Fast Five Quiz: Drowning

Richard H. Sinert, DO

Disclosures

June 25, 2020

Patients are especially likely to be asymptomatic if they experience brief, witnessed submersions with immediate resuscitation.

Patients who are symptomatic may exhibit:

  • Altered vital signs (eg, hypothermia, tachycardia or bradycardia)

  • Anxious appearance

  • Tachypnea, dyspnea, or hypoxia: If dyspnea occurs, no matter how slight, the patient is considered symptomatic

  • Metabolic acidosis (may exist in asymptomatic patients as well)

  • Altered level of consciousness, neurologic deficit

  • Cough

  • Wheezing

  • Hypothermia

  • Vomiting, diarrhea, or both

Management of hypoxemia is the key to the management of patients who have a drowning episode. A surprising degree of hypoxia may be present in a relatively asymptomatic patient. Continuous pulse oximetry should be used, and a rapid glucose determination, complete blood cell count, electrolyte levels, lactate level, and coagulation profile should be obtained, if indicated. Collect urine for urinalysis, if indicated. Measure liver enzyme levels, especially aspartate aminotransferase and alanine aminotransferase levels. Consider a blood alcohol level and urine toxicology screen to look for the use of drugs. Cardiac troponin I testing may be useful as a marker to predict children who have an elevated risk of not surviving to hospital discharge.

If initial test results show an elevated serum creatinine level, marked metabolic acidosis, abnormal urinalysis, or significant lymphocytosis, serial estimations of serum creatinine level should be performed. Acute renal impairment is known to occur frequently in drowning, and although usually mild (serum creatinine level < 0.3 mmol/L or 3.4 mg/dL), severe renal impairment requiring dialysis may occur.

Arterial and central venous catheters may be useful in monitoring cardiac output and related hemodynamic parameters. Pulmonary artery catheters are less frequently used, yet may prove useful in patients with unstable cardiovascular status or in those who require multiple inotropic and vasoactive medication requirements.

Read more about the workup of drowning.

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