Medical Question: Submerged Vehicle Part 2/2

We’re concluding Mart’s question today about treatment of victims that submerged their vehicle into the water. Last post, Dianna covered the EMS response. Today, I’m going to cover emergency department management.

Jordyn (ED Evaluation):
I’m going to start from the point that EMS brings them to the hospital. You say that one patient, Ruby, is conscious. I’m going to assume she had some period of time in the water and assume she was submerged. Yes, we will treat her. We’ll be concerned about how much water she inhaled into her lungs. She’ll be placed on a monitor that watches the electrical activity of her heart, her respirations, her oxygen level and checks her blood pressure every so often.
PhotoBucket/tomcat12161
If she has a fairly normal respiratory assessment: she’s breathing at a normal rate, her breath sounds when listened to with a stethoscope are clear, and she has a good oxygen level we will likely watch her for several hours to make sure these things stay normal. However, if her breathing rate is elevated, her breath sounds indicate fluid might be building up, and/or her oxygen level are low we will escalate her care.
 We would obtain a chest x-ray to look at her lungs. Supplemental oxygen. A blood gas which is a lab test to see how well her lungs are exchanging oxygen. If she is not breathing well on her own then she will be placed on a ventilator. This is a good medical overview: http://emedicine.medscape.com/article/908677-overview
Patients that are brought in unconscious and without pulse or breathing are essentially dead. It depends a lot on what we get from the EMS crew as to whether or not we will “work” the patient… meaning try to save their life by doing CPR, etc. If EMS says, “we saw the kid go in the water and we got him out quickly”– we’ll probably work that patient for awhile. A patient that is submerged when found with an unknown downtime, no pulse, no breathing, and has a normal body temperature may not be worked at all.
If the patient comes in with no pulse, no breathing and is hypothermic or has a low body temperature, it will be up to the physician whether or not to try and save them. There’s this saying in medicine: “you have to be warm and dead”. Many times, we’ll try and correct hypothermia to see if this will bring the patient back to life, particularly in cold water drowning.
If the patient is brought to the hospital but dies, the presiding ED doctor will declare death. However, if an autopsy is going to be done, then law enforcement/coroner’s office will take possession of the body.
It is possible to come in and be in a coma. This means that you have a pulse but may or may not be breathing. If you have a pulse and are not breathing, we will do that for you by putting you on a ventilator. Whether or not a person comes out of a coma depends on a myriad of factors and writers have a lot of latitude here. The person could wake up. The person could be in a persistent vegetative state on life support for the writer’s determined amount of time. The person could progress to brain death and be legally declared dead while still on a ventilator. Or, they could simply die from complications. The sister in the coma will be admitted to the ICU on life support until one of these four things plays out.
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Martha Ramirez has enjoyed writing stories, poetry, and drawing since childhood. Her first children’s book entitled The Fabulous Adventures of Fred the Frog was created and inspired by the curiosity and fascination her toddler has with books. Writing continues to be her passion as she strives to create stories children will love as well as learn from.
She is a reviewer for Bookpleasures and a member of YALITCHAT, ACFW (American Christian Fiction Writers), the Muse Conference Board, CataNetwork Writers, American Author’s Association, and CWGI (Christian Writers Group International).  She has written articles for Hot Moms Club, Vision, and For Her Information (FHI) magazine. Martha is looking forward to starting new projects and is excited to write in a new genre. She resides with her husband and son in Northern California where she is currently at work on a new series to a YA novel.

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