Deck 10: Near Drowning

Question 1

Which of the following age groups is not considered at high risk for drowning?

A)Toddlers between ages 1 and 4 years
B)Adolescents
C)Young adults between ages 15 and 24 years
D)Adult males between ages 45 and 55 years

Answer 1

D

Question 2

Why should the near drowning victim who is spontaneously breathing be transported to the hospital in the right lateral decubitus position?

A)To reduce the risk of neck trauma
B)To reduce the risk of aspiration
C)To reduce the risk of vomiting
D)To reduce the risk of pulmonary emboli

Answer 2

B

Question 3

According to the Orlowski Score,what pH value on the arterial blood gas suggests a poor prognostic sign in near drowning victims?

A)pH below 7.25
B)pH below 7.15
C)pH below 7.10
D)None of the above

Answer 3

C

Question 4

Which of the following is NOT true regarding the hemodynamic and electrolyte effects of near drowning?

A)Near drowning victims rarely show severe electrolyte or hemoglobin abnormalities
B)Hematocrit levels can be used to determine whether fresh or salt water has be aspirated
C)The type of fluid aspirated is not important in determining the hemodynamic response to near drowning
D)Pulmonary vascular resistance is elevated when hypoxia is present regardless of the tonicity of the aspirated water

Question 5

What percent of drowning deaths in the United States each year are male victims?

A)40%
B)55%
C)78%
D)None of the above

Question 6

Which of the following can cause cerebral vasoconstriction and can lower intracranial pressure as part of the treatment for a near drowning victim?

A)Use of lasix
B)Hyperventilation with the ventilator
C)High levels of oxygen
D)Heliox

Question 7

What two abnormalities are seen most often in near drowning victims on an arterial blood gas sample?

A)Respiratory alkalosis and metabolic acidosis
B)Respiratory acidosis and metabolic alkalosis
C)Hypoxemia and metabolic acidosis
D)Hypoxemia and respiratory alkalosis

Question 8

Which of the following facts is/are important to determine when a near drowning victim arrives at the emergency room?

A)The approximate temperature of the water
B)The length of time the victim was submerged
C)The victim's age
D)All the above

Question 9

According to the Orlowski Score,what percent of near drowning patients have a good chance of recovery when only two unfavorable prognostic signs are present?

A)50%
B)65%
C)75%
D)90%

Question 10

What is the primary concern during the first week for a near drowning victim who is sent home after 24 hours of observation and appears to be doing well?

A)Long-term neurologic damage
B)Sudden heart failure
C)Pulmonary infection
D)Pulmonary embolism

Question 11

Your near drowning patient has an initial Glasgow Coma Scale score of 13.What should be done?

A)Admit patient to the ICU
B)Admit patient to the pulmonary ward
C)Observe patient for 4-6 hours and send him home if SpO₂ is normal
D)Send the patient home as soon as he demonstrates the ability to swallow

Question 12

Which of the following statements is NOT true regarding pathophysiology of drowning or near drowning?

A)Only a small percent of victims aspirate water into their lungs
B)Victims usually swallow large amounts of water
C)Cold water near drowning victims can survive longer submersion times
D)When fresh water is aspirated it is hypotonic to the blood and rapidly passes into the blood stream

Question 13

Which of the following can increase intracranial pressure in the near drowning victim?

A)Hypoxia
B)Mechanical ventilation
C)Airway suctioning
D)All the above

Question 14

Which of the following physical examination findings is/are suggestive of neurologic injury?

A)Dilated pupils that respond poorly or not at all to light
B)Pulse rate below 60/min
C)Hypothermia
D)All the above

Question 15

About how many people drown in the United States each year?

A)1,200
B)3,400
C)6,000
D)8,500

Question 16

What minimum Glasgow Coma Scale score is associated with a low risk for neurologic damage and mortality?

A)4
B)6
C)8
D)10

Question 17

Which of the following statements is NOT true regarding factors associated with drowning and near drowning?

A)Drowning rates are inversely related to per capita income
B)Drowning increases during the summer months
C)Most drowning deaths occur in a large body of water far from shore
D)Most drowning deaths in children occur while supervision is present

Question 18

Which of the following parameters would you assess to determine perfusion in a near drowning victim?

A)Capillary refill
B)Extremity temperature
C)Sensorium
D)All the above

Question 19

Which of the following statements is true regarding the performance of chest compressions on a near drowning victim while still in the water?

A)They can only be done with two-person CPR
B)Use a rate that is twice that of normal
C)Compress more slowly and deeply
D)Do not attempt compressions in the water

Question 20

You are caring for a near drowning victim,but you do not know if significant hypoxia occurred during the event.Which of the following findings suggests that significant hypoxia did occur?

A)Metabolic acidosis on the ABG
B)SpO₂ reading below 92% upon arrival to the ER
C)Extremities are cool to the touch
D)Electrolyte assessment demonstrates low sodium levels

Question 21

You are performing CPR on a drowning victim and no pulse or spontaneous breathing has returned.Beyond what time does the prognosis decrease significantly if the CPR is not successful?

A)10 minutes
B)15 minutes
C)20 minutes
D)25 minutes

Question 22

Your patient has just entered the ER and was pulled from a swimming pool unconscious.Which of the following factors predicts a poor prognosis?

A)Elevated serum glucose levels
B)Hyperthermia
C)Hyperactive pupil response to light
D)All the above

Question 23

What is the key to reducing the number of drowning victims in the future?

A)Better CPR training
B)Reducing the number of pools and spas
C)Prevention
D)Providing defibrillators at public pools