Resumo
Definição
History and exam
Key diagnostic factors
- presença de fatores de risco
- comprometimento respiratório
- evidências de submersão ou imersão
Other diagnostic factors
- hipotermia
- sinais de trauma
Risk factors
- idade (1-4 anos)
- sexo masculino
- ingestão de álcool ou drogas
- nadar sozinho/mergulhar
- falta de conscientização dos riscos da água
- exposição à água
- falta de habilidade para nadar
- doença cardíaca
- transtorno convulsivo
Diagnostic investigations
1st investigations to order
- oximetria de pulso/gasometria
- radiografia torácica
- perfil metabólico básico
Investigations to consider
- tomografia computadorizada (TC) da coluna cervical
- creatina quinase
- álcool sérico e drogas de abuso na urina
- eletrocardiograma (ECG)
- biomarcadores cardíacos séricos
- níveis de medicamentos anticonvulsivantes
Treatment algorithm
todos os pacientes
grau 1 (tosse com ausculta pulmonar normal)
grau 2 (estertores em alguns campos pulmonares)
grau 3 (edema pulmonar agudo sem hipotensão nem choque)
grau 4 (edema pulmonar agudo com hipotensão ou choque)
grau 5 (sem ventilação espontânea, pulso carotídeo presente)
grau 6 (parada cardiopulmonar)
Contributors
Authors
David Szpilman, MD
Medical Director - Brazilian Lifesaving Society - Sobrasa
Lieutenant Colonel MD, retired - Fire Department of Rio de Janeiro
Civil Defense Rio de Janeiro City - Education adviser Defesa Civil Municipal do Rio de Janeiro
Co-founder - International Drowning Researcher's Alliance - IDRA
Rio de Janeiro
Brazil
Disclosures
DS is an author of several references cited in this topic.
Justin Sempsrott, MD, FAAEM
Executive Director: Lifeguards Without Borders
Medical Director: International Surf Lifesaving Association
Medical Director: Innovative Attraction Management Starguard Elite
Kuna
ID
Disclosures
JS has received compensation for expert testimony in court cases involving drowning on behalf of plaintiffs and defense. JS received a monthly stipend as the medical director for a lifeguard training and risk management company, StarGuard Elite.
Andrew Schmidt, DO, MPH
Associate Professor
Department of Emergency Medicine
University of Florida College of Medicine - Jacksonville
Medical Director: Jacksonville Beach Ocean Rescue
Deputy Medical Director: Trauma One
Jacksonville
FL
Disclosures
AS has received compensation for expert testimony in court cases involving drowning on behalf of plaintiffs and defense.
Acknowledgements
Dr David Szpilman, Dr Justin Sempsrott, and Dr Andrew Schmidt would like to gratefully acknowledge Dr Bhakti K. Patel and Dr D. Kyle Hogarth, previous contributors to this topic.
Disclosures
BKP and DKL declare that they have no competing interests.
Peer reviewers
Ajeet G. Vinayak, MD
Assistant Professor of Internal Medicine
Department of Medicine
Division of Pulmonary and Critical Care Medicine
Charlottesville
VA
Disclosures
AGV declares that he has no competing interests.
Richard Franklin, PhD
Associate Professor
James Cook University
Townsville
Queensland
Australia
Disclosures
RF declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
European Resuscitation Council. European Resuscitation Council Guidelines 2021. 2021 [internet publication].Full text
Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16 suppl 2):S366-468.Full text
The Resuscitation Council (UK). Resuscitation guidelines. 2021 [internet publication].Full text
Davis CA, Schmidt AC, Sempsrott JR, et al. Wilderness Medical Society clinical practice guidelines for the treatment and prevention of drowning: 2024 update. Wilderness Environ Med. 2024 Mar;35(suppl 1):94-111S.Full text Abstract
Dezfulian C, McCallin TE, Bierens J, et al. 2024 American Heart Association and American Academy of Pediatrics focused update on special circumstances: resuscitation following drowning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024 Dec 3;150(23):e501-16.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- Practice guidelines for the prevention and treatment of drowning
- 2024 American Heart Association and American Red Cross guidelines for first aid
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