Kerala State Drug Formulary.pdf

General Topics
stings should be warned to avoid further exposure. Specific antisera
are available in some countries, but not in Kerala.
Drowning
Drowning is the pathological state leading to death resulting from
the aspiration of water into the respiratory tract or due to asphyxia on
immersion. Two types of drowning have been recognized - dry drowning
and wet drowning. ln dry drowning death is due to laryngeal spasm, which
proves fatal in 20% of the subjects. This also prevents the entry of water
into the lungs.In wet drowning water enters the lungs. The consequences
differ between fresh water and sea water drowning. In fresh water drowning,
water is quickly absorbed from the lungs, leading to hemodilution and
hemolysis with release of potassium from the red blood cells. In addition to
hypoxia and ventilatory failure,hyperkalemia precipitates ventricular
arrhythmias, which may prove fatal. In salt water drowning the fluid in the
lung is hyperosmotic. It absorbs more fluid into the alveoli causing pulmonary
edema and respiratory failure.Hypernatremia follows later when the salt is
absorbed into the circulation.
Secondary Drowning or near-drowning occurs a few hours or few
days after the initial resuscitation due to the secondary changes in the
lungs such as pulmonary edema, pneumonia, pneumothorax, electrolyte
disturbances and metabolic or respiratory acidosis.
Immersion syndrome. ln this, sudden death occurs due to cardiac
arrest caused by vagal stimulation brought about by sudden immersion
into cold water.
Management
First aid:
(1) clear the airway of water and foreign bodies by putting the patient
head low and by suction
(2) institute mouth-to-mouth breathing as early as possible
(3) closed chest cardiac massage should be instituted if heart sounds
are absent and
(4) all cases must be hospitalized to prevent death from secondary
drowning.
Hospital treatment: This aims at
1) maintenance of adequate oxygenation
(2) correction of metabolic and electrolyte imbalance
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