A 10-month-old girl is brought to the ED after she had been missing and was finally located at the bottom of the pool after 15 minutes of searching. 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. The process to admit this patient is initiated...
An 8-year-old boy sustained a submersion injury at a pool party, and he had spontaneous return of respiration when rescued by adults at the party. However, 3 hours later, his parents bring him to the ED, as he is in respiratory distress. His 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 diagnostics that may be necessary for this patient and what management should be undertaken...
A 2-year-old was pulled from a fast-moving river in Arizona during the spring by the swift-water rescue team after 45 minutes of submersion. She was apneic and pulseless when pulled from the river. She arrives to the ED after a 20-minute helicopter transport 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...
Drowning and submersion injuries are leading causes of accidental death and injury in children in the United States and worldwide. Drowning accounts for > 500,000 deaths globally each year and is the leading cause of death worldwide among males aged 5 to 14 years.1 In the United States, it is a leading cause of death in children aged 1 to 14 years. It is estimated that 80% of all drownings are preventable. The World Congress on Drowning defines drowning as “a process resulting in primary respiratory impairment from submersion/ immersion in a liquid medium.” The victim may either live or die after the process but is still considered to be involved in a drowning incident.2 Much of the earlier literature uses terms such as “neardrowning” to describe nonfatal drowning events. For example, many authors have defined “drowning” as any death within 24 hours of the event and “near-drowning” as any death that occurred after 24 hours. In an effort to come to a universal definition to aid in future research, in 2002, the World Health Organization (WHO) defined “fatal drowning” as any death related to drowning and “nonfatal drowning” as those victims who survived. The use of terms such as “near-fatal drowning,” “near drowning,” or “secondary drowning” has been ill-defined and has led to confusion in the literature and difficulty in estimating the true number of drowning deaths and morbidity. Therefore, those terms should be abandoned in favor of the WHO definition. Much of the literature on pediatric drowning is devoted to defining the population of children who drown, prevention strategies, and defining physiological variables in children for whom aggressive resuscitation will result in a good neurological outcome. 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.
A literature search was performed using PubMed and Ovid MEDLINE® with the search terms pediatric drowning, pediatric near drowning, pediatric submersion, prevention of pediatric drowning, hypothermia, and hypothermia and drowning. Some adult drowning literature was also reviewed. Additional sources and information, such as safety guidelines from the American Academy of Pediatrics (AAP) (www.aappublications. org), information and statistics from the United States Centers for Disease Control and Prevention (CDC), the Consumer Product Safety Commission (CPSC) of the United States, Safe Kids Worldwide, and information from the World Congress on Drowning (www.cslsa. org/events/ArchiveAttachments/Spr03Minutes/AttachmentG2. pdf), were also accessed.
Much of the literature on drowning involves 4 topics: (1) the demographics of drowning, (2) resuscitation, (3) the outcomes of pediatric drowning victims, and (4) prevention. The demographic data are retrospective data analyses from national databases and organizations, such as the WHO. Resuscitation data include consensus statements from organizations (such as the International Liaison Committee on Resuscitation) and retrospective reviews.
Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.
To help the reader judge the strength of each reference, pertinent information about the study will be included in bold type following the reference, where available.
Janet Semple-Hess, MD; Rashida Campwala, MD
June 1, 2014