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NURS 287
Rick Nilson

SUBMERSION INJURY Submersion injury results when a person becomes hypoxic due to submersion in a substance, usually water. Drowning is death from suffocation after submersion in water or other fluid medium. Near-drowning is defined as survival from potential drowning. Immersion syndrome occurs with immersion in cold water, which leads to stimulation of the vagus nerve and potentially fatal dysrhythmias. Aggressive resuscitation efforts and the mammalian diving reflex improve survival of near-drowning victims even after submersion in cold water for long periods of time. Treatment of submersion injuries focuses on correcting hypoxia, acid-base imbalances, and fluid imbalances; supporting basic physiologic functions; and rewarming when hypothermia is present.  Initial evaluation involves assessment of airway, cervical spine, breathing, and circulation.  Mechanical ventilation with positive end-expiratory pressure or continuous positive airway pressure may be used to improve gas exchange across the alveolar-capillary membrane when significant pulmonary edema is present. Deterioration in neurologic status suggests cerebral edema, worsening hypoxia, or profound acidosis. All victims of near-drowning should be observed in a hospital for a minimum of 4 to 6 hours. Delayed pulmonary edema (also known as secondary drowning) can occur and is defined as delayed death from drowning due to pulmonary complications. ANIMAL BITES Children are at greatest risk for animal bites, and the most significant problems associated with animal bites are infection and mechanical destruction of the skin, muscle, tendons, blood vessels, and bone. Animal bites from dogs and cats are the most common, followed by bites from wild or domestic rodents. Cat bites cause deep puncture wounds that can involve tendons and joint capsules and result in a greater incidence of infection. Septic arthritis, osteomyelitis, and tenosynovitis are common. Human bites also cause puncture wounds or lacerations and carry a high risk of infection from oral bacterial flora and the hepatitis virus.  Hands, fingers, ears, nose, vagina, and penis are the most common sites of human bites and are frequently a result of violence or sexual activity.  Boxer’s fracture, fracture of the fourth or fifth metacarpal, is often associated with an open wound when the knuckles strike teeth. Initial treatment for animal and human bites includes cleaning with copious irrigation, debridement, tetanus prophylaxis, and analgesics as needed.  Prophylactic antibiotics are used for animal and human bites at risk for infection such as wounds over joints, those more than 6 to 12 hours old, puncture wounds, and bites of the hand or foot.  Puncture wounds are left open, lacerations are loosely sutured, and wounds over joints are splinted.  Consideration of rabies prophylaxis is an essential component in the management of animal bites. An initial injection of rabies immune globulin is given, followed by a series of five injections of human diploid cell vaccine on days 0, 3, 7, 14, and 28 to provide active immunity. POISONINGS A poison is any chemical that harms the body, and poisoning can be accidental, occupational, recreational, or intentional. Severity of the poisoning depends on type, concentration, and route of exposure. Specific management of toxins involves decreasing absorption, enh
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