الفهرس 
ABSTRACTOnly 14 pages are availabe for public view
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Abstract
Background: In many countries, drowning is one of the leading causes of death for children under 14 years old. Children have drowned in wading pools and even bath tubs. The rate of drowning in populations around the world varies widely according to their access to water, the climate and the national swimming culture. Drowning-related injuries are the fifth most likely cause of accidental death in the US. The rate of near-drowning incidents is unknown. Drowning is death from suffocation (asphyxia) caused by a liquid entering the lungs and preventing the absorption of oxygen leading to cerebral hypoxia and cardiac arrest. It can be also dry drowning through severe laryngospasm. Near-drowning is the survival of a drowning event involving unconsciousness or water inhalation and can lead to serious secondary complications, including death, after the event. Secondary drowning is death due to chemical or biological changes in the lungs after a near-drowning incident. Submersion injury occurs when a person is submerged in water, attempts to breath, and either aspirates water (wet drowning) or has laryngospasm without aspiration (dry drowning) (10-15%). The most important contributory factors to morbidity and mortality are hypoxemia and a decrease in oxygen delivery to vital tissues, others due to altered body temperature (usually lowered). Fluid aspiration of as little as 1-3 ml/kg can result in significantly impaired gas exchange, primarily secondary to altered surfactant function. Atelectasis, pulmonary oedema, and acute respiratory distress syndrome (ARDS) from altered surfactant function and neurogenic pulmonary edema is a common complication. Hypovolemia is primarily due to fluid losses from increased capillary permeability. Ventricular dysrhythmias, pulseless electrical activity (PEA), and asystole due to hypoxemia, hypothermia, acidosis, or electrolyte abnormalities. CNS effect injury remains the major determinant of subsequent survival and long-term morbidity in cases of near-drowning primary CNS injury is initially associated with tissue hypoxia and ischemia. Fresh water is hypotonic to blood pulled into pulmonary circulation causing hemolysis of red blood cells, this leads to elevation of K+ level and depression of Na+ level. Ventricular fibrillation often causes cardiac arrest within 2-3 minutes. Salt-water is much salter than blood. So, water will leave the blood-stream and enter the lung. Cardiac arrest ensures after 8 to 10 minutes. The patient may die from chemical changes due to gas inhalation in drowning in polluted water as sewages. While in dry drowning, a patient may die from bronchospasm or die before the water enters the lung from any other cause as head injury. For prehospital care, the individual should be lifted out in a prone position. Theoretically, hypotension may follow lifting the individual out in an upright manner because of the relative change in pressure surrounding the body from water to air. Management of the ABCs is the priority, with particular attention to securing the earliest possible airway and attention to cervical spine precautions and providing adequate oxygenation (100% oxygen) and ventilation.
Objectives: The aim of the work is to make essay about drowning and near drowning in different types of water, to explain the pathophysiological changes of secondary drowning and to describe guidelines in management in pre-hospital and
in-hospital of near-drowning in adults and pediatrics.