Cardiovascular complications and mortality determinants in near drowning victims: A 5-year retrospective analysis

Drowning Complicated by Hypothermia

Audience

This scenario was developed to educate emergency medicine residents on the diagnosis and management of two concurrent conditions: drowning and hypothermia.

Introduction

Patients who present after drowning may have delayed respiratory compromise without immediate radiographic pathological findings, highlighting the need for continued observation. The presentation and management of patients with hypothermia depends on multiple factors, including core temperature. Emergency physicians should be aware of hypothermia's underlying pathophysiology, associated dysrhythmias, and different warming methods.

Educational Objectives

At the conclusion of the simulation session, learners will be able to:Obtain a relevant focused history, including circumstances of drowning and/or cold exposure.Outline different clinical presentations of hypothermia, loosely correlated with core temperature readings.Discuss management of hypothermia, including passive external rewarming, active external rewarming, active internal rewarming, and extracorporeal blood rewarming.Discuss pathophysiology of drowning.Identify appropriate disposition of patients who present after drowning.Identify appropriate disposition of hypothermic patients.

Educational Methods

This session was conducted using high-fidelity simulation, followed by a debriefing session and discussion about the diagnosis, differential, and management of both drowning and hypothermia. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. In this technique, the facilitators describe something they observed in the case, outline their reasoning as a facilitator why this observation was important or why they had questions, and then ask the learners to share their frame of reference at the time. An example: "I heard someone say that both chest tubes should be placed on the left, but then another resident said 'I disagree.' No one paused to come to a consensus. I'm wondering why this wasn't explored further in real time. Tell me more." This scenario may also be run as a structured interview case.

Research Methods

Our residents were provided a survey at the completion of the debriefing session so they might rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution's simulation center's electronic feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form1 with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7.

Results

Seventeen learners filled out a feedback form. This session received a majority of 6 and 7 scores (consistently effective/very good, and extremely effective/outstanding, respectively) other than four 5 scores.

Discussion

This is a cost-effective method for reviewing hypothermia and drowning. The case may be modified for appropriate audiences, such as simplifying the case to either drowning or hypothermia. The setting of the emergency department may also be changed to reflect different available resources (academic center or freestanding emergency department), such as the absence or presence of ZOLL catheters or ability to activate an extracorporeal membrane oxygenation (ECMO) team.

Topics

Medical simulation, drowning, hypothermia, environmental emergencies, emergency medicine.

The Therapeutic Effect and the Possible Mechanism of C-Phycocyanin in Lipopolysaccharide and Seawater-Induced Acute Lung Injury

Background

Seawater drowning-induced acute lung injury (ALI) is a severe clinical condition characterized by increased alveolar-capillary permeability, excessive inflammatory response, and refractory hypoxemia. C-phycocyanin (C-PC), a biliprotein found in blue-green algae such as spirulina platensis, is widely used in the food and dietary nutritional supplement fields due to its beneficial pharmacological effects. Previous studies have revealed that C-PC has anti-inflammatory, antioxidant, and anti-apoptotic activities.

Purpose

Therefore, this study investigated the protective effect and underlying mechanisms of C-PC on lipopolysaccharide (LPS) and seawater (SW) induced ALI (SW and LPS-induced ALI).

Methods

An SW and LPS mouse model of ALI mice was established through intratracheal administration of 5mg/kg LPS and 25% SW. Different doses of C-PC (100, 200 and 400 mg/kg) were administered by intraperitoneal injection for seven days. In addition, gap junction communication in RAW264.7 and MLE-12 cells was determined following stimulation with 25% SW and 10 μg/ml LPS after treatment with C-PC (120 μg/ml). Moreover, the arterial partial pressure of oxygen, lung wet/dry weight ratios, total protein content and MPO levels in the bronchoalveolar lavage fluid (BALF), and the histopathologic and ultrastructure staining of the lung tissues were determined. The oxidative stress index, levels of the pro-inflammatory mediators, epithelial cell viability and apoptosis, and the regulatory effect of C-PC on the NF-κB/NLRP3 axis were investigated.

Results

The results showed that C-PC significantly alleviated pathological damages, suppressed oxidative stress, inflammation and apoptosis, and enhanced the viability of epithelial cells in the lung tissues. Furthermore, C-PC was shown to inhibit activation of the NF-κB/NLRP3 pathway and the formation of the NLRP3 inflammasome complex.

Conclusions

In conclusion, C-PC shows promising therapeutic value in SW and LPS-induced ALI/ARDS, providing new insight into ALI/ARDS treatment.

Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.

Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.

The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.

Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

This2020 International Consensus on Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care Science With Treatment Recommendationson basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.

Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.

The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.

Incidence Trends and Predictors of In-Hospital Mortality in Drowning in Children and Adolescents in the United States: A National Inpatient Database Analysis

We sought to examine incidence and mortality trends of drowning-related hospitalizations in children aged <20 years and to study the presence of risk factors associated with in-hospital mortality. Retrospective analysis of the 2003-2016 Health Care Cost and Utilization Project National Inpatient Sample and Kids' Inpatient Database was performed. The estimated annual incidence rate of drowning hospitalizations declined 31.5% from 2.73 to 1.87 per 100 000 population. Most drowning-related hospitalizations were seen in <5-year-old children (66.4%) and in males (65.3%), Caucasians (41.7%), and public insurance (46%). In-hospital mortality declined 46% from an estimated 290 deaths in 2003 to 156 deaths in 2016. On multivariate analysis, age <5 years, Caucasian ethnicity, uninsured status, pool/bathtub or undetermined location, arrhythmia (adjusted odds ratio [aOR] = 1.3, P = .001), acute kidney injury (aOR = 3.4, P < .001), cerebral edema (aOR = 2.8, P < .001), cardiopulmonary resuscitation (aOR = 12.1, P < .001), and invasive mechanical ventilation (aOR = 28.4, P < .001) were found to be independent predictors of mortality.