Pediatric Drowning

Dr Nayyar Raza Kazmi

• Background Statistics
• Pathophysiology
• Emergency Management
• Long Term Issues
 Background
• 400 Deaths Annually in UK
– 45% Recreational
– 44% didnt plan to enter water
– 5% Bathing
• 200 Additional Suicide Fatalities
• Certain under reporting of events
• 372,000 Annual Fatalities
 Risk Groups
• 81% Male
• Only equals in 90+ age group
• Replicated worldwide

• Withing Paediatric Population

• Bimodal peaks
• Globally 50% are 0-25 years
• UK fares well on international ranking
 Pathophysiology
• Respiratory
impairment due
to immersion or
submersion in
any liquid

• Dry Drowning
• Wet Drowning
• Near Drowning
 Medical Issues in Drowning
• Aiways Issues
• Breathing
• Cardiac Issues
• C-Spine and Neurological Issues
• Hypothermia
• Secondary Infection
– Aeromonas, Pseudomonas, Burkholderia, Chromobacterium
 Management
• Prehospital Care
– Biggest Factor in Survival/ Recovery
– minimise submersion time
– Early Resuscitative effort
– APLS ABC Approach
 Hospital Care
• Airway
– Cervical Injury?
– Oxygenate
– Cuffed ETT if required
• Breathing
• Lung Protective Strategies
• PEEP/ Recruitment Strategies
• Circulation
– Age appropriate MAP
– 50% Fluids
• Hypothermia
– Change in resus Drugs
– Rewarming Strategies
• Neuroprotection
• Seizure COntrol
• Antibiotics
 Case Study
• 18 Months old Boy
– At a family gathering with multiple other children
– Uncle House
– Pond in Back Garden
– Was found missing from drawing room and found 15 minutes
later face down in back garden pond
• 999 was called. One of the household member
commenced CPR
• Paramedics arrived in 7 minutes
– Cardiorespiratory arrest
– ROSC was established after 2 cycles of CPR
– HEMS also arrived and intubated and ventilated the baby on
scene
– Soiled aiways were noted at time of Intubation
 PEM Arrival
• Trauma Team was ready on arrival
• A- Size 4 ETT Blood Gas Values
• B- Bilateral air entry with coarse pH 6.8
crackles on Left Lung Base pCO2 9.6
• C- CRT was 2 Secs. 20 mls/ Kg was pO2 15.2
given by HEMS Bicarbonate 7.3
• D- Paralysed. Pupils were bilateral 4 base excess/ Deficit -21
mm and sluggishly reactive Lactate 13
• E- No external signs of Injury.
Temperature was 33C
 PICU Admission
• Conventional Ventilation
– 27/10/ 25% FiO2
• Arterial Line and CVL was inserted
• Neuroprotective Measures
• Hyponatremic
– Sodium Infusion was commenced
 PICU Further Course
• Day 1-4
– Different System Based Challenges
– Persistently Tachycardic
– Fluctuant BP
– Temperature Instability
– Electrolytes issues
• Day 5-8
– CT Head showed widespread HIE Changes, followed by MRI
– Brainstem affected
– Ongoing Multiorgan Failure
– No Respiratory effort following Extubation
– RIP
Prognostic Factors