion.
• Leaving babies unattended, even for a short period of time
falling through thin ice.
•Alcohol consumption while swimming.
•Concussion, seizure, or heart attack while in water.
.
TYPES OF NEAR-DROWNING
 Wet Drowning: This is the most common type, where water enters
the lungs and impairs breathing.
 Dr y Drowning: In this case, the vocal cords spasm and close, preventingair
from
entering the lungs.
 Secondary Drowning: This occurs hours or even days after a near-
drowning incident,
wherefluid in the lungs causes delayed respiratory distress.
 Immersion Syndrome: Death occurs by cardiac arrest caused by vagal
inhibition (cold water stimulating nerve endings & water striking
epigastrium & alcohol
induce such effect)
• Mostly seen in suicide cases.
RISK FACTORS.
 Age: Young children and older adults are more susceptible.
 Alcohol and Drug Use: Impairs judgment and coordination, increasing the
risk of accidents.
 Lack of Swimming Skills: Those who are not proficient swimmers are at
higher risk.
 Medical Conditions: Certain medical conditions like seizures, heart
conditions, or hypothermia can increase vulnerability.
 Environmental Factors: Strong currents, cold water temperatures, and
hazardous water bodies can contribute to near-drowning incidents.
SIGNS AND SYMPTOMS OF
NEAR-DROWNING
Immediate Signs and Symptoms:
• Unresponsiveness: The person is not responding to stimuli.
• Difficulty Breathing: Shortness of breath, gasping, or coughing.
• Coughing Up Water or Blood: This may indicate fluid in the lungs.
• Confusion: The person may be disoriented or unable to communicate
clearly.
• Fatigue: Extreme tiredness or weakness.
Seizures: Uncontrolled muscle contractions
• Cold or bluish skin
• Abdominal swelling
• Chest pain
• Vomiting
Delayed Signs and Symptoms:
 Respiratory Problems: Pneumonia, pulmonary edema, or acute
respiratory distress syndrome.
 Neurological Issues: Brain damage, memory loss, or behavioral
changes.
 Cardiac Complications: Heart arrhythmias or heart failure.
Secondary drowning, a less common but serious condition, can occur

hours or even days after a near-drowning incident, where fluid in the
lungs causes delayed respiratory distress, manifesting as symptoms like
coughing, difficulty breathing, and fatigue .
PATHOPHYSIOLOGY OF NEAR-DROWNING
CONTD
1. Involuntary submersion• Voluntary apnea, hypoxia, hypercarbia.
2. Involuntary inspiration• Triggered by hypercarbia and hypoxia•
arterial hypoxemia, tissue hypoxia, tissue acidosis, am tachycardia.
3. Water enters lungs :Increased peripheral airway resistance,
pulmonary vessel vasoconstriction/hypertension, decreased lung
compliance, decreased surfactant.
4. Decompensation-gasping with further inhalation-swallowing with
emesis-loss of consciousness.
5. Neuronal dysfunction-blood brain barrier breaks down.
6. Cardiac dysfunction-bradycardia, arrhythmias, asystole.
7. Brain Death.
IMMEDIATE RESPONSE TO NEAR-
DROWNING.
When faced with a near-drowning situation, every second
counts. Swift and decisive action can save a life. The first
priority is to safely remove the person from the water
without endangering yourself. Once on land:
 Checking for responsiveness and breathing.
 Initiating CPR if necessary.
 Calling emergency services.
IN AN INCEDENCE OF
NEAR-DROWNING;
ARRIVAL AT THE HOSPITAL.
Upon arrival at the hospital, a comprehensive assessment of the near-
drowning victim is initiated. This evaluation involves assessing their
general appearance, respiratory effort, and circulatory status. A
detailed primary assessment is then conducted, focusing on ensuring a
clear airway, effective breathing, adequate circulation, and identifying
any neurological deficits. Finally, the patient is undressed to allow for
a thorough physical examination and treatment.
General Assessment:
•Appearance
• Work of Breathing
• Circulation
Primary Assessment:
• Airway
• Breathing
• Circulation
MANAGEMENT AT THE HOSPITAL.
Resuscitation should continue, with endotracheal intubation, adequate
oxygenation and adequate ventilation. CPR should continue if required.
Any patient who has a history of apnoea, cyanosis or has respiratory
changes should be observed for 24 h in hospital as late onset pulmonary
oedema and cerebral oedema, can occur.
In the hospital, management of near drowning focuses on:
1.Respiratory support
Immediate respiratory support is important, and includes:
 Oxygen: High flow oxygen is provided to maintain oxygen
saturation between 92% and 96% .
 Non-invasive ventilation: CPAP can improve oxygenation.
 Endotracheal intubation: If the patient has reduced LOC or
hypoxia, they may need endotracheal intubation.
CONTD
2.Airway management : Evaluate for associated injuries, especially
cervical spine injury, which can complicate airway management.
3.Cardiac support : Cardiac support may be needed, and advanced
cardiac life support (ACLS) protocol may be followed if needed.
4.Fluid infusion : Crystalloids and sometimes vasopressors may be
needed for refractory hypotension.
5.Temperature stabilization : If the core temperature is less than
34°C, active warming to normothermia should occur.
6.Neurologic assessments: Frequent neurologic assessments should
occur, using the Glasgow Coma Scale.
7.Outpatient follow up: Outpatient follow up with a chest
radiography after two weeks is advisable for all patients who have
been immersed in water.
COMPLICATIONS THAT MAY ARISE FROM NEAR-
DROWNING.
Even if a person survives a near-drowning incident, they may experience long-term health
complications. These can significantly impact their quality of life.
1. Neurological Impairments:
o Brain damage can lead to cognitive difficulties such as memory loss, difficulty
concentrating, and learning disabilities.
o Motor impairments, including weakness, paralysis, or loss of coordination.
2. Respiratory Problems:
o Chronic lung conditions like pulmonary fibrosis or chronic obstructive pulmonary
disease (COPD).
o Recurrent respiratory infections.
3. Psychological Issues:
o Post-traumatic stress disorder (PTSD.
CONTD
Other Potential Complications:
o Kidney damage
o Heart problems
o Seizures
The severity of these complications can vary widely and depends on several factors,
including:
 Duration of submersion: The longer the person is submerged, the greater the risk of
brain damage.
 Water temperature: Cold water can lead to hypothermia, which can further
complicate recovery.
 Promptness of medical intervention: Early medical care can significantly improve
outcomes.
PREVENTION STRATEGIES TO REDUCE
THE RISK OF NEAR-DROWNING AND
RESPONSE.
 Swimming Lessons: Teach children and adults basic water safety skills.
 Adult Supervision: Always supervise children around water.
 Life Jackets: Wear life jackets when boating or participating in water sports.
 Pool Safety: Install barriers, alarms, and safety covers for pools.
 CPR and First Aid Training: Learn how to perform CPR and first aid in case of
emergency.
 Emergency Response: If you witness a near-drowning incident, call emergency
services immediately and begin CPR if necessary.
 Avoid Alcohol and Drugs: Alcohol and drug use can impair judgment and
coordination, increasing the risk of accidents.
REFERENCES
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Secondary drowning, a less common but serious condition, can occur

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