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