For today's POTD, we're going to talk about drowning/submersion injuries. Hopefully you don't have to take care of a jet-skiier that gets pulled out of the East river this weekend, but in case you do, here's some tips to prepare you!
Epidemiology: 20% of deaths involve children < 14 yo, a leading cause of death in children < 5yo, typically in swimming pools, bathtubs, buckets.
History of seizures and cardiac disease increases the risk of drowning.
Bimodal distribution with second peak usually (80%) in males 15-25 yo, alcohol involved in up to 70% of cases. Typically rivers, lakes, beaches.
Pathophys: Fluid aspiration => loss of surfactant, pulmonary edema, hypoxemia from V/Q mismatch
ED Management: ACLS if in cardiac arrest, it is usually a respiratory arrest. Remove wet clothing and use rewarming techniques. Initial CXR often normal. Assess for signs of trauma. C-spine injuries are uncommon (<5%) but still evaluate for trauma especially if unwitnessed event. Intubate if O2 sat < 90% despite supplemental O2, PaO2 < 60, or PaCO2>50 as hypoxemia is the major issue. If able to protect airway, BIPAP for positive pressure.
Fresh water vs. salt water drowning distinctions do not matter much because you need to aspirate more than 11mL/kg of body weight to get blood volume changes and even more to get electrolyte changes. Most nonfatal drowning victims aspirate at most 3-4 mL/kg.
Meds: none really helpful, it is supportive care. Steroids and antibiotics have not been shown to help.
Dispo: admit if any symptoms on arrive to hospital, at least for monitoring. If asymptomatic after a near drowning, monitor for at least 4-6 hours.
Sources
https://www.nuemblog.com/blog/drowning
https://www.saem.org/cdem/education/online-education/m4-curriculum/group-m4-environmental/drowing