Abstract
Background
Drowning is one of the leading causes of death in the pediatric population. Patients
arriving to the emergency department (ED) with submersion injuries are often asymptomatic
and well-appearing, but can sometimes present critically ill and require prolonged
resuscitation. The question of how long to continue resuscitation of a pediatric patient
with a submersion injury is a difficult question to answer.
Case Report
We present a case of 6-year-old boy was found by his friends submerged in sea water
for 10–15 min. The patient was rescued by lifeguards and evaluated by emergency medical
personnel, who found him breathing spontaneously but unresponsive. En route to hospital,
the patient became apneic, cardiopulmonary resuscitation (CPR) was started, and the
patient was intubated. The patient arrived to the ED in cardiopulmonary arrest, CPR
was continued and epinephrine was administered. Return of spontaneous circulation
was achieved after 42 min in the ED. Initial laboratory test results showed severe
acidosis and chest x-ray study showed diffuse interstitial edema. Ventilator settings
were adjusted in accordance with lung protective ventilation strategies and the acidosis
began to improve. Over the next several days, the patient was weaned to noninvasive
ventilation modalities and eventually made a complete neurologic recovery and continued
to be a straight-A student.
Why Should an Emergency Physician Be Aware of This?We make the case that, in select drowning patients, duration of CPR longer than 30
min can potentially result in favorable neurologic outcomes. Prolonged CPR should
be especially strongly considered in patients with a pulse at any point during evaluation.
With the combination of prolonged CPR and judicious use of lung protective mechanical
ventilation strategies, we were able to successfully treat the patient in our case.
Keywords
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Article info
Publication history
Published online: July 22, 2022
Accepted:
July 9,
2022
Received in revised form:
June 14,
2022
Received:
March 17,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
