TENGGELAM

PENDAHULUAN
According to the World Health Organization (WHO), 0.7% of all deathsworldwide
ormorethan500,000 death seach year1are due to unintentional
drowning.Drowning is aleading cause of death worldwide among boys
5to14years of
age.2IntheUnitedStates,drowningisthesecondleadingcauseofinjuryrelateddeatha
mongchildren1to4yearsofage,withadeathrateof3per100,000,4andinsomecountrie
s,suchasThai land,thedeathrateamong2-year-
oldchildrenis107per100,000.5InmanycountriesinAfricaandinCentralAmerica,the
incidenceofdrown-ingis10to20timesashighastheincidenceintheUnitedStates.
AccordingtothenewdefinitionadoptedbytheWHOin2002,Drowningisthepro-
cessofexperiencingrespirator yimpairmentfromsubmersion/immersioninl
iquid.13Thedrowningprocessbeginswith
respiratoryimpairmentasthepersonsairwaygoesbelowthesurfaceoftheliquid(subm
ersion)orwatersplashesovertheface(immersion).
 CARE IN THE EMERGENCY
Themajorityofdrowningpersonsaspirateonlysmallamountsofwate
r,ifany,andwillrecoverspontaneously.Lessthan6%ofallpersonswh
oarerescuedbylifeg
uardsneedmedicalattentioninahospital.21Oncetheairwayhasbee
nsecured,oxygenat
ionhasbeenimproved,thecirculationhasbeenstabi-
lized,andagastrictubehasbeeninserted,thermalinsulation of the
patient should be
instituted.Thisisfollowedbyphysicalexamination,chestradiography,
and
measurementofarterialbloodgases.Metabolicacidosisoccursinthe
majorityofpatientsandisusuallycorrectedbythepatientsspontane
ousefforttoincreaseminuteventilationorbysettingahigherminute
ventilationorahigherpeakinspiratorypressure(35cmofwa-
ter)onthemechanicalventilator.
 Hospitalizationisrecommended
forallpatientswithapresentationofgrade2to6.F
ormostpatientswithagrade2presentation,nonin
vasiveoxygenadministrationresultsinnormalizati
onofclinicalstatuswithin6to8hours,andtheycan
thenbesenthome.21Patientswhoseclinicalsta-
tusdeterioratesareadmit
tedtoanintermediatecareunitforprolongedobse
rvation.Patientswithapresentationofgrade3to6
,whousuallyneedintubationandmechanicalventi
lation,areadmit-tedtoanintensivec areunit(ICU)
 PREVENTION
Everydrowningsignalsthefailureofthemostef
-fectiveintervention
namely,prevention.56Table3summarizesrecr
eationalsafetymessagesthatarebasedonevid
enceandexpertopinion.56Itisesti-
matedthatmorethan85%ofcasesofdrowning
canbepreventedbysupervision,swimmingin-
struction,technology,regulation,andpubliced
u-cation