Diseases, Disorders information

Some of your radiologic studies may show something like this. This picture was actually very nice because it came with all these arrows on it. Although this one is not subtle, that’s a big epidural hematoma, a kind of lens-shaped. Not at all subtle. This also is not very subtle. You can see something that you may see on examination, which is a big overlying cephalhematoma, and then and intraparenchymal contusion and bleed.
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Okay, moving on in our dash through critical care. Near drowning; depending on what state you live in, it may in fact be the leading cause of death of young children. Certainly in California, Arizona, many of the southern states, near drowning, or drowning is the cause of death. If you’ve drowned you can’t near-drown, I guess. We are going to talk a little bit about the epidemiology, the pathophysiology, some of the clinical findings, your management and what is the prognosis of children who have immersion events.
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Near drowning again demonstrates that toddlers and adolescents share many things in common. Near drowning has two bi-modal peaks during those age ranges. Even in the young children, the 2-5-year-old there is a very impressive male to female predominance. Four times as many boys as little girls end up drowning. In the adolescents it’s very often high risk behavior that results in drownings. Alcohol is oftentimes involved, or other drugs. Oftentimes diving off of high cliffs or other places where there are associated traumatic injuries as well.
What’s the pathophysiology of near drowning? It’s really an anoxic ischemic injury that is preceded typically with anoxia being the primary event, as the patient is unable to ventilate. It’s hard to breathe when you are under water. If you are getting no oxygen, your heart and brain don’t do so well. You may have ischemic injury to all of the organs in the body, although most will recover and not be the cause of ongoing morbidity or mortality. Aspiration of water, 80-90% of patients have some aspiration of water, although it is typically relatively low volumes. All of the studies … many of the animal studies looking at things like near drowning do things like infuse 40 ml/kg in a dog’s tracheas. Drownings typically involve much much smaller volumes of water. And the differences that are pointed out in laboratory environments of fresh water versus salt water drownings, clinically you don’t see much difference. What you do see are some of the effects of anoxic ischemic injury to the brain. You have altered mental status, you oftentimes develop increased intracranial pressure a day or two following your anoxic ischemic event.