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Chapter 25 — 5
TREATMENT
Rescue and recovery from the
water is the top priority and
time should be spent in the
diving course in this training.
Success is reliant on buddy
behaviour, acquiring positive
buoyancy during ascent and on
the surface (including ditching
of weights) and attracting
attention.
Treatment at the scene of an
accident will often determine
whether the victim lives or dies.
The standard of first aid and
resuscitation training of the
rescuers therefore influences
outcome.
The temperature of the water
and thus the degree of
hypothermia may also be a
factor. Poorer results are
achieved in warm bath water
drownings. Other factors which
influence outcomes include: the
presence of chlorine and other chemicals
and foreign bodies, the aspiration of stomach contents, the subsequent
development of pneumonitis, respiratory infection and lung damage,
haemolysis, renal failure and coagulopathies. These complications are for the
intensive care physicians to cope with.
In exceptional circumstance, near drowned victims have fully recovered after
periods of total immersion of over 15-45 minutes (especially so in children in
cold waters), so it is worth attempting resuscitation even in apparently
hopeless cases.
If the patient is unconscious the basic life support (
BSL
) priciples take precedence and should be
followed (see Chapter 42).
Oxygen
in the highest concentration available should be given by mask
to offset hypoxia. Masseter spasm (“jaw clenching”) is a common feature of hypoxia, and may
obstruct artificial respiration.
Near drowned cases are liable to deteriorate many hours after making an apparent recovery, so all
near drowned victims should be taken to
hospital
and must remain there for at least 24 hours under
observation.
Fig. 25.2