Anesthesia Considerations 

Drowning 

 

 

Considerations 

 

• Trauma/ATLS approach:

  • Possible C-spine injury 

  • Hemorrhage/occult injuries 

  • Co-ingestions 

• Hypothermia:

  • Coagulopathy

  • Arrhythmias

  • Hypovolemia

  • Rewarming technique

  • Electrolyte abnormalities 

• Multi-organ system dysfunction:

  • ARDS

  • Hypoxic brain injury

  • Electrolyte abnormalities (↑K+), cell lysis 2nd to fresh water drowning 

  • Shock

  • ARF

• Etiology of drowning:

  • Adults: arrhythmia (long QT syndrome), seizure, trauma, MI, intoxication

  • Children: abuse, unsupervision

 

 

Goals/Conflicts

 

• Primary Resuscitation to ensure adequate oxygen exchange and perfusion pressure 

• Prevent secondary injury: C-spine precautions 

• Aggressive rewarming  

• 100% mortality = Submersion > 25 min, Resuscitation > 25 min, Pulseless on arrival to ED, Unconscious at scene and on arrival to ED 

 

 

Treatment

 

• Treat hypoxia: restore oxygenation and ventilation

  • Rescue breaths

  • Endotracheal intubation

  • 100% oxygen until ROSC then FiO2 to keep SpO2 > 92%

• Treat cardiac arrest: may be PEA, systole, VT/VF

  • Follow ACLS guidelines

  • Modifications for hypothermia: active rewarming until 34ºC then passive

  • Consider 24 hours of therapeutic hypothermia (32-34ºC)

• Cervical spine injury extremely rare (0.009%): do not place C-spine collar unless mechanism for C-spine injury is suggested