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Drowning, Emergency Medicine

Colleen N. Hickey Reviewed 06/2017
 


Basics

Description

  • Definitions:

    • Drowning: “A process resulting in primary respiratory impairment from submersion or immersion in a liquid medium”

      • Fatal drowning: Death at any time as a result of drowning

      • ...

Diagnosis

Signs and Symptoms

  • Cardiopulmonary arrest

  • Cyanosis

  • Dyspnea

  • Copious pulmonary secretions

  • Loss of consciousness

  • Cerebral edema/injury

  • Evidence of trauma:

    • Intracranial hemorrhage

    • Cervical spine injury r...

Treatment

Pre-Hospital

  • Attention to ABCs:

    • Avoid further aspiration

    • Secure airway—intubate

    • Early CPR

  • Cervical spine precautions if injury suspected or concerning mechanism

  • Early rewarming attempts

  • 90% surviva...

Follow-Up

Disposition

Admission Criteria

  • Delayed symptomatology occurs:

    • Pulmonary edema (up to 12 hr later)

    • Neurologic abnormalities

  • ICU:

    • Patients who required CPR or artificial ventilation

    • Abnormal chest ra...

Pearls and Pitfalls

  • All patients with drowning incident require at least 8 hr of observation

  • Indicators of poor prognosis:

    • Acidemia (pH <7.1 on presentation)

    • Age <3 yr

    • Submersion >10 min

    • Time to b...

Additional Reading

  • Burford  AE, Ryan  LM, Stone  BJ, et al. Drowning and near-drowning in children and adolescents: A succinct review for emergency physicians and nurses. Pediatr Emerg Care.  200...

Codes

ICD9

  • 507.0 Pneumonitis due to inhalation of food or vomitus

  • 991.6 Hypothermia

  • 994.1 Drowning and nonfatal submersion

  • 799.02 Hypoxemia

ICD10

  • J69.0 Pneumonitis due to inhalation of food and vomit

  • T68.XXX...

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