Policía Costera de Vigo. Estudio piloto cuasiexperimental sobre rescate y RCP / Coastal Police of Vigo. A quasi-experimental pilot study about rescue and CPR

El ahogamiento es una de las principales causas de muerte en el mundo y en España. Los socorristas ejercen una labor de prevención y vigilancia pero su labor es estacional y temporal. En muchos lugares, la primera respuesta a la emergencia, cuando los socorristas no están de servicio, depende de la policía, a la que se le requiere habilidades de rescate y reanimación cardiopulmonar (RCP). El objetivo de este estudio es determinar la capacidad de rescate y efecto de la fatiga sobre la calidad de la RCP de un grupo de diez policías costeros cuya área de influencia es el litoral de Vigo. El diseño fue cuasi-experimental con dos factores (pretest basal/postest rescate). Los policías pudieron realizar el rescate acuático rápido y seguro 417 ± 54,5 seg, a nivel de lactacidema se registró 12,27 ± 2,36 mmol. La fatiga inducida por el rescate afectó negativamente a la calidad de la compresiones en la RCP (p = 0,002) (AU)

Drowning is a leading cause of death worldwide and in Spain. Lifeguards exert vigilance and prevention efforts but their work is seasonal and temporary. In many places the first emergency response when lifeguards are not on duty, depends on the police, which are required rescue skills and cardiopulmonary resuscitation (CPR). The objective of this study is to determine the ability of lifesaving and effect of fatigue on the quality of CPR of a group of ten coastal police whose area of influence is the coast of Vigo. The design was quasiexperimental with two factors (basal pretest / posttest rescue). Cops with basic training could perform fast and safe water rescue 417 ± 54.5 seconds, lactate level was recorded 12.27 ± 2.36 mmol. Induced fatigue during resuce effort had a nevative effect on the quality of compressions in CPR (p = 0.002) (AU)

Drowning in Aboriginal and Torres Strait Islander children and adolescents in Queensland (Australia).

BACKGROUND: Aboriginal and Torres Strait Islander (Indigenous) children are at greater risk of drowning than other children, however little is known about drowning of Indigenous children. This study identifies the previously unpublished incidence and characteristics of fatal and non-fatal drowning in Indigenous children and adolescents. METHODS: Retrospective data (Jan 2002-Dec 2008) on fatal and non-fatal drowning events among Indigenous and Non-Indigenous Queensland residents aged 0-19 years were obtained from multiple sources across the continuum of care (pre-hospital; emergency department; admitted patients; fatality) and manually linked. Crude incidence rates for fatal and non-fatal events were calculated using population data from the Australian Bureau of Statistics. RESULTS: There were 87 (6.7 % of all events) fatal and non-fatal (combined) Indigenous drowning events yielding a crude Incidence Rate of 16.8/100,000/annum. This is 44 % higher than the incidence rate for Non-Indigenous children. For every fatality, nine others were rescued and sought medical treatment (average 12 per year). There were no significant changes in Indigenous drowning incidents over the study period. Drowning rates were higher for Indigenous females than males. Overall incidence was higher among Indigenous children and adolescents than Non-Indigenous children for every calendar year and age-group (0-4 years; 5-9 years; 10-14 years) except those aged 15-19 years where no drowning events were recorded for males. Location of drowning sites was similar in both populations 0-19 years, however there were slight differences in frequency at each of the locations. The three leading drowning locations for Indigenous 0-19 years olds were pool (48 %), bath (21 %) and natural water (16 %), and for non-Indigenous 0-19 years the leading locations were pool (66 %), natural water (13 %) and bath (12 %) (p < .01). Except for pool drowning, Indigenous drowning occurred more often in geographic areas of relative disadvantage. Among Indigenous children drowning location varied with age (p < .001). Most frequent locations by age were: <1 year bath (71 %); 1-4 years pools (80 %); 5-9 years pools (75 %) and 10-19 years beach/ocean (36 %). Severity of event differed statistically with Indigenous status and by remoteness with all fatal drowning events occurring in Regional or Remote areas, and none in Major Cities. CONCLUSIONS: For every fatal drowning among Indigenous children in Queensland aged 0-19 years there are nine non-fatal events. This previously unreported survival ratio of 9:1 indicates the non-fatal injury burden in Indigenous children aged 0-19 years. Although higher Indigenous drowning rates prevailed, no significant changes over time are concerning. Equally the apparent over-representation of Indigenous adolescent females should be weighed against the absence of drowning among Indigenous male adolescents in the same age group in consecutive years of the study. Further investigation around behaviour and culture may highlight protective factors. Culturally specific prevention strategies which take into account social and demographic indicators identified in this study should be delivered to carers and peers of vulnerable age groups who frequent specific locations. Females, swimming ability, supervision and the young are areas which need to be incorporated into Indigenous-specific interventions for drowning prevention.

Efecto de la fatiga física del socorrista en los primeros cuatro minutos de la reanimación cardiopulmonar posrescate acuático / Effect of lifeguard fatigue on the first 4 minutes of cardiopulmonary resuscitation after water rescue

Objetivo: Analizar el efecto de la fatiga física provocada por un rescate acuático sobre la calidad de la reanimación cardiopulmonar (RCP).Método: Sesenta socorristas profesionales (30 hombres y 30 mujeres) formados en las Universidades de A Coruña y Vigo realizaron dos tests: el primero consistió en la realización de cuatro minutos de RCP en condiciones de reposo, y en el segundo realizaron RCP durante cuatro minutos inmediatamente después de un rescate acuático. Se utilizó el maniquí Laerdal Resusci Anne® con Laerdal PC Skill Reporting para registrar las compresiones y ventilaciones totales, las correctas e incorrectas y sus porcentajes. Resultados: En reposo y en fatiga se observó un descenso en el número de compresiones correctas y en su porcentaje conforme trascurrían los minutos de RCP. Tras el rescate acuático, aumentaron las compresiones totales (reposo: 75,4, fatiga: 84,2; p < 0,001),descendió el porcentaje de ventilaciones correctas (reposo: 55,1%, fatiga: 34,7%;p < 0,001) y el de compresiones correctas (reposo: 77,5%; fatiga: 63,6%; p < 0,001).Conclusiones: La fatiga física del socorrista, provocada por un rescate, afecta de forma negativa a la calidad de la RCP. Recomendamos, en la medida de lo posible, que se aun socorrista no fatigado el que inicie la RCP (AU)

Objective: To assess the effect of lifeguard fatigue on the quality of cardiopulmonary resuscitation (CPR) after water rescue Methods: Sixty professional lifeguards (30 men, 30 women) trained at the University of A Coruña and the University of Vigo in Spain participated in 2 tests. In the first test, the participants were rested when they performed 4 minutes of CPR. In the second, they undertook 4 minutes of CPR immediately after rescuing a mannequin from the water. The Resusci Anne Skill Reporter mannequin (Laerdal) was used to produce a computerized record of the total number of compressions and ventilations as well as the percentages of each type of maneuver the lifeguards performed correctly and incorrectly. Results: In both rested and fatigued conditions, the participants performed fewer correct compressions (absolute numbers and percentages) as CPR continued over the assigned minutes. After a water rescue, the total number of compressions increased (when rested, 75.4; when fatigued, 84.2) (P<.001), while the percentage of correct ventilations decreased (rested, 55.1%; fatigued, 34.7%; (P<.001) and correct compressions (rested, 77.5%; fatigued, 63.6%)(P<.001).Conclusions: Lifeguard fatigue after a water rescue negatively affects CPR quality. We recommend that a rested lifeguard should perform CPR whenever possible (AU)

[Drowning]. / La noyade.

Drowning is always a serious event, with high morbidity and mortality. Definitions were recently revised and simplified according to Utstein-style. The circumstances and prognosis differ in different age groups. Consequences of drowning are hypoxemia, acidosis and hypothermia. The management of drowning victims should be directed to the correction of these 3 elements. An early basic life support and an efficient oxygenation are keys of good prognosis, this one being mainly related to hypoxic cerebral damages. The most frequent complications except anoxic encephalopathy are bacterial pneumonia and ARDS.

[Water rescue. A unique area of emergency medicine with many facets]. / Wasserrettung. Ein notfallmedizinisches Spezialgebiet mit vielen Facetten.

Emergencies on or in water are relatively rare in the rescue service. For this reason, water accident treatment and management does not receive much attention in the training of emergency medicine physicians. Consequently doctors working in emergency medicine often have minimal knowledge in this area. On the other hand, the number of fatal accidents on and in water has increased in recent years. In Germany the number of non-swimmers is also increasing, so it can be assumed that the number of water-related accidents will continue to rise. Drowning accidents and near drowning are important in this context and will be discussed in detail in this review as well as hypothermia (a frequent problem), accompanying injuries and diving accidents.

Outcome of 12 drowned children with attempted resuscitation on cardiopulmonary bypass: an analysis of variables based on the "Utstein Style for Drowning".

BACKGROUND: In 2003, the International Liaison Committee on Resuscitation (ILCOR) published the "Utstein Style for Drowning" (USFD) to advance knowledge on the epidemiology, treatment, and outcome prediction after drowning. Applying the USFD and evaluating its data template for outcome analysis, we report here on the largest study published thus far of drowned children (age 0-14) who underwent attempted resuscitation on cardiopulmonary bypass (CPB). METHODS: We conducted a retrospective review of all drowned children admitted to Göttingen University Hospital between 1/1987 and 12/2005 in sustained cardiopulmonary arrest and resuscitation with CPB. We correlated eight outcome-affecting USFD variables and four additional variables not included in the USFD with potential impact on outcome to four outcome groups: survival, non-survival, survival with full recovery, and failed resuscitation. RESULTS: Out of 12 children (aged 22 months to 7.5 years), 5 survived to hospital discharge and 7 died in hospital. Two survivors recovered fully and three remained in a vegetative state. In two patients, resuscitation on CPB failed. Both children who fully recovered, compared to the 10 others, had relatively low serum K+ concentrations (2.6 and 3.7 mmol/l versus 5.8+/-3.8 mmol/l [mean+/-S.D.; n=10]), a relatively slow rewarming speed (1.9 and 1.2 degrees C/h versus 3.4+/-1.8 degrees C/h), were female (all three girls survived), received early basic life support (BLS) and showed idioventricular bradycardia. Both children with failed resuscitation had severe hyperkalaemia (11.7 and 13.3 mmol/l versus 10 others, 4.0+/-1.5 mmol/l), were relatively rapidly rewarmed (6.9 and 4.0 degrees C/h versus 10 others, 2.61+/-1.32 degrees C/h), male, and in asystole. We identified no outcome trends for age, pH, or water and core temperatures. CONCLUSIONS: Most variables relevant for outcome in drowned children can be documented with the use of the USFD. Additional variables not included in the USFD that have emerged from this study and may predict outcome include serum K+ concentration, rewarming speed, and initial cardiac rhythm.

Subcapsular liver haematoma after cardiopulmonary resuscitation by untrained personnel.

Although early cardiopulmonary resuscitation (CPR) is associated with increased survival of sudden cardiac arrest victims, it may also result in miscellaneous injuries. A 25-year-old inebriated man rescued from drowning in a swimming pool was apnoeic and pulseless after being pulled out of the water. Successful CPR was provided by untrained bystanders, including abdominal thrusts thought to remove water from the airways and chest compressions to provide haemodynamic support. As the patient progressively improved during his subsequent hospital stay, he complained of right upper abdominal and thoracic pain. A computed tomographic scan showed a 11 cm subcapsular haematoma contiguous to the right hepatic lobe. A favourable outcome was obtained after conservative, non-operative treatment. Subcapsular haematoma of the liver is a potentially life threatening complication that warrants consideration in survivors of cardiac arrest who have received closed chest compression and/or abdominal thrusts.

Afogamento na infância: epidemiologia, tratamento e prevenção / Drowning in childhood: epidemiology, treatment and prevention

Objetivo: fazer uma revisão crítica a respeito da epidemiologia e do tratamento do afogamento na população pediátrica. Fontes de dados: foram pesquisados todas as fontes bibliográficas do sistema Medline (internet), artigos apresentados em congressos, recomendações internacionais, bem como livros sobre emergência e terapia intensiva. Síntese dos dados: a cada ano, 500.000 pessoas morrem afogadas em todo o mundo. Os principais fatores de risco para o afogamento são: a idade, ser do sexo masculino, o uso de bebidas alcoólicas, a baixa condição socioeconômica e a falta de supervisão. Mundialmente, o afogamento constitui a primeira causa de morte do seo masculino na faixa et´[aria entre 5 e 14 anos, sendo a segunda causa no Brasil desse grupo. Em nosso país, há 7.210 mortes ao ano por afogamwento (5,2/100.000 habitantes), sendo mais frequentes os casos em água doce (rios, lagos e represas). Esta revisão procura difundir para os pediatras conceitos relativos a uma nova defenição do afogamento, sua nomenclatura e classificação; a cadeia de sobrevivência; as técnicas mais adequadas de resgate; o tratamento e as novas abordagens na ressuscitação da criança afogada. Conclusões: nos últimos 15 anos houve acentuada valorização do tema afogamento, resultando em redução da morbimortalidade por essa causa. Todavia, o afogamento ainda constitui grave e negligenciado problema de saúde pública, que necessita, com urgência, em âmbito nacional, de campnahas de prevenção que objetivem reduzir sua incidência n/ao só no litoral, mas principalmente np interior do país.

[Drowning in pediatric patients]. / Ahogamientos y casi ahogamientos en niños.

OBJECTIVE: Immersion accidents are still an important cause of morbidity and mortality in children. We performed a retrospective study to identify the prognostic factors associated with outcome in children who experience near-drowning, which could serve to guide decision-making. Our data were compared with other published data. PATIENTS AND METHODS: The medical records of children treated for near-drowning in our hospital from January 1995 to April 2003 were reviewed. The data analyzed referred to the patient, the accident, the patient's clinical status in the emergency unit, the unit to which the patient was admitted, and outcome. RESULTS: Sixty-two patients were included. Of these, outcome was bad in 12 (death in seven and irreversible sequelae in five). Statistically significant predictors of bad prognosis were age > or = 4 years, female sex, immersion time > or = 5 min, cyanosis in the emergency room, cardiac arrest, apnea or severe distress, hypothermia (core temperature < 35 degrees C), metabolic acidosis (pH < or = 7.10) and neurologic damage (Glasgow coma Scale score 3; Conn C; nonreactive and mydriatic pupils) on arrival at the hospital. CONCLUSIONS: Outcome is closely related to the patient's clinical status on arrival at the hospital. Although data that can serve as a guide to the final outcome of the nearly-drowned patient are available, early models to predict the final clinical results of each case, which could be used to guide initial resuscitation and subsequent treatment, are lacking.

Ahogamientos y casi ahogamientos en niños / Drowning in pediatric patients

Objetivo: Los accidentes por sumersión siguen causando importante morbimortalidad en niños. Se realiza un estudio retrospectivo para identificar los factores pronósticos asociados a la evolución clínica de niños con accidente por sumergimiento, que puedan servir de ayuda para tomar decisiones terapéuticas, comparándolos con otros datos publicados. Pacientes y métodos: Estudio retrospectivo mediante revisión de las historias clínicas de los casos atendidos por accidente por sumergimiento entre enero de 1995 y abril de 2003. Los datos analizados se refieren al paciente, el accidente, situación clínica en Urgencias y unidades donde ingresan en el hospital, valorando la evolución final de cada caso. Resultados: Se han incluido 62 pacientes, presentando mala evolución 12 (7 fallecimientos y 5 secuelas permanentes). Han resultado significativos, como datos de mal pronóstico, edad igual o superior a 4 años, sexo femenino, tiempo inmersión 5 min o más y, a la llegada al hospital: cianosis inicial que persistía en Urgencias; parada cardíaca, apnea o distrés grave, hipotermia (temperatura < 35 °C), acidosis metabólica (pH < 7,10) y afección neurológica (Glasgow 3; Conn C; pupilas midriáticas y arreactivas). Conclusiones: La evolución final del paciente está estrechamente relacionada con la situación clínica a su llegada al hospital. Aunque disponemos de datos orientativos sobre la evolución posterior del paciente casi ahogado, se carece de modelos predictivos precoces que permitan vaticinar la evolución del paciente y, por lo tanto, orientar en la actitud a tomar en las medidas iniciales de reanimación y mantenimiento posterior

Objective: Immersion accidents are still an important cause of morbidity and mortality in children. We performed a retrospective study to identify the prognostic factors associated with outcome in children who experience neardrowning, which could serve to guide decision-making. Our data were compared with other published data. Patients and methods: The medical records of children treated for near-drowning in our hospital from January 1995 to April 2003 were reviewed. The data analyzed referred to the patient, the accident, the patient’s clinical status in the emergency unit, the unit to which the patient was admitted, and outcome. Results: Sixty-two patients were included. Of these, outcome was bad in 12 (death in seven and irreversible sequelae in five). Statistically significant predictors of bad prognosis were age >= 4 years, female sex, immersion time >= 5 min, cyanosis in the emergency room, cardiac arrest, apnea or severe distress, hypothermia (core temperature < 35 °C), metabolic acidosis (pH <= 7.10) and neurologic damage (Glasgow coma Scale score 3; Conn C; nonreactive and mydriatic pupils) on arrival at the hospital. Conclusions: Outcome is closely related to the patient’s clinical status on arrival at the hospital. Although data that can serve as a guide to the final outcome of the nearly-drowned patient are available, early models to predict the final clinical results of each case, which could be used to guide initial resuscitation and subsequent treatment, are lacking

Drowning: a review of epidemiology, pathophysiology, treatment and prevention.

Although often preventable, drowning remains a leading cause of accidental death, especially in children. New definitions classify drowning as the process of experiencing respiratory impairment from submersion or immersion in a liquid. The key pathophysiological feature in drowning is hypoxia. Accurate neurological prognosis cannot be predicted from the initial clinical presentation, laboratory, radiological, or electrophysiological examinations. Prompt and aggressive resuscitation attempts are crucial for optimal survival. This article reviews the epidemiology, pathophysiology, treatment, and prevention of drowning.

Lesión medular completa y casi ahogamiento: presentación de un caso / s. t

Presentamos el caso de un paciente de 20 años de edad con un casi ahogamiento acompañado y posiblemente provocado por lesión cervical con luxofractura vertebral alta (C3-C4), con compresión medular no diagnosticada inicialmente. Se valora la evolución del caso y las condiciones del diagnóstico y tratamiento y se hacen reflexiones y recomendaciones sobre la importancia del manejo inicial adecuado de los pacientes con ahogamiento por inmersión en aguas poco profundas, teniendo en cuenta la alta probabilidad de existencia de lesión vertebral cervical y con ella lesión neurológica a nivel medular cervical(AU)

Síndrome de casi ahogamiento / Almost-suffocation síndrome

Se revisan la historia y los conceptos de este problema de salud y se actualiza el tratamiento del ahogamiento incompleto en niños, incluyendo la reanimación inicial, el transporte, y el ingreso en una Unidad de Cuidados Intensivos(AU)