What are the approach considerations in the treatment 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

The most critical role in management is prompt correction of hypoxemia and acidosis. The degree of hypoxemia is often underrecognized. Patients should receive 100% oxygen and should be monitored closely via pulse oximetry, blood gas analysis, or both. Consider intubation and positive end-expiratory pressure (PEEP) with mechanical ventilation in any patient with poor respiratory effort, altered sensorium, severe hypoxemia, severe acidosis, or significant respiratory distress.

Ventricular dysrhythmias (typically, ventricular tachycardia or ventricular fibrillation), bradycardia, and asystole may occur as a result of acidosis and hypoxemia rather than electrolyte imbalance.

Ascertaining whether the drowning occurred in warm or cold water is essential. This depends on the temperature of the water, not of the patient. Maintaining mild hypothermia (core temperature of 32-34ºC) may be indicated for 12-24 hours in patients who remain comatose after a drowning episode. [51, 75, 80]

Seizures should be appropriately treated. Blood glucose concentrations should be frequently monitored and normal glycemic values maintained. Hypotension should be avoided. [5, 81]


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