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1.
J Int Med Res ; 52(3): 3000605241233516, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38497129

RESUMO

Drowning is a common cause of childhood morbidity and mortality worldwide. Anoxia, hypothermia, and metabolic acidosis are mainly responsible for this morbidity. Drowning may lead to multiple organ damage, especially cardiac damage, in cases in which severe hypothermia and hypoxemia occur. We report a case of a 4-year-old girl who was admitted to our hospital's Emergency Department because of drowning. She had elevated troponin I concentrations and ST-segment elevation with T wave inversion. However, cardiovascular computed tomography showed no obvious abnormalities in the coronary arteries. We suggest that cardiac damage in this situation is caused by coronary artery spasms. To the best of our knowledge, this is the first case of cardiac damage with electrocardiographic changes after drowning in a preschool child.


Assuntos
Afogamento , Hipotermia , Infarto do Miocárdio , Afogamento Iminente , Feminino , Humanos , Pré-Escolar , Afogamento Iminente/complicações , Hipotermia/complicações , Eletrocardiografia/métodos , Infarto do Miocárdio/etiologia , Hipóxia/complicações , Arritmias Cardíacas
2.
BMC Infect Dis ; 24(1): 342, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38515075

RESUMO

Scedosporium apiospermum species complex are widely distributed fungi that can be found in a variety of polluted environments, including soil, sewage, and decaying vegetation. Those opportunistic pathogens with strong potential of invasion commonly affect immunosuppressed populations However, few cases of scedosporiosis are reported in immunocompetent individuals, who might be misdiagnosed, leading to a high mortality rate. Here, we reported an immunocompetent case of systemtic infection involved in lung, brain and spine, caused by S. apiospermum species complex (S. apiospermum and S. boydii). The patient was an elderly male with persistent fever and systemtic infection after near-drowning. In the two tertiary hospitals he visited, definite diagnosis was extremely difficult. After being admitted to our hospital, he was misdiagnosed as tuberculosis infection, before diagnosis of S. apiospermum species complex infection by the metagenomic next-generation sequencing. His symptoms were alleviated after voriconazole treatment. In the present case, the details associated with its course were reported and published studies on Scedosporium spp. infection were also reviewed, for a better understanding of this disease and reducing the misdiagnosis rate.


Assuntos
Infecções Fúngicas Invasivas , Afogamento Iminente , Scedosporium , Humanos , Masculino , Idoso , Antifúngicos/uso terapêutico , Voriconazol/uso terapêutico , Pulmão/diagnóstico por imagem , Encéfalo/diagnóstico por imagem
3.
Mycoses ; 67(2): e13703, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38345265

RESUMO

Scedosporium/Lomentospora species exist as saprophytic moulds that can potentially lead to serious infections in patients who have experienced near-drowning incidents. Scedosporium species are distributed across different regions of the world while Lomentospora prolificans has quite a restricted geographic distribution. We aimed to systematically review scedosporiosis cases after near-drowning, their clinical manifestations, underlying diseases, treatments, outcomes and its impact through disability-adjusted life years (DALYs). Five available sources were searched from 1 January 2007, to 20 April 2022. Thirty-eight studies, including 41 patients, were evaluated. Mean age was 33.6 ± 18.6 years (range 1-68), and 28 were male (68.3%). Central nervous system (CNS) dissemination predominated (36/41; 87.8%), presenting mainly as multiple brain abscesses (26/41; 63.4%), followed by lung involvement (22/41; 56.4%). Scedosporium apiospermum species complex was the most causative agent (38/41; 92.7%). Overall mortality was 51.2%. Half of the patients (18/37) were cured after receiving proper treatment, and in most cases, voriconazole alone or in combination with surgery or other antifungals caused survival. The mean survival time was 123 ± 27 days. Mean DALYs in 1980-2022 were 46.110 ± 3.318 (39.607-52.612). Time to diagnosis was estimated to be 120 days, and there was no association between time to diagnosis and outcome. Voriconazole is a potentially effective therapy, and combination of surgery and antifungal treatment may lead to more favourable outcome. Advances in early diagnosis and appropriate antifungal therapy may have contributed to reducing its mortality.


Assuntos
Ascomicetos , Infecções Fúngicas Invasivas , Afogamento Iminente , Scedosporium , Humanos , Masculino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Antifúngicos/uso terapêutico , Voriconazol/uso terapêutico , Anos de Vida Ajustados pela Incapacidade
4.
J Spec Pediatr Nurs ; 29(1): e12418, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38047543

RESUMO

PURPOSE: Management of children following a drowning incident is based on specific interventions which are used in the prehospital environment, the emergency department (ED) and the Paediatric Intensive Care Unit (PICU). This paper presents a review of the literature to map and describe the management and interventions used by healthcare professionals when managing a child following a drowning incident. Of specific interest was to map, synthesise and describe the management and interventions according to the different clinical domains or practice areas of healthcare professionals. DESIGN AND METHODS: A traditional review of the literature was performed to appraise, map and describe information from 32 relevant articles. Four electronic databases were searched using search strings and the Boolean operators AND as well as OR. The included articles were all published in English between 2010 and 2022, as it comprised a timeline including current guidelines and practices necessary to describe management and interventions. RESULTS: Concepts and phrases from the literature were used as headings to form a picture or overview of the interventions used for managing a child following a drowning incident. Information extracted from the literature was mapped under management and interventions for prehospital, the ED and the PICU and a figure was constructed to display the findings. It was evident from the literature that management and interventions are well researched, evidence-informed and discussed, but no clear arguments or examples could be found to link the interventions for integrated management from the scene of drowning through to the PICU. Cooling and/or rewarming techniques and approaches and termination of resuscitation were found to be discussed as interventions, but no evidence of integration from prehospital to the ED and beyond was found. The review also highlighted the absence of parental involvement in the management of children following a drowning incident. PRACTICE IMPLICATIONS: Mapping the literature enables visualisation of management and interventions used for children following a drowning incident. Integration of these interventions can collaboratively be done by involving the healthcare practitioners to form a link or chain for integrated management from the scene of drowning through to the PICU.


Assuntos
Afogamento , Afogamento Iminente , Criança , Humanos , Afogamento Iminente/terapia , Estudos Retrospectivos , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva Pediátrica
5.
Emerg Infect Dis ; 29(11): 2406-2408, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37877682

RESUMO

Scedosporium aurianticum infection developed in 2 recipients of kidney transplants in India, acquired from the same deceased near-drowning donor. Given the substantial risk for death associated with Scedosporium infection among solid-organ transplant recipients, safety protocols for organ transplantation from nearly drowned donors should be thoroughly revaluated and refined.


Assuntos
Transplante de Rim , Afogamento Iminente , Transplante de Órgãos , Humanos , Transplante de Rim/efeitos adversos , Doadores de Tecidos
6.
Future Microbiol ; 18: 933-938, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37650709

RESUMO

Invasive pulmonary aspergillosis (IPA) is uncommon in immunocompetent patients, but rare cases have been described after nonfatal drowning, particularly in contaminated water sources. Given subacute disease manifestations, diagnostic difficulties and the rapidly progressive nature of this organism, its mortality rate approaches 50%. Clinicians must rely on nonculture-based biomarkers and imaging to inform early diagnosis. There are currently no recommendations regarding diagnostics or empiric therapy for mold infections in near-drowning patients. We report a fatal case of IPA in a 4-year-old male following submersion in a manure pond. Early serum biomarkers and empiric voriconazole should be strongly considered in all patients after near-drowning in contaminated water sources.


Children that survive drowning can suffer lung infections after inhaling water. The cause is usually bacteria (germs) that live in our nose, as well as the bacteria in the water itself. In dirty water, many different bacteria are present. Strong antibiotic medicines are usually given to treat or stop infections from happening after drowning. Molds (fungus germs) can also cause lung infections, but usually in people with weak infection-fighting ability. We report a case of a mold infection that spread from the lungs to the blood and brain which led to the death of a previously healthy boy after drowning in a pond of animal waste. These mold infections can be slow and then spread quickly, so testing and treating for it with antifungal medicine in addition to antibacterial medicine needs to be done as early as possible.


Assuntos
Aspergilose Pulmonar Invasiva , Afogamento Iminente , Masculino , Humanos , Pré-Escolar , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Esterco , Afogamento Iminente/terapia , Lagoas , Imersão , Biomarcadores , Água , Antifúngicos/uso terapêutico
7.
Pediatr Emerg Care ; 39(7): 516-523, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37335544

RESUMO

BACKGROUND: Drowning is a serious and underestimated public health problem, with the highest morbidity and mortality reported among children. Data regarding pediatric outcomes of drowning are often inadequate, and data collection is poorly standardized among centers. This study aims to provide an overview of a drowning pediatric population in pediatric emergency department, focusing on its main characteristics and management and evaluating prognostic factors. METHODS: This is a retrospective multicenter study involving eight Italian Pediatric Emergency Departments. Data about patients between 0 to 16 years of age who drowned between 2006 and 2021 were collected and analyzed according to the Utstein-style guidelines for drowning. RESULTS: One hundred thirty-five patients (60.9% males, median age at the event 5; interquartile range, 3-10) were recruited and only those with known outcome were retained for the analysis (133). Nearly 10% had a preexisting medical conditions with epilepsy being the most common comorbidity. One third were hospitalized in the intensive care unit (ICU) and younger males had a higher rate of ICU admission than female peers. Thirty-five patients (26.3%) were hospitalized in a medical ward while 19 (14.3%) were discharged from the emergency department and 11 (8.3%) were discharged after a brief medical observation less than 24 hours. Six patients died (4.5%). Medium stay in the ED was approximately 40 hours. No difference in terms of ICU admission was found between cardiopulmonary resuscitation performed by bystanders or trained medical personnel ( P = 0.388 vs 0.390). CONCLUSIONS: This study offers several perspectives on ED victims who drowned. One of the major finding is that no difference in outcomes was seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services, highlighting the importance of a prompt intervention.


Assuntos
Reanimação Cardiopulmonar , Afogamento , Afogamento Iminente , Masculino , Criança , Humanos , Feminino , Afogamento/epidemiologia , Estudos Retrospectivos , Hospitalização , Alta do Paciente , Afogamento Iminente/epidemiologia , Afogamento Iminente/terapia
8.
J Trop Pediatr ; 69(3)2023 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-37019086

RESUMO

BACKGROUND: Drowning is the leading cause of death for children under the age of 15 years in Guangdong Province, China. This serious public health issue also exists in low- and middle-income countries (LMICs), which have few value-integrated intervention programs. The current study presents an integrated intervention project that aims to explore an effective pattern of prevention for child drowning in rural areas and feasibility to perform in other LMICs. METHODS: We conducted a cluster randomized controlled trial by comparing the incidence of non-fatal drowning among children in two groups in rural areas of southern China. We recruited the participants in two phases and reached a total of 10 687 students from 23 schools at two towns in Guangdong Province, China. At the first and second phases, 8966 and 1721 students were recruited, respectively. RESULTS: The final evaluation questionnaires were collected after 18 months of integrated intervention, where we obtained 9791 data from Grades 3-9. The incidence of non-fatal drowning between the intervention and control groups after intervention did not differ significantly from the baseline according to the total number of students, male students, female students and Grades 6-9 [0.81; 95% confidence interval (CI): [0.66, 1.00]; p = 0.05, 1.17; 95% CI: [0.90, 1.51]; p = 0.25, 1.40; 95% CI: [0.97, 2.02]; p = 0.07 and 0.97; 95% CI: [0.70, 1.34]; p = 0.86], except for Grades 3-5 (1.36; 95% CI: [1.02, 1.82]; p = 0.037). The study observed a significantly positive benefit of awareness and risk behaviours of non-fatal drowning between the intervention and control groups (0.27, 95% CI: [0.21, 0.33]; p = 0.00, -0.16; 95% CI: [-0.24, -0.08]; p = 0.00). CONCLUSIONS: The integrated intervention exerted a significant impact on the prevention and management of child non-fatal drowning, especially in rural areas.


Assuntos
Afogamento Iminente , Prática de Saúde Pública , Adolescente , Criança , Feminino , Humanos , Masculino , China/epidemiologia , Afogamento/prevenção & controle , Saúde Pública/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , População Rural/estatística & dados numéricos , Estudos de Viabilidade , Prática de Saúde Pública/estatística & dados numéricos , Afogamento Iminente/prevenção & controle
11.
Mil Med ; 188(11-12): e3703-e3706, 2023 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36461682

RESUMO

Iatrogenic calcinosis cutis represents a subset of calcinosis cutis resulting secondary to treatments or procedures. We present the first report of calcinosis cutis resulting from the intraosseous infusion and one of a few cases with associated transepidermal elimination. A previously healthy 2-year-old female presented with a new-onset unilateral shin rash 1 week following hospitalization for a near-drowning event. A dermatologic exam revealed multiple small, tender, firm, chalky-white papules with surrounding erythema, in addition to two erythematous macules superior and medial to the papular lesions, corresponding to prior intraosseous access sites. The rash persisted despite trials of topical mupirocin and acyclovir cream, prompting a referral to a dermatologist. An excisional biopsy was performed, revealing circumscribed dermal deposits of acellular basophilic material connected to the overlying epidermis through an invaginated keratin plug. A von Kossa silver stain highlighted the deposits, confirming the diagnosis of perforating calcinosis cutis. The lesions did not recur following the excisional biopsy. Iatrogenic calcinosis cutis may be seen as a complication of the infusion of calcium-containing fluids via intraosseous access, in addition to the more commonly observed peripheral intravenous access. Awareness of this disorder is important in order to distinguish it from an infectious mimic and guide the selection of therapy.


Assuntos
Calcinose Cutânea , Calcinose , Exantema , Afogamento Iminente , Dermatopatias , Feminino , Humanos , Pré-Escolar , Calcinose/etiologia , Calcinose/tratamento farmacológico , Calcinose/patologia , Infusões Intraósseas/efeitos adversos , Afogamento Iminente/complicações , Doença Iatrogênica , Dermatopatias/etiologia
13.
Pediatr Emerg Care ; 38(10): e1631-e1636, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36173436

RESUMO

INTRODUCTION: Drowning is one of the most frequent accidents in children. We aimed to describe demographic and epidemiological characteristics of drowned children who required admission to a pediatric intensive care unit (PICU) to identify risk factors to guide possible preventive measures to avoid severe drowning. METHODS: We conducted an observational study for 29 years (retrospective between 1991 and 2004; prospective between 2005 and 2019) that included all children (0-15 years old) requiring PICU admission after drowning. Data regarding patient characteristics, accident circumstances, and neurological outcomes at PICU discharge were analyzed. RESULTS: A total of 160 patients were included, with no significant decrease over the study period. There was a predominance of males (75%), young age (60%; 1-5 years), summer months (91.1%; May-September), tourists (14.12 [95% confidence interval, 9.2-21.7] times higher risk of drowning than residents), swimming pool accidents (88.8%), and inadequate supervision (77.9%). The mortality was 18.7%, and 7.5% of admitted children had severe neurological sequelae. The initial resuscitation maneuvers by accident witnesses were incorrect in nearly half of the patients in whom these could be analyzed. CONCLUSIONS: Emphasis should be placed on implementing preventive measures, focused on the described risk groups, and insisting on adequate supervision, swimming training programs, and training of the general population in safe rescue and cardiopulmonary resuscitation.


Assuntos
Reanimação Cardiopulmonar , Afogamento , Afogamento Iminente , Acidentes , Adolescente , Reanimação Cardiopulmonar/efeitos adversos , Criança , Pré-Escolar , Afogamento/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Masculino , Afogamento Iminente/epidemiologia , Afogamento Iminente/terapia , Estudos Prospectivos , Estudos Retrospectivos
14.
Pediatr Emerg Med Pract ; 19(6 Suppl): 1-46, 2022 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-35737684

RESUMO

Drowning and submersion injuries are highly prevalent, yet preventable, causes of pediatric mortality and morbidity. Prehospital care should focus on restoring normal ventilation and circulation as quickly as possible to limit the extent of hypoxic insult. Diagnostic testing for symptomatic patients may include blood glucose level, arterial blood gas level, complete blood count, electrolyte levels, chest radiography, and cardiorespiratory monitoring with pulse oximetry and a rhythm strip. In this review, passive external, active external, and active internal rewarming techniques for treatment of hypothermic patients are discussed. A systematic approach to treatment and disposition of pediatric drowning victims is provided, and risk factors, caveats in pediatric care, and factors affecting prognosis are also discussed.


Assuntos
Afogamento , Serviços Médicos de Emergência , Afogamento Iminente , Criança , Afogamento/diagnóstico , Humanos , Imersão , Afogamento Iminente/diagnóstico , Afogamento Iminente/terapia , Ressuscitação/métodos
16.
Nephrol Nurs J ; 48(3): 237-240, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34286933

RESUMO

Hemolysis may be an infrequent cause of hemodialysis blood leak alarms. We report the case of an unresponsive adult male who was placed on hemodialysis with a high-flux dialyzer. Within five minutes, the blood leak alarm sounded. The care team discontinued treatment and made two additional attempts to reinitiate hemodialysis with different machines, blood tubing lots, and brands of high-flux dialyzers, but continued to receive blood leak alarms. Laboratory studies were consistent with severe hemolysis. The attending nephrologist subsequently ordered continuous veno-venous hemofiltration, which was initiated and continued into the following day without incident or alarm. The patient later expired from complications of near-drowning. In the event of significant hemolysis, continuous kidney replacement therapy or hemodialysis with a low-flux dialyzer, and a lower ultrafiltration rate may be indicated.


Assuntos
Hemólise , Afogamento Iminente , Adulto , Água Doce , Humanos , Masculino , Diálise Renal/efeitos adversos
19.
Am J Emerg Med ; 41: 90-95, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33406460

RESUMO

BACKGROUND: In the present study, we aimed to investigate the demographic and clinical features, laboratory and radiologic characteristics, management, and outcomes of pediatric drowning patients in order to identify predictors of hospital admission, and to evaluate the need for respiratory support, and prognosis. METHODS: In this retrospective chart review, children aged 0 to 18 years who presented to the pediatric emergency department due to drowning between July 2009 and September 2019 were included. Demographics, initial vital signs, clinical findings, laboratory and radiologic results, and the need for respiratory support or cardiopulmonary resuscitation in the emergency department were recorded. Subjects were divided into 6 groups using the Szpilman classification system. RESULTS: A total of 89 patients were enrolled. Among the children who were admitted to the hospital, initial Szpilman score, crepitations on lung auscultation, and pathologic chest X-ray (CXR) findings were higher and Glasgow Coma Score and oxygen saturation (SpO 2) levels were lower than those of children who were discharged from the emergency department. A Szpilman score of ≥4, a lactate level of >2 mmol/L, and pathologic CXR findings were identified as predictors of hospital admission. Of the 89 patients, 22 (24.7%) underwent non-invasive ventilation (NIV) treatment and were classified as grade 3 or 4 according to the Szpilman score. Length of stay in the pediatric intensive care unit (PICU) and in the hospital was lower in patients who underwent NIV. As the Szpilman score increased as of grade 3, a positive correlation was observed with lactate levels (p <0.001, r: 0.552) and the total length of stay in the hospital (p: 0.001, r : 0.491), both of which gradually increased. CONCLUSION: The Szpilman score was associated with the duration of hospital stay and the degree of hypoxia, so it could help the physician make rapid decisions on ventilation strategy. Application of NIV in the emergency department shortened the length of stay in the PICU and in the hospital, suggesting that it can be used more often in pediatric emergency settings.


Assuntos
Afogamento Iminente/diagnóstico , Afogamento Iminente/terapia , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
20.
Prehosp Disaster Med ; 36(2): 163-169, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33500008

RESUMO

INTRODUCTION: On-boat resuscitation can be applied by lifeguards in an inflatable rescue boat (IRB). Due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) and recommendations for the use of personal protective equipment (PPE), prehospital care procedures need to be re-evaluated. The objective of this study was to determine how the use of PPE influences the amount of preparation time needed before beginning actual resuscitation and the quality of cardiopulmonary resuscitation (CPR; QCPR) on an IRB. METHODS: Three CPR tests were performed by 14 lifeguards, in teams of two, wearing different PPE: (1) Basic PPE (B-PPE): gloves, a mask, and protective glasses; (2) Full PPE (F-PPE): B-PPE + a waterproof apron; and (3) Basic PPE + plastic blanket (B+PPE). On-boat resuscitation using a bag-valve-mask (BVM) and high efficiency particulate air (HEPA) filter was performed sailing at 20km/hour. RESULTS: Using B-PPE takes less time and is significantly faster than F-PPE (B-PPE 17 [SD = 2] seconds versus F-PPE 69 [SD = 17] seconds; P = .001), and the use of B+PPE is slightly higher (B-PPE 17 [SD = 2] seconds versus B+PPE 34 [SD = 6] seconds; P = .002). The QCPR remained similar in all three scenarios (P >.05), reaching values over 79%. CONCLUSION: The use of PPE during on-board resuscitation is feasible and does not interfere with quality when performed by trained lifeguards. The use of a plastic blanket could be a quick and easy alternative to offer extra protection to lifeguards during CPR on an IRB.


Assuntos
COVID-19/prevenção & controle , Reanimação Cardiopulmonar/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Afogamento Iminente/terapia , Equipamento de Proteção Individual , Navios , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , SARS-CoV-2
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