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Emergencias : Revista de La Sociedad...This narrative review discusses the evidence relevant to key aspects of drowning, which is defined by the World Health Organization as the process of respiratory... (Review)
Review
This narrative review discusses the evidence relevant to key aspects of drowning, which is defined by the World Health Organization as the process of respiratory difficulty caused by submersion/immersion in liquid. The length of time the victim is submerged is a key factor in survival and neurologic damage. Although respiratory distress and hypoxia are the main events, other complications affecting various systems and organs may develop. Drowning is one of the main causes of accidental death worldwide, yet deaths from drowning are underestimated and morbidity is unknown. Prevention is essential for reducing both mortality and morbidity, but if prevention fails, the speed of access to and the quality of prehospital and hospital care will determine the prognosis. It is therefore essential to understand the factors and mechanisms involved in these emergencies.
Topics: Age Factors; Cardiopulmonary Resuscitation; Cause of Death; Drowning; Emergencies; Female; Hospitalization; Humans; Immersion; International Classification of Diseases; Male; Prognosis; Risk Factors; Sex Factors; Survivors; Time Factors
PubMed: 31347808
DOI: No ID Found -
The New England Journal of Medicine May 2012
Review
Topics: Age Factors; Child; Drowning; Female; Humans; Intensive Care Units; Male; Near Drowning; Resuscitation; Risk Factors
PubMed: 22646632
DOI: 10.1056/NEJMra1013317 -
BMC Pediatrics Sep 2021We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as... (Review)
Review
We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.
Topics: Accidental Falls; Accidental Injuries; Accidents, Traffic; Burns; Child; Child, Preschool; Drowning; Humans; Infant; Risk Factors; Wounds and Injuries
PubMed: 34496772
DOI: 10.1186/s12887-021-02517-2 -
BMJ (Clinical Research Ed.) Dec 2018To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft.
DESIGN
Randomized controlled trial.
SETTING
Private or commercial aircraft between September 2017 and August 2018.
PARTICIPANTS
92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized.
INTERVENTION
Jumping from an aircraft (airplane or helicopter) with a parachute versus an empty backpack (unblinded).
MAIN OUTCOME MEASURES
Composite of death or major traumatic injury (defined by an Injury Severity Score over 15) upon impact with the ground measured immediately after landing.
RESULTS
Parachute use did not significantly reduce death or major injury (0% for parachute 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants mean of 9146 m for non-participants; P<0.001) and lower velocity (mean of 0 km/h mean of 800 km/h; P<0.001).
CONCLUSIONS
Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.
Topics: Accidents, Aviation; Adult; Aerospace Medicine; Aircraft; Death, Sudden; Female; Humans; Injury Severity Score; Male; Middle Aged; Protective Devices; Wit and Humor as Topic; Wounds and Injuries
PubMed: 30545967
DOI: 10.1136/bmj.k5094 -
BMJ (Clinical Research Ed.) Dec 2003To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. (Review)
Review
OBJECTIVES
To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.
DESIGN
Systematic review of randomised controlled trials.
DATA SOURCES
Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.
STUDY SELECTION
Studies showing the effects of using a parachute during free fall.
MAIN OUTCOME MEASURE
Death or major trauma, defined as an injury severity score > 15.
RESULTS
We were unable to identify any randomised controlled trials of parachute intervention.
CONCLUSIONS
As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Topics: Accidents, Aviation; Death, Sudden; Humans; Odds Ratio; Protective Devices; Publication Bias; Randomized Controlled Trials as Topic; Wit and Humor as Topic; Wounds and Injuries
PubMed: 14684649
DOI: 10.1136/bmj.327.7429.1459 -
The Medico-legal Journal Mar 2022Internationally, drowning is a leading cause of accidental death that features in many legal cases. In these cases, possible mitigations and the 'pain and suffering' in...
Internationally, drowning is a leading cause of accidental death that features in many legal cases. In these cases, possible mitigations and the 'pain and suffering' in terms of the duration and subjective experience of drowning are often pivotal in determining levels of compensation and outcome. As a result, there is a requirement to understand the stages of the drowning process, and the duration and physiological and subjective responses associated with each stage. In this short review we focus on these issues.
Topics: Drowning; Humans
PubMed: 34791956
DOI: 10.1177/00258172211053127 -
Fa Yi Xue Za Zhi Jun 2019Dead bodies found in the water are not all caused by drowning. The important task of forensic identification is to distinguish between entering the water before and... (Review)
Review
Dead bodies found in the water are not all caused by drowning. The important task of forensic identification is to distinguish between entering the water before and after death, and to clarify the cause of death. In the practice of forensic identification, drowning is generally diagnosed on the basis of comprehensive considerations such as cadaveric signs, histopathological examinations, and diatom tests, with the exclusion of other causes of death. The emergence of virtopsy techniques provides new insights for the diagnosis of drowning. This paper reviews the post-mortem imaging studies of sinus and mastoid small chambers, respiratory tracts, lung tissues, gastrointestinal tracts and blood in the corpses in recent years. The value, potential of virtopsy in the diagnosis of drowning is discussed, with the prospects of its development direction.
Topics: Cadaver; Diatoms; Drowning; Forensic Pathology; Humans; Lung
PubMed: 31282630
DOI: 10.12116/j.issn.1004-5619.2019.03.013 -
Annals of the Royal College of Surgeons... Sep 2022The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that 'fluid prescribing be given the same value as drug prescribing', yet fluid...
INTRODUCTION
The National Confidential Enquiry into Perioperative Deaths (NCEPOD) report recommended that 'fluid prescribing be given the same value as drug prescribing', yet fluid prescription is commonly delegated to junior doctors despite being a notoriously challenging topic. When antibiotics are given as an infusion they are diluted in 100ml of fluid, which is often unaccounted for when thinking about a patient's fluid requirements. This closed-loop audit aimed to assess first, intravenous (IV) fluid therapy and second, electrolyte prescribing compliance with National Institute for Health and Care Excellence (NICE) guidelines, with and without the additional fluid given with antibiotic administration.
METHODS
Two retrospective audits were performed. Total fluid and electrolyte volume received with and without antibiotic fluids was correlated with recommendations in the NICE guidelines. Between cycles 1 and 2, potassium chloride with sodium chloride and glucose (PSG) was introduced as an alternative to IV maintenance fluid, and bolusing of antibiotics was mandatory.
RESULTS
When analysing total fluid volume input per day, 10.4% and 7.45% of patients met their fluid requirement accurately in the first and second cycles, respectively. Within cycle 1, the mean total additional fluid that was given over 3 days with antibiotics was 1,572.73ml. In cycle 2, this decreased to 469.44ml when antibiotics were given as a bolus.
CONCLUSIONS
In this closed-loop audit we noted that patients receiving IV fluids and IV antibiotics received too much additional fluid when the antibiotic dilution fluid was taken into account. Additional fluid was reduced alongside the proportion of electrolyte complications when bolusing of antibiotics was introduced. We recommend that that all nurses are trained to give antibiotics as a bolus because it can help to reduce fluid-related complications.
Topics: Anti-Bacterial Agents; Drowning; Electrolytes; Fluid Therapy; Humans; Retrospective Studies
PubMed: 35639453
DOI: 10.1308/rcsann.2022.0043 -
American Family Physician Apr 2016Nearly 4,000 drowning deaths occur annually in the United States, with drowning representing the most common injury-related cause of death in children one to four years... (Review)
Review
Nearly 4,000 drowning deaths occur annually in the United States, with drowning representing the most common injury-related cause of death in children one to four years of age. Drowning is a process that runs the spectrum from brief entry of liquid into the airways with subsequent clearance and only minor temporary injury, to the prolonged presence of fluid in the lungs leading to lung dysfunction, hypoxia, neurologic and cardiac abnormalities, and death. The World Health Organization has defined drowning as "the process of experiencing respiratory impairment from submersion/immersion in liquid." Terms such as near, wet, dry, passive, active, secondary, and silent drowning should no longer be used because they are confusing and hinder proper categorization and management. The American Heart Association's Revised Utstein Drowning Form and treatment guidelines are important in guiding care, disposition, and prognosis. Prompt resuscitation at the scene after a shorter duration of submersion is associated with better outcomes. Because cardiac arrhythmias due to drowning are almost exclusively caused by hypoxia, the resuscitation order prioritizes airway and breathing before compressions. Prevention remains the best treatment. Education, swimming and water safety lessons, and proper pool fencing are the interventions with the highest level of current evidence, especially in children two to four years of age. Alcohol use during water activities dramatically increases the risk of drowning; therefore, abstinence is recommended for all participants and supervisors.
Topics: Accident Prevention; Child; Drowning; Humans; Risk; Swimming; United States
PubMed: 27035042
DOI: No ID Found -
Minerva Anestesiologica Jan 2012Approximately 500,000 deaths due to drowning are reported annually, 30,000 of which are reported in Europe. Because of the relatively low incidence of drowning victims... (Review)
Review
Approximately 500,000 deaths due to drowning are reported annually, 30,000 of which are reported in Europe. Because of the relatively low incidence of drowning victims at emergency departments, most emergency physicians do not routinely handle drowning victims. Although confusion regarding the classification and pathophysiology of drowning could be reduced by following the Utstein style consensus, the application of therapeutic modalities and, most important, the estimation of probable prognostic outcomes remain difficult for emergency physicians. This article presents an overview of the classification, pathophysiology, emergency-department treatment and prognostic outcomes of drowning accidents.
Topics: Accidents; Adult; Aging; Algorithms; Child; Drowning; Emergency Medical Services; Humans; Hypothermia; Hypoxia; Near Drowning; Prognosis; Retrospective Studies; Rewarming
PubMed: 21623341
DOI: No ID Found