You are called to the Emergency Department to review a 56-year-old female found floating in the surf. Her initial rhythm was asystole, although return of spontaneous circulation was achieved within 5 minutes of ambulance arrival. She is currently intubated with a correctly positioned endotracheal tube, is being ventilated adequately with 100% oxygen, and has an unsupported blood pressure of 130/65 mmHg.
What are the management issues that must be considered in her further care? For each issue briefly outline any specific interventions or treatments required.
(Note to candidates: general details of resuscitation such as providing standard monitoring or obtaining vascular access are not required.)
Emergency management issues
ICU management issues
The ARC ALS2 manual (2011) has a section on drowning (pp. 127). This was my main source of information.
Pearn, John. "The management of near drowning." British medical journal (Clinical research ed.) 291.6507 (1985): 1447.
Giammona, Samuel T., and Jerome H. Modell. "Drowning by total immersion: effects on pulmonary surfactant of distilled water, isotonic saline, and sea water." American Journal of Diseases of Children 114.6 (1967): 612-616.
Modell, Jerome H., et al. "Physiologic effects of near drowning with chlorinated fresh water, distilled water and isotonic saline." Anesthesiology 27.1 (1966): 33-41.
Young, Richard SK, Edwin L. Zalneraitis, and Elizabeth C. Dooling. "Neurological outcome in cold water drowning." Jama 244.11 (1980): 1233-1235.
Szpilman, David, et al. "Drowning." New England journal of medicine 366.22 (2012): 2102-2110.
Modell, Jerome H., and J. H. Davis. "Electrolyte changes in human drowning victims." Anesthesiology 30.4 (1969): 414.
Modell, Jerome H., et al. "The effects of fluid volume in seawater drowning." Annals of internal medicine 67.1 (1967): 68-80.
Halmagyi, Denis FJ. "Lung changes and incidence of respiratory arrest in rats after aspiration of sea and fresh water." Journal of applied physiology 16.1 (1961): 41-44.
Fuller, Roger H. "The clinical pathology of human near-drowning." Proceedings of the Royal Society of Medicine 56.1 (1963): 33.