Drowning: Signs, Symptoms, and Diagnostic Tests (Nursing)

00:01 This is going to be a discussion of the signs and symptoms you should be aware of as a nurse in a drowning victim.

00:07 Every nurse needs to know the signs and symptoms of drowning.

00:10 So let's roll through what you can expect to see.

00:13 First of all, keep in mind your first presentation of that patient, the initial presentation, what you're going to see is based on the severity. So they could either be conscious and alert.

00:24 They might have moderate severity where they're kind of lethargic.

00:27 Or it could be a very severe case where they are unresponsive.

00:31 Now if the client is conscious and alert you would just expect mild symptoms.

00:36 They might have a cough, they might be breathing really fast, and their heart rate is beating really fast because they've just been through something really, really scary. With moderate severity, they're not as alert, maybe a little lethargic, but they can also be really anxious and agitated.

00:51 And when you listen to their lungs, you may hear abnormal breath sounds like Rales and Rhonchi. Now for severe cases, they're going to be unresponsive. They be Apnic, they are not breathing, they don't have pulses and they are cyanotic.

01:06 Now that we've looked at those three major categories, let's look at the symptoms, system by system.

01:13 We already talked about the coughing.

01:15 And you'll know that pulmonary auscultation is really important.

01:19 Make sure you're doing a very thorough exam on the front and on the back.

01:23 You're likely to hear Rales or Rhonchi decreased or even absent breath sounds. We know that patient's breaths can be really fast.

01:30 That's the Tachypnea. And the breathing might be irregular.

01:34 Now, watch for signs if they're in respiratory distress.

01:37 You'll see the retractions or the nasal flaring or the grunting.

01:41 Those are all signs that the patient is in respiratory distress and they're trying to pull in every accessory muscle, so that they can try to get the right amount of oxygen into your tissues.

01:52 So always be aware for signs of retractions, nasal flaring or grunting in any of your patients experiencing respiratory distress.

02:01 Now if they have pulmonary edema you might even see pink frothy sputum.

02:06 Okay. We just went through a long list of respiratory signs and symptoms.

02:11 So pause the video for a second.

02:13 Look away from your notes and see how many of those you can remember.

02:17 Hey. Welcome back! I hope you took the time to do that because that means you and I are studying together.

02:24 Now, we're going to take a look at cardiovascular.

02:27 Now the signs and symptoms in this are going to be fast heart rate or a slow heart rate. But don't you wonder like how can that be both.

02:35 Well, the Tachycardia means that body could respond, that's why that heart is beating fast. The bradycardia may be a very severe sign.

02:42 Depending on how much oxygen they were deprived of, their blood pressure might be low or might be high.

02:49 They could also have some Dysrhythmias, or they may come in and complete cardiac arrest. Asystole is more common than ventricular fibrillation, but they're incomplete cardiac arrest.

02:59 So the news in the cardiovascular system could be not bad to, whoah, really bad news.

03:06 So keep that in mind. Remember, it's all based on the severity of the experience. Now neurological they're going to have some altered mental status ranging from mild confusion.

03:17 If they're a little lethargic to an all out coma, this may put them at risk for seizures since their brain has been deprived of oxygen.

03:25 Now, if you see these signs posturing either to Decorticate or to Decerebrate, that is a sign of severe brain injury.

03:33 Watch their pupils. You know that's a late sign, but watch their size, how they react and if they're symmetrical, to give you an indication of what's going on in a neurological status.

03:43 But remember, pupil changes are a late sign.

03:46 And finally, there's also vomiting.

03:49 And that's usually common due to people ingesting water.

03:53 Now some other things to think of. We've talked about hyperthermia.

03:56 So their core temperature may be really low.

03:59 Their nail beds and their skin and their lips look for cyanosis.

04:03 And if they've swallowed water, you know, that thing that was probably making them throw up? They can also have a distended abdomen.

04:09 Remember, a person experiencing drowning can have mild to severe symptoms depending on the environment they were submerged.

04:15 The individual's health and the time and temperature of the submersion.

04:19 The quicker the victim can be rescued and receive treatment, the better the odds are for their survival.

04:24 I want you to be prepared to know what the possible test and procedures would be when caring for a client who's experienced drowning.

04:31 So let's start with the immediate bedside assessment.

04:34 You could do a Glasgow Coma scale, a GCS.

04:44 You might do an alert voice pain, unresponsive scale.

04:47 You're going to do neuro checks.

04:48 Get their core body temperature.

04:50 Particularly, if it was cold water.

04:52 You're going to monitor their pulse ox to see what their oxygenation is like.

04:56 And you're going to do blood glucose monitoring.

04:58 See how they're responding to all that stress.

05:00 Now anticipate that the healthcare provider could order several lab tests, right. Common ones would be arterial blood gases, because they want to assess the oxygenation and what the pH or the asset based status is of the client.

05:13 They could also do a CBC, which is a complete blood count.

05:17 That gives us a lot of information.

05:19 Electrolytes, BUN and creatinine.

05:21 We're checking in on those kidneys.

05:23 They could do cardiac enzymes if they think there's some cardiac involvement.

05:27 They might also do a coagulation profile, a toxicology screen, if it's indicated, and they think drugs or chemicals were involved, and they're going to look at lactic acid levels.

05:38 Now as far as cardiac monitoring, these patients should be monitored.

05:42 They'll be on continuous ECG monitoring.

05:44 And they'll also do a 12 lead ECG.

05:47 Now there are some other things they might use.

05:49 They might use End-tidal CO2 monitoring if the patient is intubated.

05:54 Now, this monitoring will measure the amount of carbon dioxide in the exhaled breath. So End-tidal CO2 levels will give you an indication of how well their lungs and their heart are functioning.

06:06 So, once they've made it through all this, if they can, when we get to the point of follow up, the patient may have pulmonary function tests to continue to measure and assess the lungs abilities.

06:17 They might have an EEG in case they had a seizure, or they have this persistent altered mental status, and they may even do a bronchoscopy in special cases if they think a foreign body aspiration was involved in the severe injury.