injuries poisoning
Drowning
Pathophysiology of Drowning
 Oxygen Desaturation is the major insult in drowning, affecting the brain, heart, and other tissues; Exposure to cold water induces systemic Hypothermia , which can be a significant problem. However, hypothermia can be protective by stimulating the mammalian diving reflex, slowing the heart rate, and constricting the peripheral arteries, shunting oxygenated blood away from the extremities and the gut to the heart and brain. Also, hypothermia decreases the oxygen needs of tissues, possibly prolonging survival and delaying the onset of hypoxic tissue damage. The diving reflex and overall clinically protective effects of cold water are usually greatest in young children. Laryngospasm often limits the volume of fluid aspirated. Distinction between freshwater and seawater drowning was once considered important due to the potential electrolyte shifts, hemolysis, and fluid compartment shifting that possibly could occur. However, studies have shown that in most patients, too little liquid is aspirated to have these effects. Aspiration can lead to Aspiration Pneumonitis and Pneumonia , sometimes with anaerobic or fungal pathogens, and Dangerous underwater breath-holding behaviors are practiced mostly by healthy young men (often good swimmers) trying to prolong their capacity to remain submerged. There are 3 described types of DUBB: Intentional hyperventilation—blowing off carbon dioxide before submerged swimming, thereby delaying central hypercarbic ventilatory responses Hypoxic training—extending capacity for underwater distance swimming or breath-holding Static apnea—breath-holding for as long as possible while submerged and motionless, including as a game In DUBBs, while submerged, hypoxia occurs first, followed by loss of consciousness (hypoxic blackout, breath-hold blackout) and then drowning. Skeletal, soft-tissue, head, and internal injuries may occur, particularly among surfers, water skiers, boaters, flood victims, and occupants of submerged vehicles. People who dive into shallow water may sustain Spinal Trauma (which may be the cause of drowning). 1.Centers for Disease Control and Prevention. Injury Prevention & Control: Leading causes of death and injury, United States, 2020. Accessed October 27, 2022. 2.Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report: Racial/Ethnic disparities in fatal unintentional drowning among persons aged≤29 years – United States 1999-2010.MMWR63:421-426, 2014. 3.Day G, Holck P, Strayer H, et al: Disproportionately higher unintentional injury mortality among Alaska Native people, 2006-2015.Int J Circumpolar Health77(1):1422671, 2018. doi: 10.1080/22423982.2017.1422671 4.Felton H, Myers J, Liu G, et al: Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities.BMJ Open5(12):e008444, 2015. doi: 10.1136/bmjopen-2015-008444 5.Sillanpää M, Shinnar S: SUDEP and other causes of mortality in childhood-onset epilepsy.Epilepsy Behav28(2):249-255, 2013. doi: 10.1016/j.yebeh.2013.04.016 6.Centers for Disease Control and Prevention. Drowning Prevention: Drowning facts. Adapted from Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed August 10, 2022. 