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Drowning (near-drowning)

Version: February 2017
Legacy ID: 109-6

Rationale

Near-drowning is defined as survival beyond 24 hours following a submersion event. Toddlers and young children, adolescents and young adults, and the elderly are at increased risk.

Causal Conditions

(list not exhaustive)

  1. Inability to swim (e.g., overestimation of capability)
  2. Risk-taking behavior, boat accidents
  3. Alcohol and substance abuse (over 50% of adult drowning deaths)
  4. Inadequate adult supervision
  5. Concomitant clinical difficulties
    1. Trauma
    2. Seizures
    3. Cerebrovascular accident
    4. Cardiac event

Key Objectives

Given a patient with a history of a submersion event, the candidate with make the appropriate diagnosis of near-drowning, assess the patient with respect to severity and complications, and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with near-drowning, the candidate will

  1. recognize the need for careful rescue, paying attention to the safety and well-being of the rescuer(s)
  2. initiate appropriate cardiopulmonary resuscitation if/when appropriate
  3. demonstrate appropriate airway management when indicated (positive-pressure bag and mask, endotracheal intubation)
  4. recognize the potential for co-existing trauma, including spinal cord injury, and implement appropriate precautions
  5. initiate additional supportive therapy as indicated by the clinical situation, including oxygen administration, intravenous fluid therapy and correction of hypothermia
  6. consult emergency medicine or critical care services appropriately when there is a need for intubation, mechanical ventilation or cardiovascular support
  7. recognize the need to continue cardiopulmonary resuscitation until the victim’s core body temperature can be restored to 32-35 degrees Celsius in the event of a cold water immersion/submersion
  8. recognize the need for an interval of observation (4 to 6 hours) following rescue/resuscitation from near-drowning
  9. initiate appropriate cardiopulmonary and neurologic monitoring
  10. recognize potential complications of near-drowning, including cerebral edema, anoxic/ischemia encephalopathy, cardiovascular collapse, cardiac dysraspiration, acute respiratory distress syndrome, or co-existing trauma
  11. order and interpret diagnostic tests in a patient with suspected complications of near-drowning (recommended: arterial blood gases, chest radiographs, complete blood count, electrolytes, electrocardiogram; additional: international normalized ratio, partial thromboplastin time, urinalysis, drug screen, urine myoglobin).