Drowning


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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

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    Key Points

    1. Most cases of drowning result in minimal or no respiratory impairment and don’t require hospital admission beyond a period of observation.
    2. Cervical spine injury is uncommon but should be considered if there is a history of trauma e.g. diving.
    3. The cause of drowning should be fully considered including medical causes or issues around supervision and safety.
    4. Key principles of management are maintaining adequate oxygenation, preventing aspiration and stabilising body temperature.

    Background

    Drowning is the process of experiencing respiratory impairment from submersion/immersion in a liquid.

    Near drowning is an obsolete term.

    Assessment

    History:

    Consider a medical cause for drowning in children who are competent swimmers.
    Including

    • Seizures
    • Arrhythmias and Long QT
    • Intoxication

    Circumstances leading to the drowning

    • Inconsistencies in story?
    • Story incompatible with developmental age?

    Timeline

    • Immersion time
    • Time to and type of basic life support delivered
    • Time to first respiratory effort
    • Details of treatment used

    Examination:

    • Evidence of hypoxic brain injury
    • Evidence of respiratory injury
    • Signs of trauma particularly head and cervical spine trauma

    Management

    Key principles of management are maintaining adequate oxygenation, preventing aspiration and stabilising body temperature.

    Vomiting is common in drowning victims and aspiration of gastric contents is a major complication. Spontaneously breathing children should initially be placed in the lateral decubitus position.

    drowing

    Hypothermia

    Hypothermia is a common consequence of drowning.
    Remove wet clothes and dry child
    Exposure should be minimised
    Active warming should occur if core temperature is less than 34C.
    This includes:

    • Warmed IV Fluids
    • Humidified oxygen delivery
    • Forced air warming blankets

    Investigations:

    Children who are asymptomatic and alert require no investigations.
    Further investigations should be guided by the child’s history and clinical condition

    • Chest X-ray findings do not correlate with clinical outcomes
    • Altered mental state in the absence of significant hypoxia should prompt a search for reasons other than drowning as a cause, e.g. hypothermia, Traumatic brain injury, co-existent medical condition, hypoglycaemia.
    • ECG: May be helpful in diagnosing prolonged QT syndrome.

    Treatment:

    Prophylactic antibiotics have no role

    Consider consultation with local paediatric team when:

    Increased respiratory effort
    SpO2 <95%
    Abnormal lung examination

    Consider transfer when:

    Persisting altered conscious state
    Respiratory compromise requiring assisted ventilation
    Ongoing hypoxia

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Consider discharge when:

    Observed for 8 hours from the time of drowning
    Asymptomatic
    Normal respiratory examination
    SpO2 ≥95%
    No ongoing safety concerns
    Referral to social work has been made if deemed appropriate

    Parent information sheet 

    Water Safety

    Additional notes

    Adverse prognostic indicators

    • Immersion time > 10 minutes
    • Rectal temperature < 30C
    • Absence of initial resuscitation efforts
    • Arrival in hospital with CPR in progress
    • Absence of respiratory effort after 40 minutes 

    Last Updated September 2017