Acute renal impairment after immersion and near-drowning.
Acute renal impairment (ARI) secondary to immersion and near-drowning is rarely described and poorly understood. A retrospective case-control study was performed: (1) to determine the incidence of ARI associated with near-drowning or immersion and (2) to define the clinical syndrome and to assess clinical predictors of ARI. Of 30 patients presenting after immersion or near-drowning, 50% were identified with ARI, with a mean admission serum creatinine of 0.24 +/- 0.33 mmol/L (2.7 +/- 3.7 mg/dl). These patients were a heterogeneous group: Eight had mild reversible ARI, three had ARI related to shock and multisystem failure, two had rhabdomyolysis-related ARI, and two had severe isolated ARI. Two patients required supportive hemodialysis and two died. Patients with ARI experienced more marked acidosis than control patients, as measured by serum bicarbonate (P < 0.001), pH (P < 0.001), and base excess (P < 0.001). There was also a higher admission lymphocyte count in the ARI group (P = 0.056). Dipstick hematuria on admission was significantly more common in patients with ARI (P = 0.016), and patients with 2 to 3+ of admission dipstick proteinuria had a higher peak serum creatinine than patients with less proteinuria (P < 0.05). Admission predictors of ARI by univariate logistic regression analysis included reduced serum bicarbonate (P = 0.002), pH (P = 0.001), and base excess (P < 0.001). The best predictor of ARI on multivariate analysis was a negative base excess (P = 0.01). In summary, acute renal impairment commonly occurs after immersion and near-drowning and is a heterogeneous condition. Although mild reversible renal impairment (serum creatinine < 0.30 mmol/L) (3.4 mg/dl) is usual, severe acute renal failure requiring dialysis can occur. It is recommended that any patient who presents after near-drowning or immersion should be assessed for potential ARI by serial estimations of serum creatinine, particularly when there is an increase in the initial serum creatinine, marked metabolic acidosis, an abnormal urinalysis, or a significant lymphocytosis. (+info)
Acute subdural hematoma due to near-drowning--case report.
A 46-year-old male was transferred to our hospital after near-drowning when swimming. Examination found no subcutaneous hematoma or abrasion on his head. Cardiopulmonary resuscitation was started immediately. Emergent computed tomography (CT) revealed no abnormalities. The next day, his consciousness level improved and repeat CT suggested an acute spontaneous subdural hematoma in the parieto-occipital region. The acute subdural hematoma was evacuated. The source of bleeding was probably an abnormally large vein located in the center of the hematoma. The patient was discharged without neurological deficit. Repeat CT is needed even if there were no abnormality on initial CT after drowning. (+info)
Epidemiology of unintentional drowning and near-drowning in Denmark in 1995.
OBJECTIVES: To determine the pattern of accidental drowning and near-drowning in Denmark. DESIGN: Prospective study of all cases of accidental drowning and near-drowning during one year. SETTING: Denmark, 1995. SUBJECTS: All patients brought to Danish hospitals after incidents of unintentional near-drowning or cooling in water and all fatal cases. MAIN OUTCOME MEASURES: Number of near-drowned patients reported prospectively by hospital departments supplemented by cases reported after requests based on the National Patient Register. Number of drownings reported by public health medical officers (as medical examiners), institutes of forensic medicine, and hospitals. RESULTS: Sixty three (38%) of 167 unintentionally immersed persons died: eight (17%) of 47 children and 55 (46%) of 120 adults. The annual incidence of serious immersion events in children leading to hospital contact was 5.2/100,000; mortality was 0.7/100,000. For adult males the annual incidence of serious unintentional immersions was 4.3/100,000 and for females 1.2/100,000. For foreigners the risk was three to four times higher than for Danes. CONCLUSIONS: More attention should be paid to the risk of drowning in children, adult males, and foreigners. (+info)
Rapidly progressive pneumonia due to Aeromonas hydrophila shortly after near-drowning.
An 87-year-old woman died of rapidly progressive pneumonia due to Aeromonas hydrophila shortly after a near-drowning event. Autopsy showed necrotizing pneumonia and postmortem cultures of both blood and lung revealed the organism. Fulminant pneumonia should be considered in patients of a near-drowning event. (+info)
Injuries in whitewater kayaking.
OBJECTIVE: To provide epidemiological data on whitewater kayaking injuries using a descriptive study. METHODS: A retrospective survey was distributed at whitewater events and club meetings, and made available and advertised on the world wide web, through postings and announcements to newsgroups, related sites, and search engines. Data on sex, age, experience, and ability were collected. Injury data collected included mechanism, activity, difficulty of rapid, and self reported severity. RESULTS: Of the 392 kayaking respondents included in the final analysis, 219 suffered 282 distinct injury events. The number of days spent kayaking per season was the only independent predictor of injury. The overwhelming majority of injuries occurred while the kayaker was still in the boat (87%). Striking an object was the most common mechanism of injury (44%), followed by traumatic stress and overuse (25% each). The most common types of injury were abrasion (25%), tendinitis (25%), contusion (22%), and dislocation (17%). The upper extremity, especially the shoulder, was the most commonly injured area of the body. Although half of injured kayakers sought medical care for their injury, and almost one third missed more than one month of kayaking because of the injury, almost all (96%) reported a complete or good recovery. CONCLUSIONS: Factors relating to likelihood of injury appear to be connected with exposure, namely the number of days a year that the sport was pursued. Except for class V (extreme) kayakers, reports of injuries paralleled the number of participants. Kayakers reported injuries predominantly on rivers that they assessed to be at a level appropriate to their skills. (+info)
Use of Washington State newspapers for submersion injury surveillance.
OBJECTIVES: To evaluate the usefulness of newspapers as a surveillance tool for submersion injury, the proportion of submersion events and important details reported in Washington State newspapers was determined. It was also determined whether a letter sent to newspaper editors to encourage reporting changed the proportion and content of reported submersion events. METHODS: Newspaper articles regarding submersion were collected from 225 Washington newspapers from June 1993 through September 1998. Newspaper articles were linked to computerized state death and hospital records. Reporting during periods before and after a letter was sent encouraging more newspaper articles on submersion injury and preventative factors was compared. RESULTS: A total of 1,874 submersion victims were identified in the three data sources. Of the 983 victims who had a death certificate, 52% were reported in at least one news article. Of the 471 persons in hospital discharge data, 25% were reported in a newspaper. Reporting of pediatric victims who died increased from 63% to 79% (p=0.008); reporting of hospitalized persons increased from 23% to 27% (p=0.3). There were increases in reporting of swimming ability (7% to 15%, p<0.001), supervision (82% to 91%, p<0.001), and alcohol use (7% to 24%, p<0.001). Reporting of life vest use decreased (35% to 23%, p<0.001). CONCLUSIONS: Newspapers failed to report about one half of fatal submersions and three quarters of submersions that resulted in a hospitalization. An effort to improve reporting was associated with an increase in the proportion of pediatric drownings that were reported, but a consistent improvement in content was found. The usefulness of newspaper articles as a surveillance tool may be limited. (+info)
Mycotic aneurysms as lethal complication of brain pseudallescheriasis in a near-drowned child: a CT demonstration.
Intracranial true mycotic aneurysms are rare and generally lethal. We report a case of a near-drowned child with brain abscesses due to Pseudallescheria boydii, a saprophytic fungus, who died after subarachnoid hemorrhage occurred. CT showed contrast-enhancing lesions indicative of aneurysms of basilar and right posterior cerebral arteries that could not be appreciated 2 days before. P. boydii is often resistant to commonly used antimycotic drugs. Because CNS infection is frequently associated with near-drowning, early diagnosis and specific therapy are strongly recommended for these patients. (+info)
Drowning and near drowning in children in the United Kingdom: lessons for prevention.
OBJECTIVES: To determine the pattern of drowning and near drowning of children in Britain and identify means of prevention. DESIGN: Study of drowned and nearly drowned children under 15 years old. SETTING: United Kingdom, 1988 and 1989. SUBJECTS: Children under 15 years either drowning or admitted to hospital after a submersion incident. MAIN OUTCOME MEASURES: Number of nearly drowned children, obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Number of drowned children notified by the Office of Population Censuses and Surveys and other national epidemiological offices; information from coroners. RESULTS: 306 children had confirmed submersion incidents: 149 died and 157 survived after near drowning. The annual incidence in England and Wales was 1.5/100,000, and mortality 0.7/100,000. Mortality was lowest in public pools 6% (2/32) and highest in rivers, canals, and lakes (78%, 56/73). Most of the children (263, 83%) were unsupervised at the time of the accident. 208 (68%) children were under 5 years old. CONCLUSIONS: Drowning and near drowning of children are problems in the British Isles. Appropriate supervision and safety barriers seem important for preventing such accidents. Improving information on dangers of drowning given to parents through the child surveillance programmes, encouraging fencing or draining of garden ponds and domestic swimming pools, and increasing supervision of swimming in lakes, rivers, and beaches should reduce the number of accidents. (+info)