Quan L
Department of Pediatrics, University of Washington Medical School, Seattle.
Ann Emerg Med. 1993 Feb;22(2 Pt 2):366-9. doi: 10.1016/s0196-0644(05)80466-4.
Submersion injury is so often lethal because it inflicts severe hypoxia. To prevent hypoxic end-organ damage to the heart and brain, the goals of resuscitation are immediate ventilation and oxygenation. Issue 1: Should submersion victims receive the Heimlich maneuver? The pathophysiologic assumptions for this intervention are that water in the airway is obstructive, thus precluding ventilation, and that aspiration of water is the major injury. Anecdotal case reports describe improved ventilation of some victims who failed prior ventilatory efforts. However, animal and human studies support that aspirated water is rapidly absorbed, does not preclude ventilation and intubation, and is best treated rapidly with positive pressure ventilation. With inadequate data to support benefit from the Heimlich maneuver and concern that the Heimlich maneuver would delay initiation of ventilation, basic life support procedures are recommended in managing the airway of the submersion victim. Issue 2: What is the role of prehospital care? Outcomes of submersion victims treated with rapid, aggressive prehospital care show that the window for medical intervention for the submersion victim is in the prehospital setting, not in the emergency department or intensive care unit. The submersion victim should be provided advanced cardiac life support, including intubation as needed, as soon as possible.
溺水损伤常常是致命的，因为它会导致严重缺氧。为防止心脏和大脑等终末器官发生缺氧性损伤，复苏的目标是立即进行通气和给氧。问题1：溺水受害者是否应接受海姆立克急救法？该干预措施的病理生理学假设是气道内的水具有阻塞性，从而妨碍通气，且吸入水是主要损伤。轶事性病例报告描述了一些先前通气努力失败的受害者在接受海姆立克急救法后通气得到改善。然而，动物和人体研究表明，吸入的水会迅速被吸收，并不妨碍通气和插管，最好通过正压通气迅速进行治疗。由于缺乏支持海姆立克急救法有益的数据，且担心海姆立克急救法会延迟通气的启动，因此建议在处理溺水受害者的气道时采用基本生命支持程序。问题2：院前急救的作用是什么？接受快速、积极院前急救的溺水受害者的结果表明，溺水受害者的医疗干预窗口在院前环境，而非急诊科或重症监护病房。应尽快为溺水受害者提供高级心脏生命支持，包括根据需要进行插管。
