Anaesthesia, 1975, Volume 30, pages 364-373
Thoughts on immediate care Anaesthetists are being increasingly called upon to give immediate treatment for various life-threatening conditions in casualty departments and elsewhere. This feature of short papers by invited experts is designed to describe the proper management of patients who require immediate care before the opinion of specialists in a particular field can be obtained.
The immersion incident F. ST C. G O L D E N
AND
J . F. RIVERS
In the past 10 years the Registrar-General’s records show that the death toll among immersion victims in waters of the United Kingdom, is on average about 700 per annum. This figure excludes immersion deaths due to suicide or where an open verdict was recorded. In America the figure is in the region of 60001to 7000’ while Miles3 estimates that the incidence on a global scale is 5.6 deaths/100,000 of the population, with Japan accounting for the highest incidence. In later years, there has been a steady increase in the number, both of incidents and deaths, which is hardly surprising when one considers the increase in population at risk. This trend is liable to continue with the ever increasing participation in aquatic activities by a population who are seeking excitement and relief from the boredom and overcrowding of our densely populated islands, but it is not only coastal waters that have experienced the upsurge in aquatic activities ; inland reservoirs and flooded gravel quarries and the like have, in recent years, become hives of recreational activity. It is therefore highly probable that every casualty officer will encounter several immersion casualties a year, while intensive care departments can anticipate the problems of management of some victims suffering the delayed effects. In the past, the majority of immersion victims were treated as drowning cases and managed accordingly but, with the increasing use of lifejackets, drowning may decline as a cause of death in immersion victims and hypothermia become more frequent, or at least many cases of drowning may be complicated by acute hypothermia. The management of such cases therefore should no longer be purely from the drowning aspect but it should also allow for the presence of hypothermia either alone or as a complicating factor. The authors are therefore of the opinion that one should talk in terms of ‘immersion’ rather than ‘drowning’. This paper examines the problem and outlines the management of such cases. F. St C. Golden, MB, BCh, DAv Med, Surgeon Commander R.N., Royal Naval Air Medical School and Physiology Dept. Leeds University, and J. F. Rivers, MB, BS, MRCP, Surgeon Commander R.N., Consultant Physician, Royal Naval Hospital Haslar.
364
The immersion incident
365
Mechanisms Survival after immersion will depend on the interaction of many factors; these include swimming ability, physical fitness, distance from safe refuge, buoyancy aids, sea state, water temperature, insulation, etc. Thus a good swimmer, in relatively warm water (15-25”C), will remain afloat until such time as he becomes too fatigued to continue to make swimming movements when he will no longer be able to keep his airway clear of the water and he will drown. This will happen relatively quickly in rough water. If the water is cold (
Thoughts on immediate care Anaesthetists are being increasingly called upon to give immediate treatment for various life-threatening conditions in casualty departments and elsewhere. This feature of short papers by invited experts is designed to describe the proper management of patients who require immediate care before the opinion of specialists in a particular field can be obtained.
The immersion incident F. ST C. G O L D E N
AND
J . F. RIVERS
In the past 10 years the Registrar-General’s records show that the death toll among immersion victims in waters of the United Kingdom, is on average about 700 per annum. This figure excludes immersion deaths due to suicide or where an open verdict was recorded. In America the figure is in the region of 60001to 7000’ while Miles3 estimates that the incidence on a global scale is 5.6 deaths/100,000 of the population, with Japan accounting for the highest incidence. In later years, there has been a steady increase in the number, both of incidents and deaths, which is hardly surprising when one considers the increase in population at risk. This trend is liable to continue with the ever increasing participation in aquatic activities by a population who are seeking excitement and relief from the boredom and overcrowding of our densely populated islands, but it is not only coastal waters that have experienced the upsurge in aquatic activities ; inland reservoirs and flooded gravel quarries and the like have, in recent years, become hives of recreational activity. It is therefore highly probable that every casualty officer will encounter several immersion casualties a year, while intensive care departments can anticipate the problems of management of some victims suffering the delayed effects. In the past, the majority of immersion victims were treated as drowning cases and managed accordingly but, with the increasing use of lifejackets, drowning may decline as a cause of death in immersion victims and hypothermia become more frequent, or at least many cases of drowning may be complicated by acute hypothermia. The management of such cases therefore should no longer be purely from the drowning aspect but it should also allow for the presence of hypothermia either alone or as a complicating factor. The authors are therefore of the opinion that one should talk in terms of ‘immersion’ rather than ‘drowning’. This paper examines the problem and outlines the management of such cases. F. St C. Golden, MB, BCh, DAv Med, Surgeon Commander R.N., Royal Naval Air Medical School and Physiology Dept. Leeds University, and J. F. Rivers, MB, BS, MRCP, Surgeon Commander R.N., Consultant Physician, Royal Naval Hospital Haslar.
364
The immersion incident
365
Mechanisms Survival after immersion will depend on the interaction of many factors; these include swimming ability, physical fitness, distance from safe refuge, buoyancy aids, sea state, water temperature, insulation, etc. Thus a good swimmer, in relatively warm water (15-25”C), will remain afloat until such time as he becomes too fatigued to continue to make swimming movements when he will no longer be able to keep his airway clear of the water and he will drown. This will happen relatively quickly in rough water. If the water is cold (
