2. Nonfatal drowning
• Nonfatal drowning generally is defined as
survival, at least temporarily, after suffocation
by submersion in a liquid medium
3. Indications for intubation
• Signs of neurologic deterioration or inability to
protect the airway
• Inability to maintain a PaO2 above 60 mmHg or
oxygen saturation (SpO2) above 90 percent
despite high-flow supplemental oxygen
• PaCO2 above 50 mmHg
Salomez F, Vincent JL. Resuscitation. 2004.
4. Management
Other types of resp support
• In symptomatic patients who do not require immediate intubation, supplemental
oxygen should be provided to maintain the SpO2 above 94 percent.
• CPAP or BiPAP can improve oxygenation and decrease ventilation-perfusion
mismatch
• Note that positive airway pressure increases intrathoracic pressure and patients
must be carefully monitored for possible hypotension
Re-warming
• Wet clothing should be removed and rewarming initiated in hypothermic patients.
• Passive rewarming (use of blankets or other insulators to reduce heat loss)
• Active external rewarming (application of warm blankets, heating pads, radiant
heat, forced warm air)
• Active internal rewarming (pleural and peritoneal irrigation with warm saline,
continuous arteriovenous rewarming, and cardiopulmonary bypass)
Christensen DW, Jansen P, Perkin RM. Pediatrics.
5. Patient disposition
• Most victims are hospitalized because of the severity of
illness or concern for clinical deterioration.
– Recent review of 75 pediatric patients found that all who
ultimately developed symptoms did so within seven hours
of immersion
• Symptomatic patients should be admitted to a
monitored setting until symptoms and physiologic
disturbances resolve
• Asymptomatic patients should be closely observed for
approximately eight hours and admitted if any
deterioration occurs
6. Outcome
• OUTCOME — Evidence pertaining to survival following a submersion injury is limited to case
studies. The following factors at presentation have been associated with a poor prognosis [4,67-75]:
• Duration of submersion >10 minutes
• Time to effective basic life support >10 minutes
• Resuscitation duration >25 minutes
• Water temperature >10ºC (50ºF)
• Age <3 years
• Glasgow coma scale <5 (comatose)
• Persistent apnea and requirement of cardiopulmonary resuscitation in the emergency department
• Arterial blood pH <7.1 upon presentation
