Apresenta

1
How Lifeguards would know the severity, treatment
and outcome of drowning on the accident site
Dr David Szpilman
2
ESTABLISHED FOR ALL LIFEGUARDS
Cardiopulmonary arrest Start CPR immediately.
Respiratory arrest Start artificial ventilation
immediately.
These cases compose only 0.5 of all cases
rescued by lifeguards at the beach
3
What about 99.5 of all cases rescued at the
beach, what should be done?
?
Should we give oxygen in all cases? , if so, how
much?
Should we call an ambulance?
Should we transport all of them to a hospital?
Should we release or keep them a while in
observation?
How are we to know the prioritization on a busy
day?, and
How are we to know which cases need an EMT or an
MD?
4
On a busy day, as a lifeguard, would you get
medical support as quickly as you needed?
or
Do you need to know how to act appropriately and
confidently in those cases?
5
Thats why rescuers need a DROWNING
CLASSIFICATION SYSTEM
It gives the exact severity of the case
It gives exactly what approach should be taken
It advises when to call an ambulance
It advises when to call an EMT or a MD
It reassures lifeguards in front of the
population, and
It allows Lifeguards and MD teams to speak the
same language
6
DROWNING CLASSIFICATION SYSTEM How it was created
and applied in Rio de Janeiro
It was updated from a classification system from
1972
It was based on the evaluation of 41,279 rescues
The final group evaluated came from 1,831 medical
reports
It was based on beach and hospital attendance
Only clinical parameters were considered to
facilitate the use
It was adapted to be understood by lifeguards
Its been used since 1973 by more than 1,400
lifeguards in Rio de Janeiro
It was recently (2001) validated by a 10 year
study with 46,060 rescues, of which 930 (2)
were drownings attended at the DRC
7
On shoreline
Check victims response - Can you hear me?
No
Yes
Open airways - look, listen, and feel respiration
Check COUGH and FOAM in mouth nose
BREATHING PRESENT?
CSI ?
Yes
Absent
No
GREAT AMOUNT OF FOAM
Rescue
Give 5 mouth-to-mouth ventilations and check
Carotid pulse/signs of circulation
SMALL AMOUNT OF FOAM
COUGH WITHOUT FOAM
RADIAL PULSE ?
Carotid pulse present ?
yes
No
Yes
No
3
2
4
1
6
5
Basic Life Support (BLS) - Drowning - Szpilman
1997
8
Rescue
NO COUGH or FOAM IN MOUTH or NOSE Mortality - 0
9
Grade 1
COUGH , WITHOUT FOAM in MOUTH or NOSE MORTALITY -
0
10
Grade 2
1. Oxygen - 5 liter / min by nasal cannula. 2.
Warm and calm the victim. 3. Hospital
observation from 6 to 48 hours.
11
Grade 3
12
Grade 4
1. 15 liters/min of oxygen by face mask. 2.
Monitor breathing with care (may stop
breathing). 3. Right side recovery position. 4.
ACLS immediate with mechanical ventilation and
I.V fluids. 5. Urgent hospitalization in ICU
required
13
Grade 5
1. Start artificial ventilation immediately
(in-water) and keep it at a rate of 12 per min.
Victim usually recover after a few breathing. 2.
After restoring ventilation, follow guideline for
grade 4
14
Grade 6
1. Start and continue CPR. 2. No one is
considered dead if hypothermic. Do not give
up! 3. Do not resuscitate if submersion time over
1 hour or obvious physical evidence of death. 4.
After successful CPR, victim should be followed
as closely as possible and treated as grade 4.
15
CLASSIFICATION and MORTALITY (n 1831)
38,975 considered rescues cases were excluded
from this table
Using clinical classification at the accident
site we can recommend the treatment and know
exactly the likelyhood of death.
Dr David Szpilman
16
How we use a classification system
Helicopter
Victim
PWC
Boat
Resquest ACLS help
Lifeguard Rescue Begins
Lifeguard Beach support
ACLS
SZPILMAN 2000
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Lifeguard first checks the need for ACLS call. If
unconscious, ACLS is dispatched immediately.
Check ventilation/circulation and start
resuscitation if arrested
22
Sun shelter
Advanced Cardiac Life Support is done on the
accident site
Liquid (crystaloid)
Ventilation
Compressions
X
Aspirator
OTT plus Bag
Back Board
Desfibrilator ECG Monitor
Medication
Pulse oxymeter
IV route
23
If victim is alive, lifeguard treat the
patient first and then call ACLS, if needed
24
94.5 are discharged home directly from the
accident site
5.5 need to be transported to DRC
25
ACLS - ambulance
26
ACLS - helicopter for difficult access
27
Drowning Resuscitation Center
28
LIFEGUARDS and MEDICAL STAFF
ONE TEAM, ONE GOAL
29
ONE WORLD, ONE DROWNING LANGUAGE
WE CARE ABOUT