CURRENT Essentials of Critical Care.pdf

Chapter 17 Environmental Injuries 253■■■Near DrowningEssentials of Diagnosis• Fresh water near-drowning associated with hypervolemia, hypotonicity,dilution of serum electrolytes, intravascular hemolysis• Saltwater near-drowning may have hypovolemia, hypertonicity,hemoconcentration• Both with hypoxemia, metabolic acidosis, hypothermia; acuterespiratory distress syndrome in 50%; cardiac arrhythmias dueto hypoxia, acidosis, electrolyte abnormalities• Renal failure, disseminated intravascular coagulation, rhabdomyolysismay occurDifferential Diagnosis• In SCUBA divers, consider arterial air embolism syndrome, pulmonarybarotrauma (pneumothorax)Treatment• Early intubation and mechanical ventilation• Aggressive volume resuscitation for hypotension• Correct electrolyte abnormalities• Supportive care for complications such as renal failure, rhabdomyolysis,disseminated intravascular coagulation, hypothermia,aspiration pneumonia■ PearlIntoxication with alcohol or drugs is a factor in more than half of neardrowning cases.ReferenceBierens JJ et al: Drowning. Curr Opin Crit Care 2002;8:578. [PMID: 12454545]