- History: event, duration of submersion, water temperature.
- Resuscitation as per PALS protocols with attention to body temperature and hypothermia.
- Obtain vascular access (see Vascular Access)
- Consider need for cervical spine immobilization.
- Airway: Consider intubating with a cuffed endotracheal tube for decreased airway compliance.
- Ventilate patient with PEEP 5 cm H2O or more to maintain oxygenation. Monitor Peak Inspiratory pressure to reduce lung barotrauma.
- Circulatory Support:
- Treat patient for signs and symptoms of shock with IV fluid resuscitation and inotropic support.
- Place nasogastric tube and provide low intermittent suction.
- Obtain lab values when possible (I-STAT 8+)
- Maintain thermos-neutrality (36-37):
- Remove all wet clothing and keep patient covered.
- If temperature >32° C, passively external warm patient with warmed blankets
- If temperature <32° C, active core rewarming techniques include warmed IV fluids, warmed blankets and chemical heat packs.
- Handle patient gently, do not rub extremities or allow patient to walk.
- Frequent neurological checks. Treat seizure activity as per Seizure protocol.
- Give sedation for agitation (See Pain/Sedation Protocol)
- Maintenance fluids at full maintenance rate (See Fluid and Blood Component Therapy)
- Assess for other injuries and treat associated problems.
- If pH is ≤ 7.0, OR acidosis is strongly suspected, administer Sodium Bicarbonate 1 mEq/Kg
- Szpilman D, Bierens JJ, Handley AJ, et al. Drowning. N Engl J Med. 2012;366(22):2102-2110. (Review)
- Bierens, JJLM. Handbook on Drowning. 1st ed. Germany: Springer-Verlag Berlin Heidelberg; 2004. (Textbook)
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