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Drowning Deaths
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
Shallow water drowning: In daily forensic practice, cases come with dead bodies recovered from shallow water collections, which do not show any signs other than that of drowning. Death in these cases creates confusion for the investigating agencies due to the genuine doubt as to how drowning is possible in a knee or hip height of water column. Lung and respiratory tract findings in these cases are generally not of the typical emphysema aquosum. Sign of vigorous respiratory efforts in terms of typical foam is rarely seen. In most of these cases, it is believed that the victim is in an incapacitated state at the time of entering the water (Figure 7.1). Drugs, alcohol, head injury, sudden mental shock or other natural diseases may be the precipitating factors for lack of vigorous struggle. Persistent laryngospasm is another possible contributing factor. In such cases, the quantity of water that enters the airway is less than that in a typical wet drowning, and this lesser waterlogged airway appearance is termed edema aquosum by many authors.
Specific Emergency Conditions in Forced Displacement Settings
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Natalie Roberts, Halfdan Holger Knudsen, Alvin Sornum, Taha Al-Taei, Barbara Scoralick Villela, Maryam Omar, Faith Traeh, Abdulkarim Ekzayez, Clare Shortall, Eric Weerts
The patient may present unconscious, in cardiac arrest or with some degree of respiratory compromise. Laryngospasm may be present and could complicate airway management. Alert patients can present with dyspnoea, cough and retrosternal chest pain.
Introduction
Published in Kevin L. Erskine, Erica J. Armstrong, Water-Related Death Investigation, 2021
The human respiratory system conveys oxygen-containing air into the body via inhalation and is comprised of the nasal and oral passages, larynx, trachea, bronchial tubes, and lungs (Figures 1.1 and 1.2A and B). The flexible and tubular larynx, trachea, and bronchial tubes are kept open or patent by rings of cartilage allowing unobstructed movement of oxygen-containing air into the lungs with inhalation and carbon dioxide waste products out of the lungs and body upon exhalation. The cells lining the airways have microscopic hairs and produce mucous which along with the cough reflex help trap particulate matter and bacteria and keep the airways free and clear of obstruction. The nerves of the larynx also sense pressure caused by the inhalation of foreign objects including fluids and can trigger brief closure or spasm, known as laryngospasm, as an additional protective mechanism to prevent obstruction of the airway and further interference with oxygenation. The skeletal muscles between the ribs (intercostal muscles), and the skeletal muscles attached to the sternum, the diaphragm, and the abdominal muscles are all important structures in respiration, as they work to expand and contract the rib cage during inspiration and expiration of air (Figure 1.3).
Prehospital Ketamine Use in Pediatrics
Published in Prehospital Emergency Care, 2023
Ashima Goyal, John Frawley, Revelle Gappy, Sariely Sandoval, Nai-Wei Chen, Remle Crowe, Robert Swor
As with all medications, ketamine use in children carries potential risks and potential for adverse events. Prior studies among adult patients have looked at airway patency, oxygen desaturation, and emergence reactions with few adverse events being identified (7). Our study noted few adverse events in the pediatric population with no prehospital deaths noted. Though oxygen desaturation events were uncommon, hypoxia is a late sign of respiratory compromise and suggests the critical need for end-tidal CO2 monitoring following sedation. Use of ventilatory support without advanced airway placement was also rare, but not necessarily unexpected as laryngospasm has been reported as an adverse event in prior studies (7, 9). One study among adults who underwent emergent sedation identified high rates of adverse events, including an intubation rate of up to 30%. (12). The indications for intubation were not always related to ketamine in this study and were noted to be in alignment with the patient’s final diagnosis (penetrating trauma, septic shock, etc). Furthermore, it was suggested that the observed intubation rate was likely based on the setting in which ketamine was given. If a patient was given ketamine by ground transport, it was likely a physician would opt for intubation upon arrival to the ED. In our study, analysis of all advanced airways placed identified that this association was due to ketamine’s use as a pre-intubation agent.
The efficacy and safety of midazolam with fentanyl versus midazolam with ketamine for bedside invasive procedural sedation in pediatric oncology patients: A randomized, double-blinded, crossover trial
Published in Pediatric Hematology and Oncology, 2022
Chalinee Monsereenusorn, Wanwipha Malaithong, Nawachai Lertvivatpong, Apichat Photia, Piya Rujkijyanont, Chanchai Traivaree
Nausea was defined as a score from 0 to 3; 0 = no nausea, 1 = nausea with loss of appetite without alteration in eating habits, 2 = nausea with decreasing oral intake without significant weight loss, dehydration or malnutrition, and 3 = nausea with retching with or without vomiting, contributing inadequate caloric intake, dehydration, or hospitalization.29 Vomiting was defined as vomiting episodes. The pain was assessed using a face, legs, activity, cry, consolability (FLACC) scale for patients aged 3 months to 7 years and a visual analog scale (VAS) for children > 7 years,5,30 and scored from 0 to 10 (Supplementary Table 1). Satisfaction was defined as a score from 0 (very dissatisfied) to 10 (very satisfied). Hypotension and hypertension were defined as a state of blood pressure <5th and >99th percentile, respectively according to age. Laryngospasm was defined as a partial or complete upper airway obstruction with oxygen desaturation.31 Desaturation was defined as a state of oxygen saturation <94% in room air.
Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement
Published in Prehospital Emergency Care, 2021
Margaret M. Morgan, Debra G. Perina, Nicole M. Acquisto, Mary E. Fallat, John M. Gallagher, Kathleen M. Brown, Jeffrey Ho, Aaron Burnett, Julio Lairet, Dennis Rowe, Mark L. Gestring
Rapid IV injection can result in transient apnea. Ketamine should be administered slowly over 1 minute or greater unless being used in RSI where it is immediately followed by a neuromuscular blocking agent and intubation. Transient apnea following IM administration appears to be rare (2).Notable side effects include hypersalivation, laryngospasm, dysphoria, nausea, dizziness, nystagmus and emergence agitation. Most side-effects are transient and self-limited and do not require any intervention or rescue. If laryngospasm occurs, it can be managed with repositioning or jaw thrust and positive pressure ventilation. In rare instances, intubation may be necessary. End-tidal CO2 should be used if available to monitor for early signs of laryngospasm or hypoventilation.Emergence reactions are believed to be rare. When they do occur, they can be safely managed with benzodiazepine administration. Pre-medicating with benzodiazepines is not recommended.