What are the approach considerations in the workup of drowning patients?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Management of hypoxemia is the key to the management of drowning. A surprising degree of hypoxia may be present in a relatively asymptomatic patient. Obtain continuous pulse oximetry.

Obtain arterial blood gas (ABG) levels in all patients with any history of submersion injury. ABG analysis is probably the most reliable clinical parameter in patients who are asymptomatic or mildly symptomatic. ABG analysis should include co-oximetry to detect methemoglobinemia and carboxyhemoglobinemia.

Remember that cervical spine trauma may be present in any victim of shallow- or rocky-water immersion injury. If the victim is unable to give a clear history of the events, has evidence of head or facial injury, or is found unresponsive in a pool or other shallow body of water, protect the cervical spine until injury is excluded.

Obtain blood for a rapid glucose determination, complete blood count (CBC), electrolyte levels, lactate level, and coagulation profile, if indicated. Collect urine for urinalysis, if indicated. Measure liver enzymes, especially aspartate aminotransferase and alanine aminotransferase. Consider a blood alcohol level and urine toxicology screen for use of drugs. Cardiac troponin I testing may be useful as a marker to predict children who have an elevated risk of not surviving to hospital discharge.


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