Submersion Events

 

 

 

 

 

 

 

Yes, summer break is officially over, but it is still warm and kids like water!

Submersion Basics

  • Submersion Events are the SECOND leading cause of accidental death in children 1-19yrs. (MVC is #1, naturally)
  • Kids are different when it comes to Environmental Emergencies
    • Less mobile (can’t get out of the water)
    • Larger body surface: mass ratio (more susceptible to heat loss)
    • Curious with less understanding of the potential hazards (particularly teenagers!)

Does the Type of Water Mater?

  • The type of water is rarely clinically significant!

  • Both salt and fresh water lead to the same end points of inactivated surfactant, pulmonary edema, and hypoxia (they do so by different mechanisms… but hypoxia is still hypoxia).
  • A low hematocrit should lead to your consideration of other occult trauma… not hemoldilution!
  • In order produce a change in hematocrit a person has to aspirate >11ml/kg
  • Typically, humans aspirate 3-4ml/kg
  • In order to see significant electrolyte changes, a person has to aspirate >20ml/kg.
  • If a person were to aspirate either quantity, it would be evident clinically!!

Submersion and C-Spine Injury?

  • Routine Immobilization is not necessary solely based on the h/o submersion
  • If there was a high impact event (diving, boating accident, water sports, assault) then yes.
  • Swimming, bathing, wading, fishing, SCUBA – then no.

Submersion leads to VQ Mismatch and Pulmonary Edema…

  • Use BiPap early: If patient has respiratory distress or edema on CXR.

 
1. Watson, R.S., et al., Cervical spine injuries among submersion victims. J Trauma, 2001. 51(4): p. 658-62.
2. Hwang, V., et al., Prevalence of traumatic injuries in drowning and near drowning in children and adolescents. Arch Pediatr Adolesc Med, 2003. 157(1): p. 50-3.

Sean Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renown educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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2 Responses

  1. November 20, 2015

    […] knowing critical care topics (ex, ECMO in ED, Submersion Injuries, Optimize Chest Compressions, and Non-Invasive Ventilation) is vital to being effective in the ED, […]

  2. June 3, 2016

    […] that still lead to childhood injuries. Some of these events are unfortunate and accidental (ex, Submersions), while others are sinister and purposeful (ex, Abuse). When we think of injury in children, we […]

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