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.