Drowning:
Drowning is a cause of accidental death in children Accidental drowning may occur because children do not have adequate protective supervision. It may be defined as submersign incident leading to death within the first 24 hours.
Near-Drowning: is a submersion incident in which the individual survives for more than 24 hours, irrespective of the eventual outcome.
Causes:
These fatalities occur between the age of 1 and 4 years and during 15-17 years especially in boys. Most childhood drowning occur in fresh water, bathtubs, swimming pools, ponds, large buckets, washing machine, toilets and tanks. In adolescents drowning occurs lake and rivers.
Reaction to Submersion:
The first reaction of child is panic, frantic, struggling and an attempt to hold the breath. Latter on gasping occurs and water is swallowed, child may vomit and aspirate vomitus. Laryngospasm may occur, leading to unconsciousness.
Pathophysiology:
Pathophysiological effects occur as a consequence of hypoxemia, aspiration and failure of other organs. Death is either due to immediate asphyxia following laryngealspasm, aspiration of fluid or due to late complication. The clinical changes and complication are also influenced by the fact whether submersion occurred in fresh water or seawater.
Causes of Hypoxemia in Drowning
a) Laryngeal spasm
b) Pulmonary shunting through non-ventilated alveoli
c) Collapse of alveoli
d) Fluid in alveoli and pulmonary edema (with sea-water)
e) Decreased lung compliance (with fresh and sea-water)
f) Complications like aspiration pneumonitis, altered alveolar capillary membrane, formation of protein-rich exudates and infection.
Nursing Management
a) Emergency Care: Mouth to mouth ventilation should be started immediately. Half of the submersion victims vomit during ventilation. Oxygen should be given as soon as possible.
b) Cardiac Massage: Effective external cardiac massage 80-100 compression/minute in children and 100- 120 compression.minute in infant should be instituted if no pulse is felt. Maximum ventilatory and circulatory support should be continued Transport the victim to the hospital if required. Obtain information' about incident such as the type of water, length of submersion, time of initiation of CPR and duration of unconsciousness.