A 10-year-old child has been found at the bottom of a public swimming pool. On arrival to the Emergency Department, the Glasgow Coma Scale is E1V1M4 and the following vital signs are noted:
You have been asked to help to manage the child.
a) Outline your resuscitative management plan. (80% marks)
b) List four factors that may influence the outcome of the immersion injury. (20% marks)
A "resuscitative management plan" would surely have an ABCDE structure, one might think - that is fairly standard. What is contentious is whether the examiners would have accepted "non-resuscitative" elements, such as the investigations for potential primary reasons behind the drowning (eg. head injury from diving into the shallow end). A reasonable person would argue that finding an extradural haematoma would contribute positively to the overall success of the resuscitation.
Factors which influence the outcome of the immersion injury could be any four of the following:
Factors at the site of submersion:
Factors on presentation to the ED
Factors after admission to the ICU:
Pearn, John. "The management of near drowning." British medical journal (Clinical research ed.) 291.6507 (1985): 1447.
Young, Richard SK, Edwin L. Zalneraitis, and Elizabeth C. Dooling. "Neurological outcome in cold water drowning." Jama 244.11 (1980): 1233-1235.
Suominen, Pertti, et al. "Impact of age, submersion time and water temperature on outcome in near-drowning." Resuscitation 52.3 (2002): 247-254.
Austin, Sébastien, and Iain Macintosh. "Management of drowning in children." Paediatrics and Child Health 23.9 (2013): 397-401.