Drowning Management | EM Quick Hits Videos

Management of Drowning

Categorization of drowning: fatal or nonfatal, and primary (where it is the only medical issue at play) or secondary (where another medical issue directly precipitated the event)
There is a trimodal distribution of fatal drowning
- Aged 1-5: The majority of events are primary in nature
- Aged 15-25: Events are usually secondary to high-risk events, traumas, or intoxications
- Aged 55+: Be strongly suspicious of ACS as the precipitating event
Drowning is primarily a respiratory/hypoxic event and should be managed as such:
- Management should therefore be focused on high PEEP and FiO2
- Arrhythmias will generally progress from sinus tachycardia to bradycardia ultimately to PEA arrest and shockable rhythms are rare
- Ensure the airway is protected and be prepared for vomiting as this occurs in 90% of patients
- Pitfall: Do not suction oral foam expulsion resulting from surfactant washout as this will prevent effective oxygenation
C-spine collars should only be used if there is a concerning mechanism of injury
Adjunctive therapies: there is no role for diuretics or prophylactic antibiotics, but ECMO may be considered in patients with profound hypoxia despite invasive ventilation