Collaborative Management
- Bathtub and bucket drowning-consider child abuse.
- Note length of time Pt in water, water temp, and whether freshwater or salt water.
- Obtain quick history (diving or boating accident, alcohol, etc.).
- Establish and manage ABCs per protocol.
- Administer high-flow O2 via NRB mask or provide PPVs or CPAP if indicated.
- Remove wet garments, and protect Pt against further heat loss.
- Anticipate and manage hypothermia and associated traumatic injuries.
- Attach ECG monitor and manage dysrhythmias per ACLS.*
Special Considerations
- *Cold Water Submersion: A Pt's chance of survival may increase significantly if the submersion event occurs in cold water; therefore, resuscitation should continue while aggressive attempts are implemented to restore normal core temp. Withhold drugs until core temp is >30°C.
Scuba Diving-Decompression Sickness (DCS)
- S/S: Joint pain, AMS, fatigue, visual disturbances, increased RR and HR, hypotension, n/v, cyanosis, and seizure activity.
- Manage ABCs normally.
- Do not place Pt in Trendelenburg position (increases ICP).
- Transfer to facility with hyperbaric oxygen capabilities.
- Consider aspirin for potential blood coagulation disorder.
- Needle chest decompression for tension pneumothorax.