Secondary Drowning: Recognizing the Signs is Essential to Survival

It’s summertime again and we are all enjoying the hot summer sun and our cool lakes and pools! As we relax and play in the refreshing waters, it is also important to remember to practice safety in order to prevent water-related accidents, particularly those that may lead to secondary drowning events. Secondary drowning, as with all accidents, occurs when we least expect it. This type of drowning is rare – it occurs in only 1-2% of all drowning injuries, but it is very important to recognize the signs and seek treatment early to prevent serious injury or fatality.

What is secondary drowning?

Secondary drowning can occur after a person inhales water into the lungs during a near-drowning or water-struggle event. Those affected tend to appear to recover quickly and resume their normal activities. Unfortunately, if water is inhaled in large enough amounts, the person can suffer a cascade of physical changes in the lungs that result in lung swelling and reduced air exchange. The signs and symptoms are often not immediately apparent, and may take as long as 72 hours after the incident to occur. Airway spasms in the throat and bronchial areas may also ensue, once again leading to reduced oxygen exchange. Secondary drowning creates a perfect environment for pneumonia to cultivate in the lungs, complicating treatment and prohibiting recovery.

What are the signs and symptoms of secondary drowning?

Initial signs and symptoms are often subtle and difficult to determine, particularly in children who are already tired after an active day of water play. They include:

  • Fatigue
  • Drowsiness
  • Cough, wheezing, or complaints of chest pain
  • Changes in their voice
  • White, blue, purple, or pale pallor to the face, lips, or nail beds
  • Sudden changes in behavior
  • A person experiencing airway spasms (indicating an inability to breathe) or frothy, pink foam in the mouth or throat is having a serious medical emergency — 911 emergency services should be notified immediately!

What should I do if I witness or experience a water-struggle event?

It is essential to closely monitor the person for signs and symptoms over the next 24-72 hours. If any of the above symptoms are detected, or you notice any abnormal behavior, seek medical evaluation immediately. Early intervention is key to recovery.

If you have any concerns that water inhalation has occurred, report to the ER for evaluation, even if signs and symptoms do not appear to be present.

How can I prevent secondary drowning?

  • Everyone should know how to swim – and all adults should learn CPR so they may be able to assist in an airway emergency.
  • Provide close, attentive adult supervision of children at all times when water is nearby – put away your cell phones, magazines, alcoholic beverages and other distractions.
  • Remember, water drowning can also occur in bathtubs, baby pools and even buckets, so be alert to unexpected sources of water when children are in the area. And don’t forget to flip over those baby pools and water buckets to empty them of water when not in use.
  • Designate a group of adults to supervise children and take turns relieving the adults of duty.
  • Erect security fencing around pool areas with self-latching locks out of reach of children. You can also add fence and pool alarms to alert you if an unsupervised entrance occurs.
  • Teach children not to panic in water, to be familiar with water safety, and to ‘blow out’ water that gets in their mouth, not inhale it.
  • Always wear Coast Guard-approved flotation devices in the water, especially in open swim areas (oceans, lakes and rivers).
  • Avoid alcoholic drinks or other mind-altering substances which may impair judgment.
  • Learn water and boating safety at your local community pools, YMCA, American Red Cross, aquatic and fitness centers, and state parks and wildlife departments.

I hope you have found this information beneficial. Have a safe and happy summer!

For more information on this topic, you may access the following resources

WebMD information about Dry Drowning
PubMed
CDC information on child water safety
CDC information on recreational water illness and injury prevention
News story from Asbury Park Press about a recent secondary drowning
News story from Good Day Austin

Donna Welborn, B.S.N., R.N.
Trauma Injury Prevention Coordinator
St. David’s Round Rock Medical Center

8 Steps to Proper Food Handling For Your 4th of July

Millions of Americans will be dusting off their grills for Independence Day. St David’s Round Rock Medical Center wants to make sure you are taking proper steps when preparing your 4th of July meals. Follow these tips to help keep you and your guests free of tummy troubles and out of the emergency room this holiday weekend.

Steps to Ensure Proper Food Safety

  1. Wash your hands thoroughly with warm water and soap for at least 20 seconds before and after handling food—especially when handling raw meats.
  2. Use separate cutting boards—one for raw meats and another for fruits and vegetables.
  3. Wash all surfaces that come in contact with your food with warm, sudsy water after food preparation, this includes cutting boards, countertops, utensils and knives.
  4. Thaw frozen food safely in the refrigerator, under cold running water or in the microwave. Never thaw food at room temperature. Remember to allow enough time for thawing before cooking (consult your cookbooks or meat labels for recommended thawing times).
  5. Don’t prepare food for others if you have diarrhea or vomiting.
  6. Use a food thermometer to ensure meats are cooked to a safe internal temperature, making sure to place the thermometer at the thickest, inner section of the meat. Cook to an internal temperature of 145°F for whole meats, 160°F for ground meats and 165°F for poultry.
  7. Refrigerate or freeze leftovers within two hours of cooking. Make sure to consume refrigerated food within 3-4 days. Don’t taste or consume foods that look or smell questionable. When in doubt, throw it out!
  8. Keep your refrigerator temperature below 40°F and your freezer below 0°F.
  9. Separate raw meats and seafood from prepared foods, raw fruits and vegetables in your refrigerator and freezer.

Helmet Safety: Preventing Head Injuries in Children During Summer Activities

Summer is here, and with it comes outdoor activities, such as skating, skateboarding and biking. It is important to practice safety measures when participating in wheeled-sport activities.

A study in the New England Journal of Medicine reported safety helmets can reduce the risk of severe brain injuries by 88 percent, yet only 55 percent of children typically wear a bike helmet.

Head injuries are classified as any trauma that leads to injury of the scalp, skull or brain. They can range from a minor bump on the skull to a serious brain injury.

Head injuries are divided into two types, closed-head injuries and open-head injuries. An open-head injury is an injury in which the head is struck with an object that breaks the skull and enters the brain. This usually occurs when a person is moving at a high rate of speed. A closed-head injury is one in which the skull is not penetrated.

Closed-head injuries in children are, unfortunately, a common occurrence in emergency rooms. Incidents can range from a mild bruise to a skull fracture with brain hemorrhage, requiring urgent neurosurgical intervention.

A study published by the medical journal of the American Academy of Pediatrics found that simply wearing a bicycle helmet is not enough to protect a child’s head—a helmet must be properly fitted. Surprisingly, only 4 percent of children in the study wore helmets that were in acceptable condition with a good fit. Too often, helmets are loose, not buckled or ride too high on the forehead, allowing them to slide or fall off. When a helmet doesn’t fit properly, it is of little or no use.

A properly fitting helmet can turn a potential emergency into a minor occurrence. The helmet is designed to absorb the impact and protect the vulnerable brain underneath.

To help ensure children are safe when biking, skateboarding or skating, the St. David’s Round Rock Medical Center trauma department partnered with the Texas Medical Association to distribute and fit bicycle safety helmets during H-E-B Wellness Days in Round Rock. On Saturday, June 14, St. David’s Round Rock Medical Center donated 50 helmets.

The Pool “Noodle” – Not Just for Relaxing

It is officially summer in Austin, and that means more time spent in the water cooling off. At St. David’s Rehabilitation Hospital, we find that many of our patients benefit from the buoyant and resistive properties of water year-round in our indoor therapy pool. One of the tools used most frequently in our pool is the “noodle.” These inexpensive pool toys can be found almost anywhere during the summer season, and many rehabilitation patients have no idea they can use their noodle for exercise in addition to using it for floating and relaxing.

Below are just a few of the many exercises you can do with just a pool and a noodle. Try them out next time you find yourself in the water – your body will thank you!

Getting started:

  • Start in the deep end of the pool, where your feet will not hit the floor
  • Keep your body vertical with your legs underneath you, rather than out in front of your body
  • Straddle a large-diameter noodle between your legs, as if sitting on a horse
  • Sit up “high in the saddle” – don’t slouch!
  • Engage your abdominal muscles by pulling your belly button in and up.

Exercise 1: Bicycling
Pedal your legs as if riding a bicycle. Begin slowly with large revolutions to stretch out your muscles. Gradually go faster once you have warmed up.

Exercise 2: “Half” Jumping Jacks
Keeping your knees straight and ankles flexed (toes pulled up toward you), bring your legs out to the side and then back together in the center. It’s like doing jumping jacks without using your arms.

Exercise 3: Cross-country Skiing
Keeping your legs straight and ankles flexed, “scissor” your legs as if cross-country skiing. Bring one leg to the front while the other goes slightly behind you. Remember to stay vertical!

Not so fast:

You can do any of the above exercises quickly, slowly or at your own pace. In general, slower movements will be larger and will help you stretch your muscles. Quick movements will be smaller and will provide more resistance for strengthening of the muscles. Make sure not go so fast that you end up sacrificing good form – and remember to sit up tall!

Arm movements:

When you feel comfortable enough, you can start to add arm movements to these exercises. This will increase your cardiovascular involvement and offer a better overall workout. To do so, you can cup your hands for resistance as you make circles. You can also swing your arms at your sides or bring them horizontally out and in across the surface of the water.

Enjoy the summer and your new water exercise regimen!

Vickie Walker, PT, Aquatics Program
St. David’s Rehabilitation Hospital

Managing Heart Failure

Heart failure has a variety of causes, including damage from a previous heart attack, chronic high blood pressure, valve disorders, infections and genetics. In general, a weakened heart isn’t able to pump blood adequately to meet the body’s demands, causing a buildup of fluid that leads to swelling (edema), shortness of breath and severe weakness. Sadly, the body’s feedback mechanisms tell the heart to work harder to compensate, further weakening an already damaged heart.

This cycle often repeats in a downward spiral. In fact, patients with heart failure can often feel like they are in a revolving door that leads back to the hospital. It is estimated that as many as 50% of patients hospitalized for an exacerbation of heart failure will be re-hospitalized within six months. However, by making some changes to your lifestyle you can help manage your heart failure, live longer, feel better and reduce trips through the hospital doors.

Here are some tips to help you manage heart failure:

Medications

  • Refill all of your prescriptions before you run out, and make sure you take your prescriptions exactly as directed at the same time(s) each day.
  • Some medications for heart failure may cause unpleasant side effects, such as a dry, hacking cough or frequent urination. Let your doctor know about side effects that are bothering you. A dosing adjustment, timing adjustment or alternative medication prescribed by your doctor may help decrease side effects.
  • Never stop taking medication or change your medication dose without your doctor’s approval.


Diet

  • Follow your doctor’s orders regarding limits on the amount of fluid you should consume each day. Invest in a mug or cup with volume measurements, and keep a log of your daily fluid intake.
  • Keep your salt intake within the doctor’s limits. Start by making small changes, like taking the salt shaker off the table. Over time, your taste buds will adjust.
  • Replace the salt shaker with salt-free herb mixes found in the spice aisle at your grocery store, or make your own mix. (Some salt substitutes are high in potassium, so ask your doctor which ones are okay for you).
  • Become a food label reader. Look for low-sodium or no-sodium versions of your favorite foods.

Activity

  • Remain as physically active as possible, within the guidelines of your doctor, and listen to your body.
  • Find physical activity that you enjoy, like walking, swimming or riding a stationary bike, and incorporate it into your routine. Start out slowly, with a few minutes of exercise several times a day, and increase the time and intensity as you are able.
  • Alternate your periods of activity with periods of rest. Be sure to sit down, and take a rest whenever you begin to feel tired or short of breath.

Daily Weigh-ins

  • Sudden weight gain, or a steady increase in weight, is a warning sign of fluid build-up in the body. Weigh yourself each day, and keep a record.
  • Weigh yourself each morning at the same time (before eating, after urinating), in the same clothes and on the same scale.
  • Keep a weight record and take it with you to your doctor appointments.

Follow up

  • Keep all follow-up appointments with your primary physician and cardiologist.
  • Pay attention to your symptoms, and update your doctor when things change. Addressing symptoms early may lead to an adjustment in your treatment plan that might save you from a more severe exacerbation or hospitalization.
  • Call your doctor if you gain more than 2 pounds in 1 day, or more than 5 pounds in 1 week (as per physician’s instructions).
  • Monitor swelling, and call your doctor to report any increased swelling in your feet, ankles or legs. You may first notice that your shoes, clothes or rings fit more tightly.
  • Call your doctor if you have difficulty breathing, including shortness of breath during usual activities, trouble breathing when lying flat or waking up breathless at night.
  • Call 911 if you experience chest pain, fainting, severe weakness, severe shortness of breath or coughing up pink, frothy mucus.

For more information and tips on managing heart failure, visit the Heart Hospital of Austin’s online Health Library at http://www.hearthospitalofaustin.com/connect-learn-interact/health-library. By taking an active role in your health, and working closely with your doctor, you can better manage your heart failure diagnosis and stay out of the hospital’s revolving door.

Resources:

Amy McGowan, RN
St. David’s South Austin Medical Center
Intermediate Care Unit

St. David’s HealthCare Announces St. David’s CancerCare

St. David’s HealthCare recently announced St. David’s CancerCare, a partnership between St. David’s HealthCare and Sarah Cannon that is designed to provide integrated oncology care for patients within St. David’s HealthCare facilities.

Sarah Cannon is the global cancer enterprise of HCA (Hospital Corporation of America) which facilitates a full range of physician-led, patient-centric integrated cancer care services in local markets and offers the highest level of quality standards, infrastructure, training and research for patients with cancer treated within affiliated partner facilities.

As part of St. David’s CancerCare, St. David’s HealthCare recently opened a new oncology floor at St. David’s South Austin Medical Center. The new oncology space provides patients in the Austin region with a wide array of cancer services, including blood and marrow transplants (BMTs), allowing them to receive specialized care in Austin.

As part of this program—a partnership between St. David’s HealthCare, Sarah Cannon, Texas Oncology and Texas Transplant Institute—the Sarah Cannon Blood Cancer Center at St. David’s South Austin Medical Center performed its first adult stem cell transplant*—a type of BMT—earlier this year.

The BMT procedure was performed by Paul Shaughnessy, M.D., Texas Transplant Institute, on Nancy Guerra, a 60-year-old woman with multiple myeloma. As a result of this procedure, Ms. Guerra is now in remission.

*Hematopoietic stem cell transplants involve hematopoietic stem cells, not embryonic stem cells.

St. David’s HealthCare employees can view the video here.

Athletes Have Heart—Protect It!

I watched with great sadness earlier this year as two high school athletes—within one month—lost their lives while playing the sports they poured their hearts into. Two others nearly died this year.

In March, a 15-year-old teen in Colorado nearly died after collapsing on the field in the middle of baseball practice due to cardiac arrest. Then in May, a 16-year-old basketball player in Chicago collapsed during a tournament, nearly losing his life. Also in May, two other students died—an 8th grader at a New Jersey school died while doing “routine activity” during gym class, and a 15-year-old West Virginia student lost his life after suffering an apparent heart attack on the field.

This is difficult news for me to digest. Deaths due to heart disorders are largely preventable if they’re identified early.

Hypertrophic Cardiomyopathy (HCM) is a serious genetic heart condition in which the heart muscle thickens. It is relatively easy to detect; however, left undiagnosed, it can be life threatening. HCM affects one in 500 student athletes every year, and it is the leading cause of sudden cardiac death in young athletes.

In August, high school football players will begin “two-a-day” practices—and soon after, they will take to the field. As you secure your son or daughter’s safety gear for their sport of choice, I urge you to protect them in a way sports gear cannot—have them screened for HCM.

On Saturday, Aug. 23, from 8 a.m. until noon, Heart Hospital of Austin will offer free heart screenings for students ages 14 through 18. The screening, which will be held at Heart Hospital of Austin, will include a 12-lead electrocardiogram (EKG) and a limited two-dimensional echocardiogram, or ultrasound of the heart, to detect HCM. Both the EKG and echocardiogram, which take about five minutes each, are noninvasive and painless. Results of the screening are reviewed by a cardiologist and are available immediately.

To date, more than 6,000 students have been screened at Heart Hospital of Austin.

Heart Hospital of Austin is located at 3801 North Lamar Blvd. Appointments are required. To schedule an appointment, visit HeartHospitalofAustin.com or call (512) 478-3627. Upon arrival, a parent or guardian will be required to fill out a questionnaire for each student.

Paul Pagley, M.D., is a clinical cardiologist with Austin Heart with medical staff privileges at Heart Hospital of Austin.

Take the Right Steps to Prevent Falls

One in every three adults age 65 and older falls each year. From broken bones to brain hemorrhages, the ramifications of a fall can be devastating to the elderly and often mark the beginning of a path towards lost independence. According to the Centers for Disease Control, 21,700 Americans died from unintentional fall injuries in 2010. In addition to modifications that may need to be made to the home, there are many behaviors that you can modify in order to protect yourself from future falls.

Consider these steps to avoid a fall:

  1. Stay fit. Being active and avoiding a sedentary lifestyle is the best way to prevent falls. A regular routine of weights, light cardio and stretching improves strength, endurance, balance and flexibility, making one less likely to fall in the first place. Additionally, exercise can slow bone loss from osteoporosis. This means you will have less risk of a fracture if a fall does occur.
  2. Nutrition. Be sure you are getting enough Vitamin D and calcium in your diet to promote strong bones and reduce your risk of hip fractures. If low appetite is a concern, talk with your doctor about adding supplements like nutritional shakes into your diet.
  3. Watch those side effects. Drowsiness, dizziness and sleepiness are common medication side effects that can make a person more likely to fall. For example, sleep aids like Ambien and Restoril, blood pressure medications such as lisinopril and metoprolol, and diuretics such as Lasix, all carry side effects that increase fall risks. Talk to a doctor or pharmacist about medication side effects, and take extra precautions to avoid falls while on medications. Do not abruptly stop taking prescription medications, unless advised to do so by your doctor.
  4. Optimize vision. Make sure to have your vision checked annually, and maintain your eyeglass prescriptions. It may also be a good idea to have a backup pair of eyeglasses, in case your favorite pair gets broken or lost.
  5. Ask for help. From blowing slippery leaves off the sidewalk, to changing light bulbs, everyone needs a little help every now and then. It’s good to be a “do-it-yourselfer,” but don’t put your health at risk.
  6. Accessorize. If you are a bit more unsteady lately, using a walking cane or walker may be just the thing you need to stay active. Talk to your doctor about resources for purchasing these items, and be sure they are the right size for you and in good condition.
  7. Get more sleep, and limit alcohol. It’s pretty straightforward. If you’re sleepy or impaired by alcohol, your balance and reaction times are dulled.
  8. Get up slowly. That lightheaded feeling that you get when you stand up too fast is due to a quick drop in blood pressure to your brain. Give your body a chance to equilibrate by taking a few seconds to transition from lying down to sitting up, then again from sitting to standing, and again from standing to walking. If you feel woozy, take a few more seconds.
  9. Tell somebody. Have a plan in advance of who you will call in the event of a fall. Even if you feel fine, have a family member or neighbor check on you, and be certain to let your doctor know about the fall at your next appointment. If you feel that you may have broken a bone, or if you’ve hit your head during the fall, the best course of action is to call 911 and get checked out at the emergency department.

Resources:

Amy McGowan, RN
St. David’s South Austin Medical Center
Intermediate Care Unit

Rethinking Our Drinking

From wine to beer to distilled liquor, alcohol flows throughout our society. In fact, alcoholic beverages are the basis of a more than $400-billion industry in the U.S. Despite alcohol’s overall social acceptance, health consciousness is growing and many people are taking a closer look at their drinking habits.

How much is too much?
Each body is different, so it is difficult to say how much alcohol is “okay” and how much is a problem. Nevertheless, here are some helpful guidelines.

The National Institutes of Health (NIH) recommends alcohol only in moderation. The NIH defines moderate drinking for men as no more than 4 drinks per day, and no more than 14 drinks per week. For women, they suggest no more than 3 drinks per day and no more than 7 drinks per week. Keep in mind, however, that these are only guidelines. Some people, such as those who are underage, pregnant, plan to drive or operate machinery, taking medications that interact with alcohol or have a medical condition that is aggravated by alcohol, should avoid alcohol altogether.

Alcohol consumption above moderate levels may put you at risk of developing an alcohol use disorder. The most serious disorder is alcoholism, and it is characterized by a strong urge to drink, not being able to stop drinking once you’ve started, experiencing withdrawal symptoms such as shakiness and nausea when you do stop drinking, or needing to drink greater amounts of alcohol in order to get the same effect.

Alcohol Withdrawal
Ironically, quitting alcohol may pose its own health threat for heavy drinkers. Alcohol Withdrawal Syndrome refers to the symptoms that occur when a person who drinks heavily and/or frequently stops or reduces the amount of alcohol they consume. Signs of withdrawal can occur within a few hours to several days of the person’s last drink, and can vary from mild to life-threatening.

Mild symptoms of withdrawal can occur between 6 hours to 7 days of the person’s last drink, and can include sweating, tremors, agitation and trouble sleeping. More serious symptoms require emergency medical treatment. These symptoms include hallucinations (seeing or hearing things or experiencing sensations like crawling skin), heart palpitations and seizures.

How to Quit Safely
If drinking is becoming a problem and interfering with your daily life, it is extremely important that you consult with your primary healthcare provider for help. Your doctor can assist you in many ways, including recommending treatment programs, determining your need for nutritional supplements and prescribing medications that can assist with withdrawal symptoms. In severe cases, inpatient care (possibly in an ICU setting) may be necessary to provide a safe environment, close monitoring and administration of intravenous fluids to correct nutritional and electrolyte deficiencies.

It is also important to establish a social support system, and you may benefit from ongoing counseling sessions, an alcohol treatment specialist and/or local support programs like Alcoholics Anonymous.

If you are concerned about your drinking, please have an honest conversation with your doctor regarding how often and how much you drink. For additional resources, visit http://www.rethinkingdrinking.niaaa.nih.gov/

Resources

Texas Cardiac Arrhythmia Institute Uses New Technology to Save Lives

The Texas Cardiac Arrhythmia Institute (TCAI) at St. David’s Medical Center is one of the world’s preeminent centers dedicated to the latest treatment advances for correcting abnormal heart rhythms, or arrhythmias, such as Atrial Fibrillation (A Fib).

Recently, David Burkhardt, M.D., an electrophysiologist at TCAI, and Javier Otero, M.D., a cardiologist who practices at St. David’s Medical Center, treated a patient with a new, implantable defibrillator.

The patient, a 46-year-old man with no previous heart conditions, underwent an ablation procedure to treat his arrhythmia. After his procedure, doctors required him to wear a Zoll LifeVest for three months while his heart healed. During this time, his arrhythmia caused his heart to stop beating. Fortunately, the Zoll LifeVest shocked his heart back into rhythm. As a result of these technologies, the patient is doing well today.

KVUE-TV recently interviewed the man about his procedure and the Zoll LifeVest that saved his life. To view the story, click here.

This year, TCAI was among the first in the United States to implant the Medtronic Reveal LINQ Insertable Cardiac Monitor (ICM) System in a patient. The Reveal LINQ ICM is the smallest implantable cardiac monitoring device available. The procedure was performed by Andrea Natale, M.D., a cardiac electrophysiologist and executive medical director of TCAI.

Time Warner Cable News recently interviewed a TCAI patient about his experience with this new technology. Click here to watch the story.

Additionally, earlier this year, a 42-year-old man was given life-saving CPR by his 12-year-old daughter after he suffered a sudden cardiac arrest. She performed CPR on her father for 12 minutes before emergency crews arrived.

Due to the quick action of this teen—and exceptional care provided by Rodney Horton, M.D., and Robert Canby, M.D., both electrophysiologists at TCAI—the patient is alive and in great shape today. He has since undergone cardiac rehabilitation and surgery to implant a cardiac defibrillator.

The Austin American-Statesman recently wrote about the heroic efforts of the 12-year-old girl who saved her father’s life. To read the full article, click here.

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