Medical care
People with a near-drowning experience who have normal oxygen levels and no respiratory symptoms should be observed in a hospital environment for a period of time to ensure there are no delayed complications. The target of ventilation is to achieve 92% to 96% arterial saturation and adequate chest rise. Positive end-expiratory pressure will generally improve oxygenation. Drug administration via peripheral veins is preferred over endotracheal administration. Hypotension remaining after oxygenation may be treated by rapid crystalloid infusion. Cardiac arrest in drowning usually presents as asystole or pulseless electrical activity. Ventricular fibrillation is more likely to be associated with complications of pre-existing coronary artery disease, severe hypothermia, or the use of epinephrine or norepinephrine.While surfactant may be used, no high-quality evidence exist that looks at this practice. Extracorporeal membrane oxygenation may be used in those who cannot be oxygenated otherwise. Steroids are not recommended. Prognosis
People who have drowned who arrive at a hospital with spontaneous circulation and breathing usually recover with good outcomes. Early provision of basic and advanced life support improve the probability of a positive outcome.A longer duration of submersion is associated with a lower probability of survival and a higher probability of permanent neurological damage.Contaminants in the water can cause bronchospasm and impaired gas exchange and can cause secondary infection with delayed severe respiratory compromise.Low water temperature can cause ventricular fibrillation, but hypothermia during immersion can also slow the metabolism, allowing longer hypoxia before severe damage occurs. Hypothermia that reduces brain temperature significantly can improve the outcome.
Several techniques followed and materials used included metal loops, pins, kangaroo tendons and screws. Significant advances in surgery occurred in the 1950s with the development of banding after Herbert A. Haxton and others demonstrated that the patella was not just to protect the knee but important for straightening the leg. Subsequently, the three surgical treatments for displaced patella fractures became tension banding, partial patellectomy and total patellectomy, the decision of which to use tailored to the individual. References


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