Pediatric Submersion Injuries: Emergency Care and Resuscitation - Trauma EXTRA Supplement (Trauma CME) -

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Publication Date: June 2022 (Volume 24, Supplement 06)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 06/15/2025. This course is included with an Pediatric Emergency Medicine Practice subscription

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Authors

Peer Reviewer

Abstract

Drowning and submersion injuries are highly prevalent, yet preventable, causes of pediatric mortality and morbidity. Prehospital care should focus on restoring normal ventilation and circulation as quickly as possible to limit the extent of hypoxic insult. Diagnostic testing for symptomatic patients may include blood glucose level, arterial blood gas level, complete blood count, electrolyte levels, chest radiography, and cardiorespiratory monitoring with pulse oximetry and a rhythm strip. In this review, passive external, active external, and active internal rewarming techniques for treatment of hypothermic patients are discussed. A systematic approach to treatment and disposition of pediatric drowning victims is provided, and risk factors, caveats in pediatric care, and factors affecting prognosis are also discussed.

Case Presentations

A 10-month-old girl is brought to the ED after she had been missing for 15 minutes and was finally located at the bottom of the pool. Rescue breaths were given by bystanders, but on arrival to the ED, she is in full cardiorespiratory arrest with a GCS score of 3. She is intubated, and passive rewarming measures are initiated. After intraosseous access is obtained, 2 doses of epinephrine are given with a return of spontaneous circulation after 10 minutes. What additional care should be provided while awaiting admission of this patient?

An 8-year-old boy sustained a submersion injury at a pool party, and had spontaneous return of respiration when rescued by adults at the party. However, 3 hours later, he is brought to the ED by his parents, as he is in respiratory distress. Pulse oximetry is 89%, and diffuse crackles and rales with retractions are noted on chest examination. His GCS score is 15 with a normal neurologic examination. You consider any diagnostic tests that may be necessary for this patient and what management should be undertaken...

During the spring, a 2-year-old girl is transported to the ED after being pulled from a fast-moving river by the swift-water rescue team following 45 minutes of submer­sion. She was apneic and pulseless when pulled from the river. After a 20-minute helicopter transport, she arrives to the ED in full cardiorespiratory arrest, with CPR in progress. Her GCS score is 3, her pupils are fixed and dilated, and her rectal temperature is 34°C. When she is intubated, pulmonary edema is evident. Intraosseous access and central line access are obtained. While examining the patient, you consider your management options...

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