It’s #traumatuesday! This series we are providing #coderedtips on how to optimise casualty management.
In recognition of World Water Day (22nd March), we are discussing the management of immersed or drowned casualties.
RESCUE
- Try to avoid vertical removal from water when rescuing a casualty due to hydrostatic squeeze from immersion. A vertical raise could significantly drop their blood pressure, leading to cardiovascular collapse/cardiac arrest.
- If spinal injuries are suspected, do NOT attempt immobilisation until the casualty has been rescued (but try to limit neck extension/flexion).
- Resuscitative efforts should be made if there was a possibility of an air pocket underwater or if a life jacket was worn (potential intermittent airway submersion), unless there are signs unequivocally associated with death.
- Patients who have been submerged <10 minutes have a high chance of good outcome. Those submerged >25 minutes are likely to have a poor outcome.
- Rescue efforts of up to 90 minutes may be appropriate for children or those submerged in icy cold water.
AIRWAY
- Give 5 INITIAL RESCUE BREATHS with high flow oxygen before commencing CPR.
- The casualty may be difficult to ventilate due to reduced lung compliance from inhaled water. Further airway support to provide high ventilation pressures may be required due to pulmonary oedema. 🚁
- Approximately 80% of drowned casualties will aspirate water into their stomach and there is a high risk of regurgitation during resuscitation efforts (especially if they have ingested alcohol/drugs). HAVE SUCTION READY.
- Large amounts of FOAM can also be common during resuscitation and efforts to remove this with suction are FUTILE. Use POSITIVE PRESSURE VENTILATION (IGEL or ideally intubation) to manage this.
HYPOTHERMIA
- This is often associated with an immersion incident and can cause extremely slow heart rates (bradycardia) requiring CPR.
- Bradycardia often responds to improved ventilation and oxygenation; however be aware that hypothermia can cause stiffness of the chest wall, making CPR and ventilations difficult.
- Prevent further heart loss by removing wet garments and using insulated blizzard blankets. Effective re-warming in the pre-hospital setting is unlikely to be achieved and a prolonged resuscitation attempt may be required.
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Reference
Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2022) Immersion and Drowning In: JRCALC clinical guidelines [app]. Version 11.23. Bridgwater: Class Publishing. Available from https://jrcalcplus.co.uk [accessed 22nd March 2023].