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December 03, 2018
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PEDIATRIC ASSOCIATES OF DAVIDSON COUNTY is currently working towards National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH).

What is PCMH?

PCMH is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.

How does this benefit my child and family?

  • 24x7 phone access to your care team by calling 615-329-3595
  • Same day appointments
  • Preventative care and physicals (health risk assessments, sports and school physicals)
  • Acute care for illness and injuries
  • Well child visits, screenings and vaccinations
  • Online electronic access to your care team
  • Referrals to top specialists and mental health providers
  • Management of multi-specialty care plan including mental health
By Rick Pescatore, Seth C. Hawkins
May 16, 2018
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Rick Pescatore, Seth C. Hawkins, For the Inquirer
Updated: Thursday, May 3, 2018, 12:20 PM

For years, always beginning in the spring, reports of “dry drowning” have appeared. Last year, when the death of a young child in Texas was attributed to “dry drowning,” the resulting accounts spread significant fear among parents.

Social media, in particular, spread tales of healthy children who suddenly developed respiratory emergencies or even died without warning, sending legions of “worried well” to emergency departments and pediatricians’ offices. Well-meaning activists posted warning signs at local pools and organized awareness campaigns and legislation.

Yet, there is no such thing as “dry drowning.”

In lay terms, to say a person drowned implies death. But in medical terms, the word refers to a range of issues.

Drowning always follows some kind of submersion in a liquid, but it is not always fatal. The outcome can range from mild respiratory symptoms to death.

 

People who think “dry drowning” exists describe it as a rare condition.

But real drowning — the wet kind — sadly is not rare. It is a leading cause of pediatric injuries and deaths.

The definition of drowning, established at the 2002 World Congress on Drowning, is “the process of experiencing respiratory impairment from submersion or immersion in liquid.” In other words, no drowning can occur without exposure to liquid and some respiratory problem.

Drowning has only three subtypes: drowning without injury, drowning with injury, and fatal drowning.

Further, there has never been a case reported in medical literature of an otherwise asymptomatic and healthy child who suddenly developed serious respiratory distress or died days after being in water.

But it is important to know that symptoms can get worse in the hours immediately after a drowning event. So even mild symptoms after a drowning episode warrant medical attention.

What do we mean by “mild symptoms”? Anything that feels worse than the sensation that, while drinking a glass of water, some of it went down “the wrong way.”

Every “dry drowning” tragedy has later been found to have its roots in another medical condition. But this part of the story seems never to make its way to social media.

Frankie Delgado, the 4-year-old boy whose 2017 death renewed the Facebook fervor over dry drowning, was later found to have died of viral myocarditis, a rare but dangerous heart condition with no relation to drowning, swimming, or any other water exposure. Other “dry drowning” cases have later been traced to rib fractures, pneumonia, collapsed lungs, and numerous other well-known medical conditions.

It has happened that people have died of drowning hours after leaving the water. But they died of untreated complications from “wet” drowning, not any sort of esoteric condition that could not have been prevented by timely medical attention.

Drowning is never “dry.”

Nearly every major medical organization has spoken out against misleading terms such as “dry,” “near,” or “secondary” drowning applied to cases in which a patient got worse within hours of water exposure.

Developing symptoms days later almost certainly has nothing to do with water exposure, unless there was a separate complication such as infection from bacteria in the water.

Think of it this way: If someone develops pneumonia related to food entering the lungs during a choking episode days earlier, he has not experienced “foodless choking.” That term makes no more sense than “dry drowning.”

Children with continued respiratory problems or other symptoms after swimming should always be brought to an emergency department for evaluation. A child who maybe had a brief coughing episode but no further symptoms almost certainly requires no further medical care.

Words matter when it comes to caring for our children. The widely spread tales of critically ill “dry drowning” victims succumbing days after swimming to a “rare” medical condition created fear among parents. Many likely grew to distrust physicians who tried to assure them their children did not need to be evaluated for a mythical condition.

 

Worse of all, the “dry drowning” uproar drew attention from the real crisis we face every summer: protecting children from all-too-real drownings in swimming pools, natural bodies of water, even 5-gallon buckets for the youngest kids.

The dangers of drowning are real, and not esoteric or rare, and we owe it to our children to approach this hazard armed with knowledge and understanding, not fear and fervor. We must remember that our most important tool is prevention: swimming lessons, appropriate pool fencing, and continuous supervision while kids are in the water. If, despite all these efforts, there is still a drowning incident, anyone with symptoms should receive medical attention.

Online networking platforms are an ideal medium to spread important information about public health and patient care. But we owe it to ourselves and to our children to approach information — especially anything that sounds hard to believe, or doesn’t come from sources we know and trust — with skepticism and diligence. And if it sounds especially unlikely — “dry drowning” surely fits that description — always be extra cautious.

Rick Pescatore, DO, is director of clinical research of the department of emergency medicine at Crozer-Keystone Health System. Seth C. Hawkins, M.D. is an assistant professor of emergency medicine at Wake Forest University. Hawkins is also director of Lifeguards Without Borders and medical director of Starfish Aquatics Institute.

Read full story: Drowning is never dry: Two ER doctors explain the real swimming danger kids faceDrowning is never dry: Two ER doctors explain the real swimming danger kids face

More Coverage: Don't Panic Over 'Dry Drowning' Reports, ER Docs Say

May 08, 2018
Category: Uncategorized
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PEDIATRIC ASSOCIATES OF DAVIDSON COUNTY - is currently working towards National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH).

What is PCMH?

PCMH is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.

How does this benefit my child and family?

  • 24x7 phone access to your care team by calling 615-329-3595
  • Same day appointments
  • Preventative care and physicals (health risk assessments, sports and school physicals)
  • Acute care for illness and injuries
  • Well child visits, screenings and vaccinations
  • Online electronic access to your care team
  • Referrals to top specialists and mental health providers
  • Management of multi-specialty care plan including mental health

Tennessee Department of Health - Health Alert Network

Colleagues,

The Tennessee Department of Health (TDH) has received reports of 9 cases of acute hepatitis A since January 1st: 8 of 9 are in middle Tennessee. Although a small number, this is higher than usual, and some cases have risk factors seen in large outbreaks currently going on in Kentucky (400 cases in 30 counties) and other states, including men who have sex with men and recreational drug users. The other common risk factor seen in other states is homelessness. TDH anticipates additional cases in coming weeks and months, given the long (1 month) average period between exposure and illness.

Based upon the experience of Kentucky and other states, Tennessee is at risk of a significant hepatitis A outbreak in the coming months. Clinicians can take the following important steps now to protect high risk patients and mitigate the spread of illness:

1. Hepatitis A vaccine is already recommended for adults at high risk of exposure or severe illness, but most adults who need vaccine have not received it. A single dose of the 2-dose series can provide protection for more than a decade. Offer vaccine or refer your patients who need hepatitis A vaccine now:

  • Persons who use recreational drugs (injection or non-injection)
  • Men who have sex with men
  • Homeless persons
  • Persons with chronic liver disease, including chronic hepatitis B or C

TDH is able to make some vaccine available through local public health departments to adults with these risk factors: local supplies vary. International travelers going to countries where hepatitis A is endemic are also recommended to receive vaccine from their healthcare provider or travel clinic.

2. Consider hepatitis A vaccine for any child through 18 years who has not had it. Tennessee began requiring this vaccine for kindergarten in 2011. It is routinely given at age 1, but the CDC advises it may be given to any older child through age 18 years who has not had it. Federal Vaccines for Children (VFC) Program vaccine may be used for any eligible child, including children without health insurance coverage and those on TennCare.

3. Recognize and report cases to public health. Persons with the acute onset of symptoms of hepatitis (yellowing of eyes or skin, fever, nausea/vomiting, dark urine, pale stool, abdominal pain, fatigue and loss of appetite) should have a serologic test for acute hepatitis A IgM. Do not test persons without signs of acute hepatitis: false positive IgM results can occur in persons without clinical illness, especially in the elderly. Acute hepatitis A is reportable to your local health department to initiate a time-sensitive contact investigation and provide post-exposure prophylaxis to at-risk contacts within 2 weeks of exposure.

This message was sent to EMS, Hospital, Public Health, ICP, and ED roles in TNHAN.

NO CONFIRMATION IS REQUIRED. PLEASE DISSEMINATE FURTHER AS YOU DEEM NECESSARY.

Thank you,
Tennessee Department of Health