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Old 05-22-2007   #1
iliketohike's Avatar
Durango, Colorado
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Techniques for dealing with wet drownings???

Last night I pulled out the WOFR book to brush up on responding to the most likely incident in our sport. Anybody have anything to add/say about how to respond to wet and dry drownings? Maybe a link? It seems like something we should all have dialed, if we guide or not. Those two posts just made me think, and I hope this is appropriate and not offensive in anyway.

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Old 05-22-2007   #2
Amsterdam, Netherlands
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not a technique per-say but the one (near) drowning I've been involved in, the biggest thing that we learned was to carry one of those mouth-to-mouth puke protectors with you on the river so there is no trepidation whatsoever about mouth-to-mouth resuscitation. mouth to mouth saved the guys life.

"I would drag my balls across broken glass just to hear her fart into a walkie talkie" -Jay Drury
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Old 05-22-2007   #3
Durango, Colorado
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I was taught in the pre-hospital enviroment to get them out of the water as soon/safely as possible, open/protect the airway [including sweeping out vomit and the like] and beginning positive pressure ventilation immediately... and get them to 100% Oxygen as quickly as you can... and start chest compressions if needed.... and monitor those ABC's constantly.

Always consider C-spine, hypothermia and other internal injuries but get their brain O2 ASAP.

And the pocket masks are key... carry them everywhere you can... these accidents always seem to happen when you least expect them [of course] so just do your best.... or whatever.

ETA: My instructor taught us a techique for anyone with pulmonary edema that's conscious [And required PPV] to sit them up... he claimed it helped push fluid into the bloodstream. I'm sure one of our MD friends can comment on that.
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Old 05-22-2007   #4
Golden, Colorado
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Yep - Your ABCs are critical. Expect vomitting, and keep the airway clear. One thing about rescue masks - You can get ones that you manually inflate the air cushion around the face mask, instead of those standard Red Cross ones that are factory sealed. In urban environments it doesn't matter, but in the backcountry where you might have large elevation gains or losses, the factory sealed ones can kind of shrivel up and go limp making it hard to get a good seal around the mouth and nose. Just make sure you know how to inflate it. I bought mine through NOLS.
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Old 05-22-2007   #5
Abron Cabron
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I second what was already posted and would add- Sitting up a conscious pt (patient) w/ fluid in their lungs is very important because : lying down the fluid is covering a larger surface area of the inside of the lungs (fluid filling the alveoli) which decreases the available surface area for the gas exchange of carbon dioxide and O2 to take place. the gas exchange crosses from pulmonary circulation through a membrane in the alveoli into the lungs to be inspired/expired (alveoli are the 'grape sacs'or terminal end of the lungs). So lying down, a person with fliud in their lungs will do much worse than sitting up. even if they are unresponsive (with a pulse), sitting them up @ a 45deg angle will help gravity push the fluid back into circulation passively through diffusion. PPV (positive pressure ventilation) with a bag valve mask, or by rescue breathing, is also very important to make this process more active.

This refers mostly to cardiogenic or high altitude pulmonary edema (HAPE). I don't think you would relly want to try and push a lungful of riverwater into a pts circulation, so if you were performing CPR suction and/or rolling the pt onto their side(rescue position- like how you position a passed out drunk/puking friend-not on their back!) between compressions to see if any fluid comes out.
wilderness medicine is all about improvising so do what you got to do- i don't think anyone would fault you for trying something that occurs you (like maybe lifting their lower body up to help get the fliud out by gravity) just don't interrupt compressions for too long.
correctly done compressions are the single most important part of BLS resuscitation- keeping the blood/o2 flowing to the brain-and when you release each compression, the negative pressure draws air into the lungs, which is part of why the docs keep upping the compression /ventilation ratio. (CPR is 30:2 for adults now-next year who knows?) Pocket masks are (again) really good to have.... i saw an article in rapid mag @ making a waterproof kayaking first aid kit out of a wide mouth nalgene.- super easy and fits even in play boats. i need to recycle one of my crusty old nalgenes (my first aid is currently a pelican 1400 for rafting)

the difference between wet and dry drownings is basically like running out air because of a lack of air (like being in outerspace or stuck underwater with your mouth closed) (dry) until hypoxia causes laryngospasm which leads to

(wet) being underwater while breathing in water, or having fluid fill your lungs from within the body ie: pressure in the pulmonary arteries making fluid cross the capillary membrane into the lungs (HAPE)

Maybe someone else can explain that better, but i think thats pretty much what happens. also the colder the water the better the chance of resuscitation ( younger patients especially)

medicine is frickin cool and i definitely recommend at least WFA if not a full wilderness first responder class for all of us outdoor types. Urban medicine (is actually a great job and the best way to get actual experience) is mostly about darwin award winners/gomers(PC: our geriatric population) /and actual no shit bad luck accidents, but wilderness medicine is likely as not about being able to help you or your best buds. or your customers. No disrespect meant to any one- i agree that talking about this stuff is important- remember the little thing at the end of the GI-joe cartoons where they would dish out some lesson to kiddies and then say ' now you know- and knowing is half the battle!'
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Old 05-22-2007   #6
iliketohike's Avatar
Durango, Colorado
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thanks all

I hope the comments keep rolling in. I took my WOFR, but even that isn't enough I think. Dealing with trauma is a skill, and there is really no way to train for it. It's like what they say about war. You can never tell how someone is going to react untill they are actually experience it. I've seen some shit that made me want to puke, and getting over that and helping someone is the key.

As far as I know wet drowning is when the person has breathed water, and dry is when they have passed out without breathing water and that Lasagna thing has not relaxed yet. You're likely to see dry drowning if you get to the person within say (I dunno, does anybody really?) 10 minutes and that person faught drowning so hard they never breathed and pass out. But not everybody can fight like that, so most likely you (we) will see wet drownings.

The mask thing was not in my WOFR books and it makes sooo much sense. I am going to buy one for sure. It's got to be hard to rescue breath for someone while and after they are puking up river water. I really appreciate that one.

Prevention is, of course, key, but it's only a matter of time doing the sports we love that we will see trauma. Dealing with it the best way we can could mean the difference between someone dying and living. My number one fear after something goes wrong is that my potential rescuer will give up or freak out when they could have done better, and this applies to both roles for me.

It still amazes me how few people keep a proper kit (I don't have one). With the cold water we paddle, and with proper training, we might be able to turn deaths into close calls. But never, ever critique a rescue directly. Does the white water community have an accident log like the Mountaineers puts out? I'd buy that too.
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Old 05-22-2007   #7
no tengo
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this is all well and good but what i have heard is without a defib the victim is very likely to die. i am saving up to buy one.
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Old 05-23-2007   #8
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Durango, Colorado
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internet connection lost...bad post
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Old 05-23-2007   #9
iliketohike's Avatar
Durango, Colorado
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Originally Posted by mania View Post
this is all well and good but what i have heard is without a defib the victim is very likely to die. i am saving up to buy one.
I've heard the same thing too, from people with way more river experience than me. What about trying to get some guiding companies to pool their resources to buy a few AED's to place along commercial stretches. Like the backboards on Gore?
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Old 05-23-2007   #10
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"wet" drownings?

Is there any such thing as a "dry drowning"?

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