HWN Suggests

Pediatric Drowning and Hypothermia

Pediatric hypothermic cardiac arrest is rare, shrouded in urban legend, and confounded by significant publication bias. While amazing outcomes can occur, there is generally a very high mortality rate. Protective hypothermia only occurs with rapid cooling, and commonly in small children who tend to have a large body surface to weight ratio. Any linkage between water temperature and submersion outcomes remains controversial, with recent data suggesting an absence of association. Patient hypothermia may itself be a result of asphyxial injury to the brain, and not a target for management.

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 Pediatric Submersions

Initial resuscitation should focus on airway control. if cardiac arrest ensues, then compressions should be started, with prioritization of a definitive airway and oxygenation. Cardiac arrest in the pediatric patient with a history of drowning is presumed to be due to hypoxia. If return of spontaneous circulation (ROSC) is obtained then standard post-ROSC measures should be taken.

Articles of Interest

Definitions and Debunking Drowning Myths

Despite the prevalence of drowning, there is no widely-accepted protocol for the management of pediatric drowning victims. For example, the utility of a chest x-ray will stir significant debate, even without supporting evidence to obtain one.

Drowning - PEM Currents: The Pediatric Emergency Medicine Podcast

Learn about drowning physiology, when to admit to the hospital, and how to assess the child who went under water unexpectedly but looks fine

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Fatal and nonfatal drowning are among the leading causes of death and lifelong severe neurological impairment among children and adolescents. This study aimed to complement research from Leipzig 1994–2008 to seek trends within risk factors, treatments, and outcomes throughout the last decade.

Drowning in children

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Drowning Module

“Drowning” is the respiratory impairment from being in or under liquid. Terms such as “dry drowning” or “wet drowning” or differentiating between submersion/immersion have fallen out of vogue and are not useful in management or treatment.

IN TOO DEEP: Diving into Pediatric Drowning

It is recommended that patients who are asymptomatic after a non-fatal drowning be observed for approximately eight hours, as most patients will develop symptoms within seven hours of immersion.

Pediatric Drowning

When it comes to pediatric drowning, prevention is the best medicine. However, if you find yourself treating a drowning patient in the ED, this case will have you well prepared.

Pediatric Drowning Case: Favorable Neurologic Outcomes Possible With Prolonged CPR

The likelihood of intact neurological function after a submersion injury is multifactorial. A combination of variables, including the circumstances surrounding the submersion injury and the treatment course, affects the likelihood of intact neurological function after drowning.

Pediatric Drowning: Current Management Strategies for Immediate Care

The immediate care of drowning victims is challenging because of unique pathophysiological mechanisms and complex management issues. Current resuscitation strategies focus on restoring oxygenation and perfusion and preventing secondary pulmonary and neurological injury. Hypothermic patients should be rewarmed to more than 328C, recognizing that rewarming may be difficult in the absence of normal circulation. Extracorporeal rewarming can be considered for victims with profound hypothermia or cardiac arrest in the context of rapid immersion in cold waters.

Pediatric Drowning: In Over Your Head

Patients who are breathing spontaneously and maintaining their oxygen saturation >90%, or their partial pressure of oxygen >90 mmHg with a fraction of inspired oxygen (FiO2) of 50%, may be observed with oxygen alone under continuous pulse oximetry monitoring.3 In individuals who do not meet the above criteria, a trial of NIPPV may be considered. For those who are unable to maintain their airway, rapid sequence intubation is definitive management.

Pediatric Submersion Injuries: Emergency Care and Resuscitation

Although much of the resuscitation of the drowning pediatric victim is basic to all respiratory and cardiac arrest situations, there are some caveats for treatment of this type of injury.

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Drowning is not a fair injury. Drowning risk varies among races and cultures and sexes in our country. White people have the lowest drowning rates overall, but they have the highest drowning rates in 1-to-4-year-olds. In our country, Native Americans and Alaskan Natives have the highest drowning rates in all age groups and in all settings.

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