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Emotional sequelae of parents and sibs following the drowning or near-drowning of a child.

This study reports the findings from an investigation to evaluate the intra-family dynamics that occurred with 111 cases of childhood drowning and near-drowning in the City of Brisbane in 1971-1975. Personal interviews were obtained with 77 of the families. 24 per cent of parent-dyads separated following the drowning of their child, whereas none of the 54 families of surviving children separated. Accident generated stresses within the studied families tended to persist for years after the incident. Parents volunteered the information that they drank more, experienced sleep disorders and nightmares, and reported significant anxiety states. 19 per cent of parents of drowned children received specialist psychiatric treatment following the drowning. Two cases of surviving children received specialist psychiatric therapy (these were both parents who had inflicted non-accidental injury on their child, and had attempted to drown their child in the bath). In one sense, a child's death is more honourable from society's point of view if the child dies from a chronic medical illness such as leukaemia. In the case of a child's death in the family bath tub or the backyard swimming pool, the extra society sanctions of culpability and accusation further intensified the likelihood of the normal grief process being transformed into a pathological variant.

Adult

Drowning and near-drowning. Pathophysiology and therapy.

Drowning is one of the three leading causes of accidental death. Dry drowning, the type in which no water enters the trachea, responds readily to resuscitation efforts. The current concept of drowning recognizes few differences between saltwater and freshwater aspiration; the therapeutic approach is the same for both types. The physician should be prepared to deal with the drowning victim at the scene of the accident as well as in the hospital. Hospitalization for observation is necessary in every instance, as adult respiratory distress syndrome may develop and cause secondary drowning.

Adolescent

Drowning and near-drowning involving children: a five-year total population study from the City and County of Honolulu.

A study of all serious childhood immersion accidents (both drowned and near-drowned cases) is reported from Hawaii. This is a total population-based survey of 140 consecutive cases (0--15 years) occurring during the five-year period (1973--1977. Age-specific, sex-specific, and osmolality-specific (salt versus fresh water) data are presented both for survivors and fatalities. The overall annual drowning rate of 3.1 per 100,000 children at risk is low, for a water-oriented society. The survival rate following loss of consciousness in the water is 73 per cent. There is no evidence from this study that osmolality affected the probability of survival. The rank order of importance of drowning sites is swimming pools, surf, sheltered salt water bathing, domestic bath tubs, fresh water streams, salt water canals, and garden fish ponds. Specific accident rates, by sex, outcome, and site of immersion are also presented. No secular trend in the rate of drowning was observed in this study. Comparison with the only other available total population survey (Australia) of childhood immersions reveals common epidemiological and demographic patterns in modern urban societies and suggests that safety regulations play a role in reducing swimming accidents and fatalities in children.

Adolescent

Freshwater drowning and near-drowning accidents involving children: a five-year total population study.

A large total population study of childhood fresh water immersion accidents is reported. The study was undertaken in the City of Brisbane over the five-year period 1971 to 1975 inclusive, and 111 fresh water immersion accidents involving children were studied and analysed. The childhood fresh water immersion accident rate, including drowning and near-drownings, of 10-43 per year per 100,000 at risk (fatality rate of 5-17) is the highest reported. If an unsupervised child gets into difficulties in fresh water and loses consciousness he has a 50% chance of dying. The immersion accident rate has doubled over the last six years. Age-specific immersion accident rates have been calculated, and have revealed that, in the toddler group (12 months to 23 months), the fresh water immersion accident rate is 50-01 per 100,000 (fatality rate of 22-55). Rates for drowning and near-drowning accidents after a fresh water immersion, by site, age and outcome (survival versus fatality), are also presented for the first time. Swimming pools produce 6-20 immersion accidents per year per 100,000 children at risk, and the domestic family bath tub produces 1-78. Possible factors explaining the high incidence are discussed, and comparisons of drowning rates from other centres are made.

Accidents

Prognostic factors in pediatric cases of drowning and near-drowning.

Ninety-three cases of drowning or near-drowning in the pediatric age group between 1972 and 1976 were reviewed. A scoring system for prognostic factors was developed using one point for each of five unfavorable factors involved in the drowning or near-drowning of each patient. The prognostic factors were 1) age less than three years; 2) maximum submersion time estimated longer than five minutes; 3) resuscitation not attempted for at least ten minutes after rescue; 4) patient in coma on admission to hospital, and 5) arterial blood pH of less than or equal to 7.10. This scoring system significantly predicted the eventual outcome of patients who had experienced the postsubmersion syndrome. Patients with scores of less than or equal to 2 had a 90% chance of full recovery; those with scores of greater than or equal to 3 had only a 5% probability of survival. The early institution of resuscitative efforts was the single most important factor influencing survival.

Adolescent

Drowning and near-drowning: current concepts and neutrophil function studies.

A near-drowning by a young man in an indoor pool is reported, and the current concepts of therapy are discussed. Laboratory studies of the patient's neutrophil function and chemotactic response were performed on the day of admission and on hospital days 2 and 4. Neutrophil function and chemotaxis were equal to control values, indicating no effect of near-drowning on these aspects of the host immune system. Hospital admission and supportive therapy including intubation, positive end-expiratory pressure, steroids, and antibiotics are recommended, if necessary, in management of the nearly drowned patient.

Adolescent

Sand aspiration in drowning and near drowning.

Aspiration of sand and other foreign material is often discovered at autopsy in victims of drowning, but is not commonly seen radiographically. Two such cases are described, one of drowning and one of near drowning. In each case, the sand was radiopaque because of its calcium carbonate content and created a "sand bronchogram", i.e., sand in the tracheobronchial tree. With early recognition, successful bronchoscopic removal of the aspirated sand is possible.

Adult

Saltwater drowning and near-drowning accidents involving children. A five-year total population study in south-east Queensland.

A large total population study of childhood saltwater immersion accidents is reported. A total of 49 cases (16 fatalities, 33 survivors) occurred in the five year period from 1971 to 1975 in southeastern Queensland. As a group, more children survive a potentially fatal saltwater immersion (67%) than do those who lose consciousness in freshwater (50%). The serious saltwater accident rate (loss of consciousness or death) in childhood (from 0 to 15 years inclusive, is 3.37/100,000 children per year at risk (fatality rate 1.12). This is low; comparison with freshwater data shows that although the surf presents special hazards to children, it is very much safer than other types of water. Age-specific and site-specific accident and survival rates for saltwater immersions are presented for the first time. Toddlers are disproportionately represented (33% of all children) and their survival rates are lowest. Boating and the use of surfboards, in current practice, are negligible threats to children. The saltwater immersion rate is increasing (although the absolute risk is small) and reasons for this are discussed. Childhood saltwater immersions were unaffected by tidal state. All but one case of immersion occurred during daylight hours, and in younger children immersion occurred often on weekends.

Accidents

Drowning and near-drowning in the Australian Capital Territory: a five-year total population study of immersion accidents.

A total population study of all serious immersion accidents is reported from the Australian Capital Territory. The annual immersion accident rate of 4-69 per 100,000 of the population at risk is low, and the fresh water fatality rate of 2-58 per 100,000 is very low. The annual fatality rate for childhood swimming pool accidents is 0-34 per 100,000 children (that is, under 16 years of age) at risk. Serious immersion accidents are not increasing in frequency, in striking contrast to the epidemic trends seen from other centres. Factors which might explain this are discussed.

Accidents

Profile of pediatric drowning victims in a water-oriented society.

Drowning accounts for 32% of all pediatric accidental deaths in Dade County, Florida. Swimming pools, primarily home pools, are the most common site, 38%; followed by canals, 27%; lakes, ponds and rockpits, 13%; and the ocean and bay, 11%. The majority of drowning victims could not swim and were dead at the scene of the accident. Most pool victims were white, male, and 3 years old. Most victims were thought to be engaged in a non-pool related activity before the accident. Children who drowned in lakes, ponds, and rockpits, canals, and the ocean and bay were usually of school age and unsupervised. Black children had a higher rate of drowning than white children in these sites. Recommendations to prevent drowning: 1) Community education programs; 2) Safety fence around the perimeter of swimming pool; 3) Higher water levels in pools; 4) Investigation of "drown-proofing" instructions for preschool children; 5) Mandatory swimming and water safety instructions in public schools; 6) More supervised public swimming sites.

Adolescent

[Recovery from apparently hopeless fresh-water drowning (author's transl)].

Report of 3 cases of drowning (children). 2 patients survived without severe injury, 1 patient died after 13 days. The protective action of hypothermia to the brain and heart in hypothermic drowning is emphasized. Even in apparently hopeless cases resuscitation should be started immediately and should not be discontinued too early. Especially in hypothermic drowning efforts can be successful after more than 60 min. of resuscitation. In cases of drowning an emergency physician should be called immediately (emergency-ambulance, rescue-helicopter). A short survey of pathologic physiology, emergency therapy and intensive care of drowning is given.

Adolescent

[About the problem of "lungs in drowning" (author's transl)].

In order to remove any misunderstanding I would like to reply to the publication by HEINEN und DOTZAUER as follows: The statements and conclusions of the authors must inevitably give rise to the impression that my detailed investigations of the reticular fibre texture of the drowned lung is to a large extent non-specific and thus of no use for an expert opinion on death by drowning. The authors, who base their statements on a dissertation by Mrs. HEINEN, have apparently overlooked the differences in aetiology between typical and atypical drowning and thus also have misunderstood the pathogenesis of the typical drowned lung both with respect to gross and fine tissue aspects. Characteristic of typical drowning is acute diffuse bronchostenotic emphysems of the lung.

Bronchi

Drowning in Australia: a national appraisal with particular reference to children.

National statistics of drowning (accidental and submersion) for Australia, by State, age and sex have been compiled. The national rate is 3.29 per 100 000 which compares well with that from other countries of similar latitude. The national childhood drowning rate (age group of 0 to 14 years) is 5.19 per 100 000; the rate for the 0 to four years age group ranges from almost zero in the Australian Capital Territory to 15.69 in Queensland. In all States, a drowning rate for preschool children is at least four times that of school children. Preschool versus total drowning ratios have been calculated, by State; the rank order of this data (those of Victoria are highest at 4.65) is further evidence that climatic factors alone are not necessarily major predisposing causes leading to high drowning statistics of preschool children observed in other series.

Adolescent

[Intense therapy in two cases of "near-drowning" (author's transl)].

A short review of the pathophysiological mechanisms in case of 'drowning' or 'near drowning' with or without aspiration of hypo- or hypertonic water is given. In our clinical experience on 22 cases, 17 did not need intensive care and improved without further problems. 3 came dead into the clinic, there being more than 30 min latency between cardiac arrest and the beginning of resuscitation, resuscitation, therefore, being without success. The last 2 cases of 'near-drowning' with fresh water aspiration developed, 100 min and 50 min respectively after the drowning accident, fulminant pulmonary oedema, which could be cured after application of PEEP in Engstroöm-IPPB in one case. In our opinion PEEP should be applied in all cases of intraalveolar pulmonary oedema in the same way as was advised for interstitial pulmonary oedema, if the individual case requires mechanical ventilation at all. The possibility of pulmonary oedema developing, even hours after the accident and primary resuscitation, should be born in mind in all cases of 'near-drowning'.

Adolescent