Submersion injury

Background

• Leading cause of death by injury among children <15yr
• No significant clinical differences between fresh-water and salt-water injuries
• Types
  • Dry Drowning (~20%)
    • Laryngospasm prevents water entry into lungs
  • Wet Drowning (~80%)
    • Water is aspirated into lungs with resulting surfactant wash-out

Work-Up

1. Consider labs/CXR only in pts w/ GCS <13 or if unable to maintain PaO2 >60
   1. CXR
   2. CBC, Chemistry, troponin, coags, UA, total CK

Treatment

• Assume C-spine injury if unclear mechanism
• O2 to keep SaO2 >95%
  • Significant injury often requires mechanical ventilation (high PEEP)
• Warmed IV fluids if needed
• Abx
  • Controversial
  • Consider if concerned for pulmonary aspiration (must cover pseudomonas)

Disposition

• GCS >13, O2 sat >95%, normal pulm exam
  • Consider discharge after 4-6hr of obs
• GCS <13, supp O2 required, or abnormal pulm exam
  • Admit

Source

Tintinalli