DROWNING AND THE TREATMENT OF NON-FATAL SUBMERSION

PEDIATRICS ◽  
1966 ◽  
Vol 37 (4) ◽  
pp. 684-698
Author(s):  
Jerome Imburg ◽  
Thomas C. Hartney
Keyword(s):  
Ventricular Fibrillation ◽  
Pulmonary Function ◽  
Fresh Water ◽  
Animal Studies ◽  
Sea Water ◽  
The Body ◽  
Positive Pressure ◽  
Cardiac Massage ◽  
Central Nervous System Damage ◽  
Intermittent Positive Pressure Breathing

Animal studies have shown that fluid enters the body via the lungs in sea-water and fresh-water drowning. In fresh-water drowning in dogs, there is marked and rapid hemodilution with death due to ventricular fibrillation in about 4 minutes. In sea-water drowning in dogs, there is hemoconcentration; the blood water is lost into the sea water in the lungs with bradycardia and death due to asystole in 6 to 8 minutes. Studies of human drowning victims show similar, but less striking, changes in hemodynamics. In human non-fatal submersion the problems are usually those produced by impaired pulmonary function and central nervous system damage due to hypoxia. Hemodilution and ventricular fibrillation have not been documented in human nonfatal submersion. Therapeutic measures may be divided into those of an immediate urgent nature to be employed at the accident scene: expired air resuscitation, which should be started on reaching the unconscious victim in the water, and external cardiac massage, when indicated. Later measures to be instituted in the hospital include: cardiac resuscitation, intermittent positive-pressure breathing, hypothermia, tracheostomy and tracheal tiolet, oxygen therapy, antibiotics, steroids, and intravenous fluids to correct defects in blood elements (hemoglobin, electrolytes, pH). Later, pulmonary function should be studied for impairment due to alveolar damage and fibrosis. Permanent neurologic sequellae may develop.

RESUSCITATION AND TREATMENT FOLLOWING SUBMERSION

PEDIATRICS ◽  
1966 ◽  
Vol 37 (4) ◽  
pp. 666-668
Author(s):  
Joseph S. Redding
Keyword(s):  
Fresh Water ◽  
Positive Pressure Ventilation ◽  
Sea Water ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Cardiac Massage ◽  
Closed Chest ◽  
Myocardial Failure ◽  
Exhaled Air ◽  
Electrical Defibrillation

In resuscitation from drowning it must be remembered that when breathing movements are absent no time must be wasted in attempts to drain the lungs. Reoxygenation must be started immediately with exhaled air. Positive pressure ventilation with oxygen should be substituted as soon as possible. It should be continued in victims of sea water submersion until a blood specimen can be examined and any plasma deficiency corrected. In fresh water drowning intermittent positive pressure ventilation combined with closed chest cardiac massage is a preliminary to external electrical defibrillation. Prevention of delayed death depends upon the management of massive hemolysis, hypervolemia, electrolyte imbalances, aspiration pneumonitis, and myocardial failure.

Drowning treated with intermittent positive pressure breathing

1960 ◽  
Vol 15 (5) ◽  
pp. 849-854 ◽  
Author(s):  
Joseph Redding ◽  
G. Carl Voigt ◽  
Peter Safar
Keyword(s):  
Ventricular Fibrillation ◽  
Sea Water ◽  
Venous Pressure ◽  
Arterial Hypotension ◽  
Positive Pressure ◽  
Partial Restoration ◽  
Anesthetized Dogs ◽  
Slight Rise ◽  
Intermittent Positive Pressure Breathing ◽  
Comparable Period

A standardized dog experiment was designed to simulate human victims of submersion who seem to first develop laryngospasm, followed by flooding of the lungs. The tracheal tube of lightly anesthetized dogs was clamped until the onset of apnea. The lungs were then flooded for 30 seconds with fresh water or sea water, or apnea was permitted to continue for a comparable period without flooding. Resuscitation was attempted with intermittent positive pressure breathing (IPPB), utilizing room air. All control dogs (obstructive asphyxia, without flooding) survived. Freshwater drowning caused mild arterial hypotension, severe rise in venous pressure and bradycardia, followed by sudden ventricular fibrillation in 1–4 minutes in spite of IPPB. Sea-water drowning caused severe arterial hypotension, slight rise in venous pressure and bradycardia. IPPB led to partial reoxygenation and partial restoration of circulation. When IPPB was discontinued all dogs started breathing spontaneously, but within a few minutes developed asystole with pulmonary edema. Submitted on January 25, 1960

Sodium Regulation and Adaptation to Fresh Water in Gammarid Crustaceans

1968 ◽  
Vol 48 (2) ◽  
pp. 359-380
Author(s):  
D. W. SUTCLIFFE
Keyword(s):  
Body Weight ◽  
Fresh Water ◽  
Body Surface ◽  
Sea Water ◽  
Sodium Concentration ◽  
The Body ◽  
Outward Diffusion ◽  
Gammarus Zaddachi ◽  
Freshwater Habitats ◽  
Sodium Regulation

1. Sodium uptake and loss rates are given for three gammarids acclimatized to media ranging from fresh water to undiluted sea water. 2. In Gammarus zaddachi and G. tigrinus the sodium transporting system at the body surface is half-saturated at an external concentration of about 1 mM/l. and fully saturated at about 10 mM/l. sodium. In Marinogammarus finmarchicus the respective concentrations are six to ten times higher. 3. M. finmarchicus is more permeable to water and salts than G. zaddachi and G. tigrinus. Estimated urine flow rates were equivalent to 6.5% body weight/hr./ osmole gradient at 10°C. in M. finmarchicus and 2.8% body weight/hr./osmole gradient in G. zaddachi. The permeability of the body surface to outward diffusion of sodium was four times higher in M. finmarchicus, but sodium losses across the body surface represent at least 50% of the total losses in both M. finmarchicus and G. zaddachi. 4. Calculations suggest that G. zaddachi produces urine slightly hypotonic to the blood when acclimatized to the range 20% down to 2% sea water. In fresh water the urine sodium concentration is reduced to a very low level. 5. The process of adaptation to fresh water in gammarid crustaceans is illustrated with reference to a series of species from marine, brackish and freshwater habitats.

CO2 and acid-base transients after hyperventilation

1962 ◽  
Vol 17 (5) ◽  
pp. 805-811 ◽  
Author(s):  
Joseph A. Lipsky ◽  
Joseph F. Tomashefski ◽  
Earl T. Carter
Keyword(s):  
Steady State ◽  
Tidal Volume ◽  
Recovery Period ◽  
The Body ◽  
Positive Pressure ◽  
Acid Base ◽  
Alveolar Air ◽  
Arterial Blood ◽  
Intermittent Positive Pressure Breathing ◽  
Male Subjects

Fourteen male subjects were mechanically hyperventilated by intermittent positive pressure breathing. Tidal volume and respiratory frequency were increased approximately three times and one and one-half times control, respectively. Breath-by-breath analyses of CO2 output indicate a loss of approximately 2.5 liters of CO2 from the body stores in 12 min. Only one-third of that volume was restored during the ensuing 12-min recovery period, mostly as a result of hypoventilation rather than apnea. Over the entire recovery period, the volume of CO2 regained by the blood store approximated 75% of the CO2 content lost during hyperventilation. Under the conditions of these experiments, tissues regained less than 20% of the depleted CO2 store. CO2 retention patterns may be more effective than arterial blood or alveolar air analyses in determining a return to a steady state when tissue stores have been considerably reduced. Submitted on August 24, 1961

scholarly journals Salt and Water Balance in the East African Fresh-Water Crab, Potamon Niloticus (M. Edw.)

1959 ◽  
Vol 36 (1) ◽  
pp. 157-176 ◽  
Author(s):  
J. SHAW
Keyword(s):  
Water Balance ◽  
Fresh Water ◽  
Sea Water ◽  
Freezing Point ◽  
Salt Content ◽  
The Body ◽  
Sodium Balance ◽  
East African ◽  
Sodium Loss ◽  
Salt And Water Balance

1. The mechanisms of salt and water balance in the East African fresh-water crab, Potamon niloticus, have been investigated. 2. The freezing-point depression of the blood is equivalent to that of a 271 mM./l. NaCl solution. 3. The animals cannot survive in solutions more concentrated than 75% sea water. Above the normal blood concentration, the blood osmotic pressure follows that of the medium. 4. The urine is iso-osmotic with the blood and is produced at a very slow rate. The potassium content is only half that of the blood. 5. The animal loses sodium at a rate of 8 µM./10 g./hr. mainly through the body surface. Potassium loss occurs at one-sixteenth of this rate. 6. Sodium balance can be maintained at a minimum external concentration of 0.05 mM./l. Potassium requires a concentration of 0.07 mM./l. 7. Active absorption of both sodium and potassium occurs. The rate of uptake of sodium depends on the extent of previous sodium loss. The rate of sodium uptake may be affected by such environmental factors as the salt content of the water, temperature and oxygen tension. 8. The normal oxygen consumption rate is 0.72 mg./10 g./hr. A minimum of 2.3% is used in doing osmotic work to maintain salt balance. 9. The salt and water balance in Potamon is discussed in relation to the adaptation of the Crustacea to fresh water. The importance of permeability changes is stressed.

scholarly journals The Physiology of Contractile Vacuoles

1934 ◽  
Vol 11 (4) ◽  
pp. 364-381
Author(s):  
J. A. KITCHING
Keyword(s):  
Fresh Water ◽  
Sea Water ◽  
Tap Water ◽  
Marine Species ◽  
The Body ◽  
Contractile Vacuole ◽  
Body Volume ◽  
Water Value ◽  
Contractile Vacuoles ◽  
Sustained Increase

1. The rate of output of fluid from the contractile vacuole of a fresh-water Peritrich Ciliate was decreased to a new steady value immediately the organism was placed in a mixture of tap water and sea water. The rate of output returned to its original value immediately the organism was replaced in tap water. The contractile vacuole was stopped when the organism was treated with a mixture containing more than 12 per cent, of sea water. 2. Transference of various species of marine Peritricha from 100 per cent, sea water to mixtures of sea water and tap water led to an immediate increase of the body volume to a new and generally steady value. Return of the organism to 100 per cent, sea water led to an immediate decrease of the body volume to its original value or less. 3. Marine Peritricha showed little change in rate of output when treated with concentrations of sea water between 100 and 75 per cent. In more dilute mixtures the rate of output was immediately increased, and then generally fell off slightly to a new steady value which was still considerably above the original (100 per cent. sea water) value. The maximum sustained increase was approximately x 80. Return of the organism to 100 per cent, sea water led to an immediate return of the rate of output to approximately its original value. 4. When individuals of some marine species were placed in very dilute concentrations of sea water, the pellicle was frequently raised up in blisters by the formation of drops of fluid underneath it, and the contractile vacuole stopped. 5. Evidence is brought forward to suggest that in the lower concentrations of sea water marine forms lost salts. 6. The contractile vacuole probably acts as an osmotic controller in fresh-water Protozoa. Its function in those marine Protozoa in which it occurs remains obscure.

Active Transport and Sodium Fluxes at Moult in the Amphipod, Gammarus Duebeni

1969 ◽  
Vol 51 (3) ◽  
pp. 591-605
Author(s):  
A. P. M. LOCKWOOD ◽  
W. R. H. ANDREWS
Keyword(s):  
Fresh Water ◽  
Body Surface ◽  
Major Part ◽  
Sea Water ◽  
Sucrose Solution ◽  
The Body ◽  
Active Sodium ◽  
Sodium Influx ◽  
Sodium Uptake ◽  
High Level

1. The sodium fluxes of individual Gammarus duebeni, which moulted in sea water, have been followed daily from the morning following moult for at least 6 days. 2. Sodium influx from sea water declined from 15.1µM/animal/hr. on the first morning after moult to 1.7µM/animal/hr. by the tenth day after moult. 3. Sodium influx from 10 mM/l. NaCl plus sucrose solution isotonic with sea water declines from 4.48µM/animal/hr. to 0.14µM/animal/hr. in inter-moult animals. 4. Thionine inhibits over 90% of the influx from 10 mM/l NaCl plus isotonic sucrose on the first day after moult, and this, together with other evidence, suggests that the major part of the influx from this medium is due to active sodium uptake. The rate of active uptake is comparable with, or faster than, the rate of uptake by animals acclimatized to fresh water. 5. The influx occurs primarily across the body surface. It is suggested that the high level of sodium uptake is associated with the water uptake which occurs at moult.

Studies on the Permeability To Water Of Selected Marine, Freshwater And Euryhaline Teleosts

1969 ◽  
Vol 50 (3) ◽  
pp. 689-703 ◽  
Author(s):  
DAVID H. EVANS
Keyword(s):  
Fresh Water ◽  
Brown Trout ◽  
Water Permeability ◽  
Sea Water ◽  
Tritiated Water ◽  
Marine Species ◽  
The Body ◽  
Freshwater Species ◽  
Silver Eel ◽  
As Species

Measurements were made of the flux of tritiated water across various marine, freshwater and euryhaline teleosts. The effects of temperature, body size, species differences, salinity, stress and anaesthetization were studied. 2. The Q10 of the flux of water across teleosts is approximately 1·90 and the flux is related to the 0·88 power of the body weight. 3. All of the freshwater species studied were more permeable to water than the marine species. Euryhaline teleosts appear to have about the same permeability as species to which they are most closely related. 4. While the flounder and the yellow eel are more permeable to water in fresh water than in sea water, the silver eel and the brown trout do not change their permeability and the 3-spined stickleback is less permeable to water in fresh water than in sea water. 5. While stress markedly increases the permeability to water of large brown trout, it has no effect on small brown trout and seems to decrease the water permeability of the plaice. 6. Anaesthetization has no effect on the water permeability of the goldfish but markedly increases the permeability to water of the silver eel. 7. The relationship between the flux of water and either the drinking rate in sea water or the urine flow in fresh water is discussed.

Changes in Body Chloride, Density, and Water Content of Chum (Oncorhynchus keta) and Coho (O. kisutch) Salmon Fry when Transferred from Fresh Water to Sea Water

1951 ◽  
Vol 8b (3) ◽  
pp. 164-177 ◽  
Author(s):  
Virginia Safford Black
Keyword(s):  
Water Content ◽  
Fresh Water ◽  
Chum Salmon ◽  
Coho Salmon ◽  
Sea Water ◽  
The Body ◽  
Oncorhynchus Keta ◽  
Normal Range ◽  
Experimental Conditions ◽  
Salmon Fry

Changes in body chloride, density and water content of chum and coho salmon fry were measured when these fish were transferred from fresh water to sea water, and the reverse. Both species tolerated 50% sea water (8–9‰ Cl). Chum fry survived direct transfer from fresh water to sea water (15–17‰ Cl), but showed a marked increase in body chloride during the first 12 hours, followed by a return to the normal range between 12 and 24 hours. Coho, however, died within the first 36 hours, after a 60% increase in chloride. Coho fry lost more water than chum fry after introduction to sea water. The density of both species approximated that of the water within an hour of transfer to the new medium. When returned to fresh water after 12 hours in sea water the body chloride, density, and water content of both species regained normal levels within 10 hours. Chum salmon go to sea as fry, whereas cohos remain in fresh water a year or more. Although coho fry seem capable of some adjustment to sea water after a preliminary period in 50% sea water, permanent acclimatization could not be demonstrated under the experimental conditions.

Restoration of circulation after fresh water drowning

1961 ◽  
Vol 16 (6) ◽  
pp. 1071-1074 ◽  
Author(s):  
Joseph S. Redding ◽  
Richard A. Cozine
Keyword(s):  
Ventricular Fibrillation ◽  
Fresh Water ◽  
Hypertonic Saline ◽  
Vertebral Column ◽  
Artificial Respiration ◽  
Respiratory Arrest ◽  
Spontaneous Circulation ◽  
Positive Pressure ◽  
Artificial Circulation ◽  
Anesthetized Dogs

Lightly anesthetized dogs were subjected to obstructive asphyxia, simulating laryngospasm. After respiratory arrest the lungs were flooded with fresh water for 30 sec, according to a standardized experiment. Ten dogs were treated with intermittent positive-pressure artificial respiration with 100% oxygen. Six of the ten dogs suddenly developed ventricular fibrillation less than 2 min after artificial respiration was started. In these animals an artificial circulation was maintained for 20 min by repeated compression of the heart between the sternum and vertebral column. Then, after intravenous administration of hypertonic saline and epinephrine solutions, a 480-v shock was applied to the chest wall. In five of the six dogs there was an immediate resumption of spontaneous circulation. In an additional ten dogs ventricular fibrillation was produced by the same sequence of obstructive asphyxia and flooding of the lungs. In five, treatment was identical except that injection of hypertonic saline was omitted. Circulation was restored in four. In the remaining five, ventilation was performed with air. Restoration of circulation was successful in one. Submitted on June 12, 1961

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