救急 / 集中治療 / 小児

溺水 — 管理パス

本質は低酸素、換気が優先。ハイムリックは推奨されない。二次低体温・ARDSに注意。

根拠：AHA / ILCOR。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。

ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。

ステップ 1 · Symptomatic/hypoxic?
Symptomatic / hypoxic?
💡 Drowning = respiratory impairment from submersion; the core injury is hypoxia (laryngospasm/aspiration → lung injury/ARDS/pulmonary edema). Rescue: do not endanger yourself; the priority is oxygenation and ventilation — open the airway, give rescue breaths first (drowning is a hypoxic arrest, ventilation before standard C-A-B). No need to clear water from the airway; abdominal thrusts/Heimlich are not recommended (ineffective, delay ventilation). Cervical collar not routine (only with trauma/shallow-water diving signs).

パス全体像

  1. 【判断】Symptomatic/hypoxic?
    Symptomatic / hypoxic?（Drowning = respiratory impairment from submersion; the core injury is hypoxia (laryngospasm/aspiration → lung injury/ARDS/pulmonary edema). Rescue: do not endanger yourself; the priority is oxygenation and ventilation — open the airway, give rescue breaths first (drowning is a hypoxic arrest, ventilation before standard C-A-B). No need to clear water from the airway; abdominal thrusts/Heimlich are not recommended (ineffective, delay ventilation). Cervical collar not routine (only with trauma/shallow-water diving signs).）
    • Symptomatic / needs oxygen / abnormal consciousness or breathing → Symptomatic/hypoxic → oxygen ± intubation
    • Completely asymptomatic, normal exam and oxygen saturation → Asymptomatic · observe 4–8 h
  2. 【終点】Asymptomatic · observe 4–8 h
    Completely a有症状, normal exam, normal SpO2, stable vitals: observeに対しabout 4–8 hours;の場合they remain a有症状 〜あり normal oxygen・exam, they may be 退院d (delayed deterioration is uncommon but warrants the observation period). Admitの場合respiratory symptoms/falling oxygen appear during observation.
  3. 【終点】Symptomatic/hypoxic → oxygen ± intubation
    Symptomatic/hypoxic (needs oxygen, respiratory distress, abnormal consciousness): oxygenへkeep SpO2 >94%, CPAP/BiPAPに対しpersistent hypoxia/dyspnea, 挿管 + PEEPの場合unableへprotect the airwayまたはstill hypoxic on high-flow oxygen, manage as ARDS/pulmonary edema; arrest → BLS/ACLS (cold-water/小児 prognosis can be better); rewarmの場合hypothermic; 有症状 patients needing oxygen goへICU.

よくある質問

溺水 — 管理パスはどの臨床課題を扱う診療パスですか？
本質は低酸素、換気が優先。ハイムリックは推奨されない。二次低体温・ARDSに注意。
溺水 — 管理パスの主要な意思決定ステップは何ですか？
Symptomatic/hypoxic?
溺水 — 管理パスはどのような対応方針を示しますか？
Asymptomatic · observe 4–8 h：Completely a有症状, normal exam, normal SpO2, stable vitals: observeに対しabout 4–8 hours;の場合they remain a有症状 〜あり normal oxygen・exam, they may be 退院d (delayed deterioration is uncommon but warrants the observation period). Admitの場合respiratory symptoms/falling oxygen appear during observation.；Symptomatic/hypoxic → oxygen ± intubation：Symptomatic/hypoxic (needs oxygen, respiratory distress, abnormal consciousness): oxygenへkeep SpO2 >94%, CPAP/BiPAPに対しpersistent hypoxia/dyspnea, 挿管 + PEEPの場合unableへprotect the airwayまたはstill hypoxic on high-flow oxygen, manage as ARDS/pulmonary edema; arrest → BLS/ACLS (cold-water/小児 prognosis can be better); rewarmの場合hypothermic; 有症状 pa…
溺水 — 管理パスのうち直ちに対応が必要な状況はどれですか？
Symptomatic/hypoxic → oxygen ± intubation：Symptomatic/hypoxic (needs oxygen, respiratory distress, abnormal consciousness): oxygenへkeep SpO2 >94%, CPAP/BiPAPに対しpersistent hypoxia/dyspnea, 挿管 + PEEPの場合unableへprotect the airwayまたはstill hypoxic on high-flow oxygen, manage as ARDS/pulmonary edema; arrest → BLS/ACLS (cold-water/小児 prognosis can be better); rewarmの場合hypothermic; 有症状 patients needing oxygen goへICU.
溺水 — 管理パスはどのガイドラインに基づいていますか？
Drowning (AHA/ILCOR resuscitation guidelines; emergency management) · 準拠：AHA / ILCOR

出典

  • Drowning (AHA/ILCOR resuscitation guidelines; emergency management)

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