What are sources of secondary CNS injury in drowning?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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In contrast, drowning that is associated with prolonged hypoxia or ischemia is likely to lead to both significant primary injury and secondary injury, especially in older patients who cannot rapidly achieve core hypothermia. Sources of secondary injury include the following:

  • Reperfusion

  • Sustained acidosis

  • Cerebral edema

  • Hyperglycemia

  • Release of excitatory neurotransmitters

  • Seizures

  • Hypotension

  • Impaired cerebral autoregulation

Although cerebral edema is a common consequence of prolonged submersion (or submersion followed by prolonged circulatory insufficiency), retrospective reviews and animal studies have not demonstrated any benefit from the use of intracranial pressure monitoring with diffuse axonal injury. However, as submersion injuries may be associated with trauma (especially to the head, neck, and trunk), focal or persistent neurologic deficit may indicate mass lesions or other injury amenable to surgical intervention.

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