208 Environmental Emergencies
Sports-Diving Accidents
(ii) Sudden preceding illness, such as a myocardial infarction,
cerebrovascular accident or epileptic seizure that may have led to
the drowning.
(iii) Alcohol or drug use (a contributing factor in up to 70% of
drownings).
(iv) Hypothermia.
5 Check FBC, U&Es, blood sugar and ABGs. Attach a cardiac monitor and
pulse oximeter to the patient.
6 Perform an ECG and request a CXR.MANAGEMENT1 Record the rectal temperature and re-warm the patient if the core tempera-
ture is low.
2 Commence cardiopulmonary resuscitation if the patient has no detectable
cardiac output or is not breat hing.
(i) Be careful to control the cervical spine if a neck injury is suspected.
(ii) Insert a nasogastric tube early to decompress the stomach.
Gastric regurgitation is common in up to 85% of patients
requiring basic life support.
(iii) Continue prolonged resuscitation efforts, which may be
successful particularly with drowning in cold water associated
with sudden hypothermia.
3 Otherwise, give high-f low oxygen and aim for an oxygen saturation above
94%.
4 Call an airway-skilled doctor to intubate the patient if unconscious or he or
she develops respiratory failure with a PaO 2 of <75 mmHg (10 kPa) on 50%
oxygen, or a rising PaCO 2 >56 mmHg (7.5 k Pa).
5 Refer all patients to the medical team or ICU for admission.
(i) Delayed adult respiratory distress syndrome (ARDS) may
develop 6–72 h after submersion, previously referred to as
‘secondary drowning’.
(ii) Initiate cerebral protection measures in the comatose patient.
Prevent and treat hypoglycaemia, hypotension, seizures and
intracranial hypertension. Maintain normocarbia.SPORTS-DIVING ACCIDENTS
Dysbarism is the medical complication of exposure to gases at higher than
normal atmospheric pressure. It manifests clinically as decompression illness
(DCI), which may be further classified by the acuity, evolution, presence or
absence of barotrauma and the organs involved.