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Author: Ryan Pedigo, MD (Chief Resident and PGY-3, Harbor-UCLA Medical Center –
@DrPedigo (https://twitter.com/drpedigo)) // Editors: Manpreet Singh, MD (@MPrizzleER
(https://twitter.com/mprizzleer)) and Alex Koyfman, MD (@EMHighAK
(https://twitter.com/emhighak))
Must decide if they arrested and then got cold, or arrested because they were cold
If arrested because they were cold, CPR duration does not predict outcome
Case report of 190 minutes of CPR with full neurologic recovery – cold is protective!
In general, a cardiac arrest from hypothermia requires a temperature under 32°C
Potassium greater than 12 mEq/L is criteria for terminating resuscitation
If patient’s chest is frozen solid and chest is not compressible, do not resuscitate
Did they have a drowning incident? Was it submersion or immersion?
Submersion: Patient goes under water immediately, becomes hypoxemic, arrests and cools
Extremely poor prognosis except perhaps in pediatric patients who can cool faster
Immersion: Patient is in the water but able to breathe, arrests due to hypothermia only
Prognosis is good
(http://www.emdocs.net/wp-content/uploads/2015/04/Hypothermia.jpg)
Drowning Pearls
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Pathophysiology
Breath holding underwater > involuntary gasp > aspiration/laryngospasm > LOC > active aspiration
> death
90% “wet drowning” and 10% “dry drowning”
Aspiration leads to loss of surfactant, atelectasis, V/Q mismatch, and ARDS
Hypoxemia leads to a significant metabolic acidosis
Management
No prophylactic antibiotics (consider if drowned in obviously infected source such as sewage tank)
C-spine immobilization only if high concern for injury (injuries only occur in 0.5% of drowning)
(http://www.emdocs.net/wp-content/uploads/2015/04/Drowning.jpg)
References:
Drowned. (http://www.nejm.org/doi/full/10.1056/NEJMra1013317)
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