Pediatric Drowning: Current Management Strategies for Immediate Care
Section snippets
Definitions
In 2002, the World Congress on Drowning published expert consensus recommendations regarding drowning definitions, prevention, rescue, and treatment. Two recent reviews have summarized some of the expert conclusions 4, 5. The final report, Handbook on Drowning, was published in 2004 [6].
Terminology describing drowning has varied for decades. Lack of uniformity has resulted in confusion among clinicians and difficulty in interpreting and comparing reported data. Thus, a major goal of the World
The Pathophysiology of the Drowning Process
Understanding the drowning process provides rationale for current rescue and treatment strategies. The drowning process begins when the victim's airway lies below the surface of a liquid medium (usually water). Typically, voluntary breath-holding ensues. Small amounts of water are aspirated from the oropharynx/larynx, which triggers involuntary laryngospasm resulting in hypoxia. Large amounts of water are subsequently swallowed. With prolonged hypoxia, laryngospasm abates and more water is
Predicting Outcomes
A great deal of research has focused on epidemiological, clinical, and laboratory predictors of outcome for drowning victims. Four outcomes can occur in pediatric drowning: (1) full recovery (neurologically intact), (2) neurological impairment, (3) persistent vegetative state, and (4) death [20]. Predictors studied to date include demographic characteristics (age and sex), historical factors (submersion time, time to resuscitation, and cardiopulmonary resuscitation [CPR] at the scene), and
Scene Interventions
The immediate care of the drowning victim begins at the scene (Table 1). The importance of bystander resuscitation to restore oxygenation cannot be overemphasized. Mouth-to-mouth breathing should be initiated immediately, even while the victim is still in the water [8]. Any delay in pulmonary resuscitation exacerbates the existing hypoxia and decreases the victim's chances of intact survival 22, 36, 37. In fact, some studies have shown survival only in those victims who received bystander
Prevention
Prevention is the key link in the chain of survival [40]. A recent review of unintentional drowning deaths in the United States found that 78% of drowning deaths among infants were in bathtubs. Of drowning injuries in children 1 to 4 years, 56% were in artificial pools, and among those occurring in children older than 5 years, 63% occurred in fresh bodies of water [65]. Most pool drowning episodes occurred in the child's own home. The use of 4-sided pool fencing has been shown to reduce the
Summary
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 32°C, recognizing that rewarming may be difficult in the absence of normal circulation. Extracorporeal rewarming can be considered for victims with profound hypothermia or
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Cited by (9)
Predictors of emergency department discharge following pediatric drowning
2018, American Journal of Emergency MedicineCitation Excerpt :No standard emergency management of pediatrics drowning victims exists, despite the significant morbidity and mortality due to drowning worldwide. This may be due in part to the wide variation of clinical presentation of these patients [10]. Asymptomatic patients may require little to no laboratory or radiological evaluation while tests in symptomatic patients may include various labs and imaging [11].
Submersion Injuries
2012, Emergency Medicine: Clinical Essentials, SECOND EDITIONA quest for an integrated management system of children following a drowning incident: A review of the literature
2024, Journal for Specialists in Pediatric NursingPredictors for hospital admission of asymptomatic to moderately symptomatic children after drowning
2019, European Journal of Pediatrics