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Paediatrics & Child Health - part 7

Đuối nước: tử vong do ngạt 24 giờ sau khi tập ngâm. A: 28 nguyên nhân sau: co giật, người đứng đầu hoặc chấn thương cột sống, rối loạn nhịp tim, rượu / thuốc uống, ngất xỉu, ngưng thở, tự tử, hạ đường huyết. M. H : Hầu hết các bệnh nhân được tìm thấy sau khi bị chìm trong nước trong một thời gian không quan sát được | 120 Near-drowning CONDITIONS D Drowning death from asphyxia 24h of submersion in water. Near-drowning survival 24h after submersion episode. A 2 causes seizures head or spine trauma cardiac arrhythmias alcohol drug ingestion syncope apnoea suicide hypoglycaemia. 1 year bathtubs buckets of water. Consider child abuse in all cases. 1-5 years residential swimming pools. 15-19 years ponds lakes rivers and oceans. A R Inability to swim failure to observe water safety rules unsupervised swimming. E UK incidence 0.8 100000 year 54 children died of drowning in 2000. Worldwide 2 million died of drowning in 1998 BMJ . Peak age toddlers 4 years of age and 15-19 years. M F 12 1 boating injuries M F 4 1 non-boating injuries bathtubs F M. _H Most patients are found after having been submerged in water for an unobserved period. Relevant factors in the history include time under water associated trauma drug alcohol use water contamination water temperature rescue manoeuvres response to resuscitation. E Hypothermia tachycardia bradycardia tachypnoeia GCS. Severe cases may result in cardiorespiratory arrest. P Following submersion in water 90 aspirate water or gastric contents wet drowning 10 develop laryngospasm dry drowning . In both cases resultant hypoxia and metabolic acidosis can affect CNS hypoxic neuronal injury and subsequent cerebral oedema. Cardiovascular cardiac dysrhythmias - myocardial damage that may cardiogenic shock and hypovolaemia 2 to capillary permeability and intracompartmental fluid shifts. Respiratory aspiration causes disruption of surfactant pulmonary oedema and may result in ARDS. The mammalian diving reflex is protective and occurs if suddenly immersed in cold water. It produces apnoea bradycardia and vasoconstriction of nonessential vascular beds with shunting of blood to the coronary and cerebral circulation. I Bloods ABG FBC U E LFTs drug alcohol screen blood cultures. Monitoring cardiac pulsoximetry. Trauma series cervical spine chest pelvic X-ray. CT