Cases reported "Drowning"

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1/13. Drowning and near-drowning--some lessons learnt.

    Over a period of sixteen months, 17 cases of submersion injury (encompassing victims of drowning and near-drowning) were attended to at our Accident and Emergency Department at Changi General Hospital. Most of the victims were inexperienced recreational swimmers, and in 6 of them, early bystander cardiopulmonary resuscitation enabled them to recover without severe morbidity. Non-cardiogenic pulmonary oedema with resulting chest infection was the commonest complication in survivors. Most of the episodes occurred in an urban setting in swimming pools without supervision by lifeguards. About two-thirds of the cases were adults over the age of fifteen years. In addition, there were patients in whom submersion injury was associated with more sinister conditions (fits, traumatic cervical spine injury, dysbarism, intoxication from alcohol or drugs), some of which were unsuspected by the doctors initially. Apart from the immediate threats of hypoxia and pulmonary injury, active search for any possible precipitating causes and associated occult injury should be made. In this study, the determinants of survival from near-drowning were early institution of cardiopulmonary resuscitation, presence of pupil reactivity, and presence of a palpable pulse and cardiac sinus rhythm.
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2/13. Pulmonary interstitial fibrosis following near-drowning and exposure to short-term high oxygen concentrations.

    Following near-drowning in fresh water, a 19-year-old man experienced severe adult respiratory distress syndrome, necessitating ventilatory support with positive end-expiratory pressure and high oxygen concentrations. Post-extubation, his course was highlighted by persistent hypoxemia and interrupted by a lung abscess which responded promptly to antibiotics. Pulmonary function tests were consistent with severe restrictive disease and chest radiograph revealed persistent bilateral alveolar and interstitial infiltrates. An open lung biopsy on the 26th hospital day showed interstitial fibrosis. Over the ensuing two months, the chest radiograph and pulmonary function tests returned towards normal. We attribute the pulmonary fibrosis to incomplete resolution of the alveolar interstitial pathology secondary to the near-drowning and exposure to high oxygen mixtures.
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keywords = chest
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3/13. Drowning: another plunge.

    Hypoxia, pulmonary edema, acidosis, and aspiration compose the syndrome of near drowning. A review of 20 cases of near drowning indicated that the initial chest roentgenogram bears little weight in assessing the present or future clinical status. In some cases a 24 to 48 hour delay occurred before roentgenographic evidence for pulmonary edema was noted. The composition of fluid aspirated does not affect the outcome. The results of this report suggest that patients with a history of near drowning should be followed closely for at least 48 hours despite an initial normal chest roentgenogram.
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keywords = chest
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4/13. skin tension and cleavage lines (Langer's lines) causing distortion of ante- and postmortem wound morphology.

    The assessment of individual wounds at autopsy may be complicated by the superimposition of a number of injuries or damage to tissues that occurred after death, either of which has the potential to distort the morphology of the initial injury. Additional factors that may change the shape of wounds are (1) the relationship of the wound to the so-called skin cleavage lines (Langer's lines) and (2) tension placed on the skin. Three autopsy cases are reported to demonstrate once more how wound morphology may be altered by such factors. In case 1, rectangular stab wounds to the base of the neck in a 53-year-old man, which suggested that a square or rectangular tool may have caused the injuries, were altered to more typical knife stab wounds once skin tension had been released at autopsy. The uppermost wounds, however, continued to gape due to the effects of skin cleavage lines. In case 2, slit-like wounds resembling stab wounds in the neck of a 54-year-old woman found in a river were shown to be circular once skin tension had been released. In case 3, the effects of either cleavage lines or skin tension could be demonstrated on excised wounds from a 43-year-old man whose body had also been found in a river; tensile forces easily changed circular into slit-like wounds. Tension and/or skin cleavage lines may transform round skin defects into slit-like wounds resembling knife stab wounds, round out genuine stab wounds and artefactually lengthen stab wounds. These factors must be taken into consideration carefully when wounds are assessed at the death scene prior to autopsy.
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5/13. Pathogenesis of unexplained drowning: new insights from a molecular autopsy.

    OBJECTIVE: To perform a molecular autopsy involving the RyR2-encoded cardiac ryanodine receptor/calcium release channel to determine whether mutations responsible for catecholaminergic polymorphic ventricular tachycardia (CPVT) represent a novel pathogenic basis for unexplained drownings. methods: A cardiac channel molecular autopsy was performed on 2 individuals who died of unexplained drowning and whose cases were referred to the Sudden death genomics Laboratory at the Mayo Clinic in Rochester, Minn. Comprehensive mutational analysis of all 60 protein-encoded exons of the 5 long qt syndrome-causing cardiac channel genes and a targeted analysis of 18 RyR2 exons known to host RyR2-mediated CPVT-causing mutations (CPVT1) was performed using polymerase chain reaction, denaturing high-performance liquid chromatography, and dna sequencing. RESULTS: Both individuals harbored novel mutations in RyR2. Postmortem mutational analysis revealed a familial missense mutation in exon 14, R414C, in a 16-year-old girl. A 9-year-old boy possessed a sporadic missense mutation in exon 49, V2475F. Both amino acid positions involve highly conserved residues that localize to critical functional domains in the calcium release channel. Neither substitution was present in 1000 reference alleles. CONCLUSIONS: This molecular autopsy study provides proof of principle that RyR2 mutations can underlie some unexplained drownings. A population-based genetic epidemiology study that involves molecular autopsies of individuals who die of unexplained drowning is needed to determine the prevalence and spectrum of KCNQ1 and now RyR2 mutations as potential pathogenic mechanisms for drowning.
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keywords = chest
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6/13. neisseria mucosus septicemia after near-drowning.

    neisseria mucosus is a normal inhabitant of the upper respiratory tract which may rarely cause serious infection. A 21-year-old woman had N mucosus bacteremia and the adult respiratory distress syndrome (ARDS) after a near-drowning episode. Despite appropriate antibiotic therapy and intensive respiratory support, the patient died. bacteremia with this organism is rare, and we believe it has not previously been reported in association with near-drowning.
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7/13. Chest radiographs of near-drowned children.

    From 1972 through 1983 there were 10 near-drowned children (7 boys and 3 girls) aged 1 to 4 years, treated as inpatients at the Children's Hospital of the Medical Academy Dresden. Three of them showed a severe aspiration pneumonia which in one case was complicated by bilateral pneumothoraces. In a further five children there were radiological signs of pulmonary oedema. Only in two children were the X-ray pictures of the chest normal.
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8/13. Sequential intellectual recovery after near-drowning.

    Sequential neurological and intellectual recovery after childhood near-drowning is discussed. Decisions concerning the persistence and intensity of resuscitation require a knowledge of the natural history of intellectual improvement after rescue from near-drowning. A severe case of fresh-water immersion, leading to recovery, is described. Evidence is presented to suggest that the time interval of one hour before the first spontaneous respiratory gasp forms the upper limit of the apnoeic time bracket after which survival can still be expected, and to indicate that intellectual improvement (to a measured IQ of 97) can occur even after initial decerebrate signs if vigorous therapy is prosecuted. The proportion of cases capable of sequential neurological improvement is unknown. A time base for sequential clinical and intellectual improvement after near-drowning is presented to form a yardstick with which future cases may be compared.
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keywords = upper
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9/13. invasive pulmonary aspergillosis after near-drowning.

    After near-drowning following a car accident, a 27-year-old man developed severe ARDS. Six days later aspergillus fumigatus was isolated in his sputum, and invasive pulmonary aspergillosis developed thereafter. Aspergillus titre increased, and chest tomograms revealed cavities in both lungs. The treatment consisted essentially of amphotericin b and 5 fluorocytosine, intravenously and by inhalation, intensive postural drainage and mechanical ventilation with PEEP. After 41 days he was cured and discharged from the ICU. Six months later he returned to his job and clinical examination was normal.
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keywords = chest
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10/13. Resuscitation from drowning.

    The resuscitation of a 21-year-old man after submersion in fresh water for at least 5 min is described. On admission to hospital the patient appeared dead with fixed dilated pupils, deep cyanosis and asystole. Twenty min later the patient was transferred to the intensive care unit with a recordable blood pressure. On arrival there he was breathing spontaneously and so was not ventilated. A few hours later he developed pulmonary oedema and died.
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