Drowning: Treatment and Pharmacologic Interventions (Nursing)

00:01 There are various treatments for clients who've experienced drowning.

00:04 Let's start from the very beginning.

00:07 The immediate interventions what you do in the victim is first found.

00:10 This is considered the resuscitation phase.

00:13 So the first thing you're going to do a very quick assessment of circulation airway and breathing. Now if they require CPR then you should initiate it and follow the current AHA guidelines.

00:24 If you suspect a trauma, they're going to need to immobilize the spine. Now when we think about monitoring guidelines, please know that they're going to decide once the patient is to the hospital, if they need to be admitted to ICU or just to the basic med search floor.

00:40 But here's something I want to really slow down and make sure you get.

00:44 You're going to need direct observation, even for patients that are asymptomatic.

00:49 Typically this is a minimum of 4 to 6 hours.

00:52 So even if that patient seems alert conscious, they're just coughing a little bit.

00:57 You still want to take them to the hospital and have them be observed for 4 to 6 hours. Now, in the immediate interventions in the resuscitated phase, what are we going to do once they get to the hospital or the ambulance personnel get there with supplemental oxygen? We're going to put it on, right.

01:13 The client's going to need supplemental oxygen with the appropriate delivery method for that patient. If they're in respiratory failure, or their Glasgow Coma Scale is less than eight, they're going to be endotracheal intubated.

01:27 Now, if they're intubated, they can be put on a mechanical ventilator.

01:30 And we're going to make sure they have PEEP, positive end expiratory pressure, for really severe cases.

01:36 If they're hypothermic we're going to do active rewarming.

01:41 Now they're in the emergency department.

01:43 They're in the hospital.

01:44 They're going to be on continuous cardiac and oxygen saturation monitoring.

01:48 We're also going to have to manage their fluids. Now, you have to be really careful with IV fluids for a drowning victim, because we don't want to make their pulmonary edema worse, if that is present.

01:58 They're going to give bronchodilators for the patient's bronchospasm, particularly when they've had water in their lungs and then antibiotics are going to be given if aspiration pneumonia is a risk or has developed.

02:10 Now when it gets really, really severe, you're going to use something like ECMO for really severe cases that are unresponsive to those other things we just talked about. Now, therapeutic hypothermia is also something that could be considered, particularly, if the client had a cardiac arrest.

02:27 If they're having seizures, you're going to make sure that you take seizure prophylaxis and manage that.

02:32 And if they're not on a ventilator, they may consider CPAP or BiPAP to support their oxygen.

02:38 Once the immediate crisis is over, there's going to be things that are done for ongoing management and monitoring.

02:44 First of all, ICP, intracranial pressure monitoring, may be done for clients who have significant neurological symptoms.

02:51 We're going to have to keep an eye on their blood sugar, so we need to do some glycemic control. Body is under tremendous stress and they may have really elevated blood sugars because of that.

03:01 Even if they aren't diabetic.

03:04 Now they may need to be sedated and have pain relief depending on what their injuries were.

03:09 We really want to make sure that we're preventing secondary complications.

03:13 Now, the secondary complications that are common with very severe cases of drowning include things like pneumonia, ARDS, or even multiorgan failure. This client's going to need some type of nutritional support, and if they can't eat, you have to look at starting enteral feeding.

03:31 Now, if it progresses up to a point where the patient should be discharged from the hospital but can't go home, they're going to need some type of rehabilitation assessment and planning.

03:41 Now, before we go on, I just want to give you some advice from my experience. When a patient is brought into the ER in an arrest or after a drowning.

03:51 Of course the family members and friends are going to want to know if this patient is going to survive. They're asking you what their prognosis is.

04:00 Be very cautious. Don't give a definitive prognosis.

04:04 The best thing to say is that we're going to do everything we can to try and help them. But don't give your opinion on what you think the prognosis is of the patient. Especially with cold water drowning clients.

04:17 Now, you want to make sure that when you're looking at how they're going to respond neurologically, what the outcome is going to be, that's going to be a lot of people coming together to assess someone who has abnormal neurological outcomes.

04:29 And finally, it is a marathon, not a sprint.

04:34 So we're going to use several assessments.

04:36 We call them serial assessments rather than just a single point determination.

04:40 One neuro check, one ICP reading.

04:43 Everything has to be taken all together so you can see what the trend is.

04:47 So while you're taking care of a client and their family who's experienced drowning, keep these factors in mind so you know what tests and procedures might be ordered and how best to interact with the family.

04:59 Now, there are certain medications that are often used with drowning clients.

05:03 Now, when you're considering The farm treatment for drowning victims.

05:07 We're going to talk about common medications that could be considered and prescribed.

05:11 First of all, bronchodilators are pretty universal.

05:15 These are going to help with the bronchospasm that come after drowning.

05:18 If they're significant inflammation they're likely to get corticosteroids.

05:23 Now this last one is kind of controversial.

05:25 We know that when they get water in their lungs it washes out that surfactant.

05:29 And it can't work. So sometimes, they will try surfactant replacement therapy. But remember it's very controversial.

05:36 And it's only used in very select cases.

05:39 Now someone is sedated and we need for analgesia.

05:42 If we have intubated patients they'll consider things like propofol and the other medications that I have listed for you there.

05:50 This is to help the patient stay calm, power down and really focus on healing. If the patient is at risk for seizures, then we're also going to give the medications that you see in the handout to try to manage those seizures. Now if the healthcare care provider suspects an infection, they're going to order antibiotics and think you'll be looking for an antibiotic that has a broad spectrum coverage.

06:13 We're doing that because they likely have a pneumonia from aspiration pneumonia, and it's typically going to include an antibiotic that covers oral anaerobes and gram negative organisms.

06:25 Now, some other medications that might be considered if the patient is not hemodynamically stable, they might try some vasoactive agents to kind of support their cardiovascular system if they're having increased intracranial pressure. They might take mannitol or hypertonic saline.

06:41 That insulin control is used for glycemic control.

06:44 We might give them stress ulcer prophylaxis if they're going to be in the hospital for an extended period of time, and if they're immobile, we're going to start them on DVT prophylaxis.

06:54 So, that wraps up some of the medications that will be considered for a patient who's experienced drowning or is in the hospital for an extended period of time.