Drowning 

 

 

Considerations 

 

  • Trauma/ATLS approach:

    • Possible C-spine injury 

    • Hemorrhage/occult injuries 

    • Co-ingestions 

  • Hypothermia:

    • Coagulopathy

    • Arrhythmias

    • Hypovolemia

    • Rewarming technique

    • Electrolyte abnormalities 

  • Multi-organ system dysfunction:

    • ARDS

    • Hypoxic brain injury

    • Electrolyte abnormalities (↑K+), cell lysis 2nd to fresh water drowning 

    • Shock

    • ARF

  • Etiology of drowning:

    • Adults: arrhythmia (long QT syndrome), seizure, trauma, MI, intoxication

    • Children: abuse, unsupervision

 

 

Goals/Conflicts

 

  • Primary Resuscitation to ensure adequate oxygen exchange and perfusion pressure 

  • Prevent secondary injury: C-spine precautions 

  • Aggressive rewarming  

  • 100% mortality = Submersion > 25 min, Resuscitation > 25 min, Pulseless on arrival to ED, Unconscious at scene and on arrival to ED 

 

 

Treatment

 

  • Treat hypoxia: restore oxygenation and ventilation

    • Rescue breaths

    • Endotracheal intubation

    • 100% oxygen until ROSC then FiO2 to keep SpO2 > 92%

  • Treat cardiac arrest: may be PEA, systole, VT/VF

    • Follow ACLS guidelines

    • Modifications for hypothermia: active rewarming until 34ºC then passive

    • Consider 24 hours of therapeutic hypothermia (32-34ºC)

  • Cervical spine injury extremely rare (0.009%): do not place C-spine collar unless mechanism for C-spine injury is suggested

 

 All rights reserved 2017 © anesthesiaconsiderations.com

 Feedback & inquiries: