See: [Cameron - Drowning](x-devonthink-item://10DC3BB1-027C-40D6-BDB3-4AF0C6B160E6?page=790) see also: [[Hypothermia]] > [!key points] > - The finding of *hypothermia* usually reflects a lack of perfusion and is a **very poor prognostic sign**. CPR should not be continued for a prolonged period in an asystolic child solely to warm the patient unless severe environmental hypothermia is the cause - there is no important clinical difference between freshwater and saltwater immersion **Terms** - "breaking point" - wen a conscious diving patient takes an involuntary breath - "shallow water blackout" - hyperventilating before diving causes plasma CO2 concentrations to become so long that hypoxic unconsciousness occurs before breaking point is reached sea water --> loss of surfactant --> reduced compliance --> need more PEEP hypoxia causes marked bradycardia, hypotension, and irreversible brain injury within 3-10 minutes # management ## ventilation - PEEP and low volume ventilation (Peep 5-10 increase rapidly as tolerated until adequate oxygenation achieved) # drowning prognostic indicators Outcomes are often determined by extent of neurologic injury: often either survive or die. **Poor prognostic indicators** often include: - prolonged duration of submersion - Lack of bystander CPR - Prolonged pre-hospital CPR - PEA on arrival - Fixed dilated pupils - Severe acidosis - Aponea **Good prognostic factors:** All these are good predictive factors for a favourable outcome after near drowning. - Submersion time less than 5 minutes - CPR commenced within 10 minutes of retrieval from water - First spontaneous breath within 30 minutes of retrieval from water - Return of spontaneous circulation prior to arrival at hospital. ## Orlowski scale - age <3 - submersion > 5 min - no attempted resus in first 10 min after rescue - coma on arrival to ED - metabolic acidosis pH < 7.1 90% chance of good recovery if <3 of the above present 5% recovery if >3 present # factoids - Aspiration of as little as 1 - 2.2ml/Kg of water can cause hypoxia - *fresh water* aspiration causes transient hemodilution and if large enough volumes are aspirated then significant hemolysis and hyponatremia can occur. - *Saltwater* drowning causes hemoconcentration and hypernatremia. - It is unlikely to develop a delayed pulmonary edema from drowning after normal initial observations, examination and CXR. An alternate cause needs to be considered. # Related Questions ## drowning - [x] 11Q: [Drowning](x-devonthink-item://4134DDB3-6E12-474A-9F6F-64135C0C6048?page=18) -- [Answer](x-devonthink-item://AC92B5F1-8EE6-461A-B03E-F70AE7DC1275?page=19) - [ ] 12Q: [Drowning](x-devonthink-item://310EEEDE-D794-4365-8865-5B3DD1C20510?page=13) -- [Answer](x-devonthink-item://6D5125AD-DE4D-435B-8D13-6EA35DB8E785?page=17) - [ ] 13Q: [Drowning](x-devonthink-item://5FC539E5-7F1D-48E5-B062-83009DA98093?page=12) -- [Answer](x-devonthink-item://D25C2F83-6C30-4F45-8B5B-6E7E57BD24A3?page=6) - [ ] 14Q: [Drowning](x-devonthink-item://2504F01B-CEAF-41E8-803B-B3AE1B07A49E?page=6) -- [Answer](x-devonthink-item://00427DF6-6D28-4FEB-A0CA-DF96DBBBCE97?page=24) - [ ] 15Q: [Drowning](x-devonthink-item://87BC05C2-0A6B-436D-B51A-75E14AA5EA7E?page=9) -- [Answer](x-devonthink-item://98D17FA0-225B-4E94-B21C-4E36D5C76A7C?page=62) -- [prop](x-devonthink-item://093F49C6-2E32-460E-9C00-3E9F15CD417E?page=26) - [ ] 16Q: [Drowning](x-devonthink-item://6092BF31-E542-4019-8E17-0C628DD3B0F1?page=6) -- [Answer](x-devonthink-item://E15CEB64-C6A5-4A7D-84B4-E7D1DC667B0E?page=4)