Care of Drowning Patients in the ED

• 500,000 worldwide deaths per year/10 per day in US on average
• Main goal of resuscitation is to reverse hypoxemia: endotracheal intubation, mouth-to-mouth, BVM depending on setting
• In water resuscitation can be considered (mouth-to-mouth only) while the patient is being actively rescued
• CPR with Airway emphasis- five rescue breaths, 30 compressions, then 2 breaths/30 compressions until the airway can be secured
• Turning the patient over and performing abdominal thrusts or back blows is not helpful
• ARDSnet protocol is generally used when intubated
• No steroids or prophylactic antibiotics are indicated
• Consider trauma (CT head and C-spine precautions based on history/exam)
• Warm up your patient as needed--assume hypothermia on presentation
• Can consider therapeutic hypothermia after ROSC and when rewarmed---no clear benefit here

References

Szpillman D et al. Current Concepts: Drowning. NEJM 2012;366:2102-2110.