Re: Drowning.....

[Guest guest]

Hello ,

Many questions, I will address them one at a time. But first you mention

cold water drowning but haven't specified the alternative to normothermic

drowning. So I am taking this as Œdrowning; across the board.

If you are speaking of EAV while you and the victim are in the water then

EAV (mouth to mouth and or nose) should only be attempted by those who are

proficient at water rescue. The layperson shoyld never attempt any type of

resuscitation when both the rescuer and victim are in the water. If you are

asking what should happen if the victim is pulled from the water onto your

vessel then resuscitation attempts are indicated.

Post Fasnet disaster back in the late 70¹s (I think it was or very early

80¹s) it has been the recommendations to wherever possible extricate victims

from the water in a horizontal position. Victims in the water may be

unresponsive but have a pulse, hydrostatic pressure from the water pushes

blood from the lower limbs and abdomen upward. If lifted vertically the

blood then suddenly returns from the upper bosy into the lower body and

dramatically reduces blood pressure and significantly impedes myocardial

function which may place the patient into cardiac arrest.

However it is regocgised that sometimes taking someone out of the water has

to be done vertically in emergency situations and this is unavoidable. If

this must be done ie from sea into a RIB, then ensure the victim has minimal

time in the vertical position ­ get em flat ASAP.

Which do you do ­ initial resus with potential for exhaustion or rapid ex

and then full CPR. The answer is dictated by the scenario confronting you.

In general terms it is safer for you to get yourself and the victim out of

the water first and then commence CPR effectively on dry land or a boat. I

would only attempt mouth to nose resus on a patient in the water if I am no

where near land and there is a vessel going to my aid ­ my measures would be

a compromise until I can get he patient out.

Mike

[Guest guest]

Hello ,

Many questions, I will address them one at a time. But first you mention cold

water drowning but haven't specified the alternative to normothermic drowning.

So I am taking this as `drowning; across the board.

If you are speaking of EAV while you and the victim are in the water then EAV

(mouth to mouth and or nose) should only be attempted by those who are

proficient at water rescue. The layperson shoyld never attempt any type of

resuscitation when both the rescuer and victim are in the water. If you are

asking what should happen if the victim is pulled from the water onto your

vessel then resuscitation attempts are indicated.

Post Fasnet disaster back in the late 70's (I think it was or very early 80's)

it has been the recommendations to wherever possible extricate victims from the

water in a horizontal position. Victims in the water may be unresponsive but

have a pulse, hydrostatic pressure from the water pushes blood from the lower

limbs and abdomen upward. If lifted vertically the blood then suddenly returns

from the upper bosy into the lower body and dramatically reduces blood pressure

and significantly impedes myocardial function which may place the patient into

cardiac arrest.

However it is regocgised that sometimes taking someone out of the water has to

be done vertically in emergency situations and this is unavoidable. If this must

be done ie from sea into a RIB, then ensure the victim has minimal time in the

vertical position – get em flat ASAP.

Which do you do – initial resus with potential for exhaustion or rapid ex and

then full CPR. The answer is dictated by the scenario confronting you. In

general terms it is safer for you to get yourself and the victim out of the

water first and then commence CPR effectively on dry land or a boat. I would

only attempt mouth to nose resus on a patient in the water if I am no where near

land and there is a vessel going to my aid – my measures would be a compromise

until I can get he patient out.

Mike

[Guest guest]

Further to Mikes comments, it depends how long the patient has been in the

water. If it is a short time (i.e. minutes) get them out anyway you can and then

treat them. The hydrostatic effect is only relevant for a patient who has been

in the water for some time.

As Mike points out, if a patient is lifted out of the water vertically, it can

put them straight into VF, if they have been in there for some time.

Personal safety obviously comes first: get the casualty to a safe place and then

start CPR.

Rod

Re: Drowning.....

Hello ,

Many questions, I will address them one at a time. But first you mention

Post Fasnet disaster back in the late 70¹s (I think it was or very early

80¹s) it has been the recommendations to wherever possible extricate victims

from the water in a horizontal position. Victims in the water may be

unresponsive but have a pulse,

[Guest guest]

Re drowning,

The water also has to be very cold for successful ROSC.

All previous successful cases such as the junior doctor under ice for +45 mins,

have been young, fit, and very cold (less than 5 Deg C) water.

The old chestnut of " they're not dead till they're warm and dead " only works in

such cases if there are also no predetermining factors

(i.e age, overweight, pre existing cardiac conditions etc)

In " warm " water (i.e over 5 degrees) it sometimes has to be accepted that

victims of submersion are just dead.

There are many papers to support this.

Some excellent ones from Mike Tipton.

Phil=

[Guest guest]

Hi Gents – Just to throw my 2 pence in…..

There is a difference here between a casualty with cold shock & hypothermia.

Cold shock (0 to 60 secs) is the series of physiological events within the body,

characterized by incapacitation, immediate loss of breathing control and a high

risk of sudden drowning

Falling into water below 15 degrees C, you can suffer from the loss of control

breathing – uncontrolled gasping of air. Unfortunately the physiological

effect of this, manifests itself by loss of the `gag reflex' and so an open

invitation to drown. For marine crews, the only protection is what they are

wearing. Adrenaline increase, panic, heart & BP increasing 2 / 3 +, with the

dangers of a huge cardiac event, as previously stated in posts – Patient

previous conditions considered.

If the cold immersion stage is abated, blood pooling, well before hydrostatic

squeeze, will cause swimming failure due to cooling of the muscles = will be the

cause of event, not hypothermia

Also `post rescue collapse' & `secondary drowning' need to be considered, post

event.

Having worked at sea in Alaska for extensive periods (sea temp = 0), the routine

followed by rescue by fast rescue boat, is a matter of speed to remove the

casualty, from the water, as soon as is humanly possible. Fast rescue boats I

work with, all have the luxury of a rescue cradle, which enables horizontal

rescue every time.

I have a small specific `man over board' kit which has:

• Bag Valve Mask.

• Hand held suction – Manual

• Nasopharyngeal x4 Sizes

• Guedel Airways x6 Sizes

• Major Trauma dressing

• Cellular blanket – Waterproofed one side

• Survival blanket – Disliked by many BUT will protect from wind

T

his is all that is taken in the rescue boat by the locally trained boat crew.

I re-iterate and drill coxswains, endlessly in the necessarily of the speed of

the rescue with

Manhandling as gently as possible, horizontally lift out of the water and head

to the stern of rescue boats, to minimize shock – Suction, Guedal & BVM if

possible – I do not advocate ECC in the boat as it is practically impossible.

Total trauma survey, once inboard with sufficient capability and resources to

maintain AV, cardiac interventions, good suction etc….. In conjunction with

re-warming regimes.

Water temperature is important, with time period spent in the water, protection

worn by the casualty and their previous medical history, if known.

Having witted on about cold water, proven hypothermia, characteristically a slow

on set, should be given the warm & dead approach, with ECC only started, once it

can be maintain properly (inboard).

However, we should remember Hypothermia is a reversible cause in the management

of cardiac arrest and so should be treated as per ALS algorithms and not become

a confusing issue in such management.

Marti Hagues & #9786;

>

> Re drowning,

>

> The water also has to be very cold for successful ROSC.

> All previous successful cases such as the junior doctor under ice for +45

mins, have been young, fit, and very cold (less than 5 Deg C) water.

> The old chestnut of " they're not dead till they're warm and dead " only works

in such cases if there are also no predetermining factors

> (i.e age, overweight, pre existing cardiac conditions etc)

>

> In " warm " water (i.e over 5 degrees) it sometimes has to be accepted that

victims of submersion are just dead.

>

> There are many papers to support this.

> Some excellent ones from Mike Tipton.

>

> Phil=

>

[Guest guest]

Hi Marti,

A question I have wanted to ask someone working in such extremely cold climates

for a long time but never had the opportunity...

I heard that the Norwegian experience of such patients is to place them in a

warm (rather than hot) ambulance once ashore.

I have been told that if you place a patient into a hot ambulance it heats them

up way too fast and although there is very impressive results in the short term

as the extremities of the body starts to rewarm there is a potential of

`down-drop' after this initial stage. The core blood prematurely circulates to

the extremities and becoming dangerously cool – returning to the heart and

placing the patient into a VF arrest.

Have you heard similar or have I been told a load of hog wash?

Mike

> >

> > Re drowning,

> >

> > The water also has to be very cold for successful ROSC.

> > All previous successful cases such as the junior doctor under ice for +45

mins, have been young, fit, and very cold (less than 5 Deg C) water.

> > The old chestnut of " they're not dead till they're warm and dead " only

works in such cases if there are also no predetermining factors

> > (i.e age, overweight, pre existing cardiac conditions etc)

> >

> > In " warm " water (i.e over 5 degrees) it sometimes has to be accepted that

victims of submersion are just dead.

> >

> > There are many papers to support this.

> > Some excellent ones from Mike Tipton.

> >

> > Phil=

> >

>

[Guest guest]

Hey Mike,

As stated before, in such extreme temperatures, it is vitally important to get

victims out of the water ASAP - From then on, manhandling should be extremely

careful & slowly, slowly, slowly re-warming.

Warm room, yes. Hot no.

I cannot quote any specific reference but can see the obvious dangers of fast

warming for unconscious casualties.

I would totally agree that fast warming is potentially lethal.

Body in warm blankets, (armpit and groin areas) " warm to the wrist " temps -

105-108 degrees F, Heating pads or electric blankets can be used on low...As

soon as the body temperature has returned to 100 degrees (F) the heating element

should be turned off to prevent overheating. (All controlled environment stuff

with the luxury of a Vessel clinic)

The " core " temperature may be the only thing keeping any cardiac output, so to

draw that lifesaving warmth to extremities through instant vasodilatation =

Madness.

Thankfully I have not had Hypothermic victims in extreme environments, although

many in temperate Europe, so I have not had direct experience of dragging bodies

out of frozen lakes ! I have had a few in the water in the Arctic, but

thankfully, the persons in these instances have had full PPE with self righting

lifejackets and the knowledge not to panic, not to swim and adopt help position

until plunked out of the Seas.

I am sure Mr Steve Sharpe can spin you a few dits about 'Ice Breaking' drills

through rivers & lakes in Norway - Never effected him ??????? Much ?

Marti H

> > >

> > > Re drowning,

> > >

> > > The water also has to be very cold for successful ROSC.

> > > All previous successful cases such as the junior doctor under ice for +45

mins, have been young, fit, and very cold (less than 5 Deg C) water.

> > > The old chestnut of " they're not dead till they're warm and dead " only

works in such cases if there are also no predetermining factors

> > > (i.e age, overweight, pre existing cardiac conditions etc)

> > >

> > > In " warm " water (i.e over 5 degrees) it sometimes has to be accepted that

victims of submersion are just dead.

> > >

> > > There are many papers to support this.

> > > Some excellent ones from Mike Tipton.

> > >

> > > Phil=

> > >

> >

>

[Guest guest]

Marti,

Cold shock is indeed the major medical problem with sudden immersion, however,

you have missed the forest for the trees. The cause of death is not " Adrenaline

increase, panic, heart & BP increasing 2 / 3 + " .

Physiologically, these patients have respiratory alkalosis that results from

hyperventillation.

If possible, measure blood pH, and ventilate appropriately. In the absence of

pH measurements, it is usually prudent to increase the inspiratory:expiratory

ratio to 1:3 or 1:4.

Like severe asthma and cardiac arrest, this is a situation in which

overly-enthusiastic bagging will harm your patient.

Tyler

> > > >

> > > > Re drowning,

> > > >

> > > > The water also has to be very cold for successful ROSC.

> > > > All previous successful cases such as the junior doctor under ice for

+45 mins, have been young, fit, and very cold (less than 5 Deg C) water.

> > > > The old chestnut of " they're not dead till they're warm and dead " only

works in such cases if there are also no predetermining factors

> > > > (i.e age, overweight, pre existing cardiac conditions etc)

> > > >

> > > > In " warm " water (i.e over 5 degrees) it sometimes has to be accepted

that victims of submersion are just dead.

> > > >

> > > > There are many papers to support this.

> > > > Some excellent ones from Mike Tipton.

> > > >

> > > > Phil=

> > > >

> > >

> >

>

[Guest guest]

I have had no experience in handling a drowning person, but reading through all

the correspondence where the danger of vertically lifting the patient out of the

water was repeatedly highlighted, but considering that probably that would be

the easiest and quickest route - have there been studies about lifting

vertically but keeping head lowered and then positioning horizontally in the

rescue craft? I probably look foolish asking this, but it seems to me, this

might be a reasonable method, especially if the person has been in the water for

a while.

Thanks for all the feedback,

Kishore.   

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