Drowning Pearls

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    Drowning Pearls

    Thanks to our PEM fellow Dr. Michelle Vasquez for a great morning report today!

    Some questions that came up afterwards:

    Is there a difference in drowning with salt vs freshwater?

    -turns out that while there are blood and electrolyte shifts, the amount of water needed to induce a clinically significant difference between the two types of water is so much that the pt has essentially suffered a fatal drowning, and therefore the difference does not change management.  

    UpToDate states “Aspiration of more than 11 mL/kg of body weight must occur before blood volume changes occur, and more than 22 mL/kg before electrolyte changes take place” but non fatal drowning usually is more on the lines of 3-4mL/kg.

    When are antibiotics indicated in drowning?

    No great evidence for antibiotics in drowning unless water is grossly contaminated. However if pt develops a pneumonia afterwards, make sure to cover for water-borne pathogens like Pseudomonas.

    In the awake but symptomatic patient, what are indications for intubation?

    •Signs of neurologic deterioration or inability to protect the airway

    •Inability to maintain a PaO2 above 60 mmHg or SpO2 above 90 percent despite high-flow O2

    •PaCO2 above 50 mmHg

    Consider using bipap on patients who don’t meet the above criteria for immediate intubation, but are symptomatic

     

     

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