EM Ottawa - By James Gilbertson, Amanda Mattice - May 04, 2023
Summary
Overall, the key take-home points for management of a fatal or non-fatal drowning patient in the emergency department includes the following:
- Management in the resuscitation bay:
- Anticipate a difficult and soiled airway, use a SALAD approach
- Employ ARDS ventilation settings
- Prompt OG or NG tube decompression
- Obtain a core temperature and initiate hypothermia rewarming early
- C-spine injuries are rare (0.5%), collar only if obvious signs and mechanism
- No antibiotics are indicated unless drowned in sewage
- Submersion duration is the only factor with reliable evidence for prognostication.
- Safely discharge the well appearing drowning patient home 6-hours post event if meets all three of:
- Normal mentation.
- Normal age adjusted vitals.
- Never required O2.