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Submersion injury
From WikEM
Contents
Background
- Definition: "The process of experiencing respiratory impairment from submersion/immersion in liquid"[1]
- Term "near-drowning" no longer used
- Three possible outcomes = death, survival with morbidity, survival without morbidity
- Consider secondary causes such as intoxication, syncope, cardiac arrhythmia, ACS, non-accidental trauma, etc.
Pathophysiology
- Submersion → voluntary breath holding → aspiration → coughing/laryngospasm → aspiration continues → hypoxia → death[2]
- Aspiration destroys surfactant which → alveolar collapse, atelectasis, non-cardiogenic pulmonary edema, and V-Q mismatch.
Clinical Features
Differential Diagnosis
- Immersion pulmonary edema
- Submersion injury (drowning and near-drowning)
- Scuba diving emergencies
- Lightning injuries
- Hypothermia
- Marine toxins and envenomations
- Spinal cord trauma
Evaluation
- CXR (on arrival and after 4 hours)
- ABG
- Other work-up generally not needed unless specifically indicated by history or exam[2], but may consider:
- Labs, EKG
- CT head/C-spine (if history of trauma) - C-spine injury extremely unlikely without evidence or history of trauma (<0.5% in large cohort study)[3]
Management
- Supportive care based on presentation is cornerstone of management.
Disposition
- Discharge after 4-6 hours of observation if:
- Normal mental status, SpO2 >95% on room air, normal CXR and respiratory exam
- Admit all others
See Also
Video
References
- ↑ World Health Organization (WHO) "Global Report on Drowning". ../docss/Final_report_full_web.pdf (Accessed 02/01/2017)
- ↑ 2.0 2.1 Szpilman, D., Bierens, J. J., Handley, A. J., & Orlowski, J. P. (2012). Drowning. N Engl J Med, 366(22), 2102-2110. doi: 10.1056/NEJMra1013317
- ↑ Watson RS, Cummings P, Quan L, et al. Cervical Spine Injuries Among Submersion victims. J Trauma 2001; 51:658.
