Jul 16, 2014

Interviewer: The pool covers are starting to come off the pool. It's time to think about drowning and drowning safety. We'll talk about that next on The Scope. Medical news and research from University of Utah physicians and specialist you can use for a happier and healthier life. You're listening to The scope. Have you ever thought for a second what would you do if somebody was drowning? I mean what would you do after you got them out of the water and back up on the pool deck? We're going to find out right now with Dr. Scott Youngquist. He's in the emergency department here at University of Utah Hospital. Drowning, somebody drowns, the get their lungs filled with water. You pull them up on the deck. What then?

Dr. Youngquist: Bring them up and lay them on a flat surface, hard surface and if they're not breathing on their own begin CPR and mouth-to-mouth resuscitation.

Interviewer: All right.

Dr. Youngquist: There are some groups that actually recommend doing the Heimlich maneuver. We don't recommend that.

Interviewer: Interesting.

Dr. Youngquist: And the idea being that maybe you can force some water out of their lungs by doing the Heimlich maneuver which is basically applying a firm upward thrust to upper abdomen. And it works great if you've choked on a piece of chicken or something like that, but there's no evidence that it benefits patients whose lungs are full of water. It kind of makes sense that it wouldn't work as well because you've just got this column of water that you're pushing on. There's not really anything behind it, sort of like a piece of chicken that's got an airbag behind it.

Interviewer: Yeah.

Dr. Youngquist: And patients need immediate oxygenation and circulation of blood so the recommendation is that you begin CPR and mouth-to-mouth resuscitation. The other consideration though is that if the patient has dived into the pool and struck the bottom, and if the drowning is caused by a spinal injury then you want to be careful not to manipulate the neck too much while you're performing mouth-to-mouth resuscitation. So that's why we say lay them out on a flat surface. Try not to move them while help arrives. Have somebody call 911 and begin CPR.

Interviewer: So number one, call 911.

Dr. Youngquist: Yes.

Interviewer: Number two, if they're not breathing, CPR.

Dr. Youngquist: Yes, with mouth-to-mouth.

Interviewer: With mouth to mouth. Because I thought that the current standard was you didn't do the mouth-to-mouth anymore.

Dr. Youngquist: That's correct. In all cases except for causes of respiratory arrest. So if somebody's drowned then we'd begin mouth-to- mouth resuscitation in addition to CPR. It's one of those special cases.

Interviewer: Got you. Does that help clear the water out? I mean what happened to that water? I'd never thought of that.

Dr. Yongquist: Yeah. The idea is that some of that water is going to be absorbed into your circulation. Some of it they're going to choke back up. And the idea is you're trying to ventilate any unfilled parts of the lung, segments of the lung so that you can get some oxygenation in there. With enough airway pressure, a lot of times it comes up and either goes down the back of their throat or it'll be coughed out of the mouth.

Interviewer: Got you. But nothing you can actively do other than just providing CPR with mouth-to-mouth.

Dr. Youngquist: Yeah. The CPR will also drive some water out of the lungs as well.

Interviewer: OK. And then other than that, that sounds like about it, huh?

Dr. Youngquist: Yeah, wait for help to arrive. There's nothing else you can do.

Interviewer: All right. You bring up an interesting point, and it is the last question. So if they did hit their head on the bottom, are there any consideration actually getting them up and out of the pool or is the goal at that point just get them up and out of the pool.

Dr. Youngquist: Yeah. The goal is pretty much to get them out to do CPR as quickly as possible. If you can be careful about manipulating the neck. But the number one priority is getting them oxygenation and circulation restarted so whatever you have to do to get them out of the pool to a place where you can begin to perform resuscitation, that's the number one priority.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah's Health Sciences radio.

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