This past Tuesday, December 7, our class was fortunate enough to be visited by an MD and ER nurse from the University of South Alabama's emergency room as a continuation of our "Trauma Week''. We began the class with a lecture about drowning and the treatment of a drowning patient in the Emergency Room. The first peak of drowning incidents according to age occurs in the age group of five and below. Different age groups often drown under different circumstances, though. Babies are most likely to drown in bathtubs. Children aged 1-4 and 5-13 are most likely to drown in swimming pools. 5-13 year old children also have a high risk of drowning in natural bodies of water as well. Teens aged 14-17 are most likely to drown in natural bodies of water. The second peak of drowning incidents according to age 15-30. This group mostly results from recreational swimming. In the United states, males, African Americans, and those with a low socioeconomic status are disproportionately affected by drowning fatalities. 90% of drowning events occur in lower class countries. Annually, 500,000 people die of drowning each year. But what is drowning? Drowning is defined as a process of experiencing respiratory impairment from submersion in liquid with clinical outcome of death or survival. There are many myths put out about drowning. For example, there is no such thing as "wet" or "dry" drowning, there is no such thing as a "near drowning", and not all drowning victims require cervical neck immobilization. There are many associated injuries with drowning including hypothermia, seizures, sudden cardiac arrest, trauma, non-cardiogenic pulmonary edema,cerebral hypoxia, and cardiac hypoxia. Immediate action to treat a drowning patient is essential. Should a patient not respond after two breaths, begin CPR ASAP. When treating a drowning patient, one must follow BAC (order of action): breathing, airway, circulation. It is strongly recommended that drowning patients should be intubated should they be unable to protect their airway or have the inability to maintain PaO2 >90%.
After this lecture on drowning, we received a quick overview on "our patient". The patient is an 18 year old female who had a seizure in the pool (found 3 minutes later)
She was unresponsive, not breathing, and had no pulse. EMS places AED, non-shockable rhythm. She was packaged and transported by EMS to ER: Downtime 12 minutes. In the ER, the process of warming the patient began quickly. The patient was given medication to stop seizures. Labs were taken to discover the patient's electrolytes and to monitor the heart. After extensive care, the patient was taken to the ICU where specialists were called.
-neurosurgery: brain swelling problems; lack of oxygen
-cardiology: did just bruise the heart(cracking the chest) and it was in arrest for a period
-general surgery: The gut without oxygen is a fickle little organ
Finally our guests showed us where to place an intubation tube by demonstrating with a camera sent down the doctors throat! The ER nurse also showed us how we may insert medications directly into the bone marrow through an Intraosseous infusion (IO). This involves drilling directly into bone. She even let us try it for ourselves on a fake bone! This experience was extremely informative, but also very entertaining!
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