PRACTICAL THERAPEUTICS .10. NEAR-DROWNING

Near-drowning and drowning are major causes of neurologic injury and d eath in young persons. Most victims aspirate water, and pulmonary edem a develops in many of these cases. Prolonged submersion causes cerebra l asphyxia and adversely affects the brain within five minutes. Immedi ate ventilation and oxygenation are essential in the reversal of cereb ral anoxia. During field resuscitation, precautions should be taken to protect the cervical spine because of the possibility of injury. The Heimlich maneuver is used only after unsuccessful attempts at ventilat ion suggest foreign-body obstruction. Prehospital advanced cardiac lif e support with tracheal intubation is-indicated in patients with sever e injuries. On arrival at the hospital, ventilation with continuous po sitive airway pressure or positive end-expiratory pressure enhances pu lmonary function. Many water submersion accidents are avoidable; close supervision of infants and toddlers, installation of a fence around h ome swimming pools, and abstinence from alcohol during participation i n water sports are some practical precautions.