Correlation of spontaneous respiration and neurologic damage in near-drowning

Jacobsen, Wayne K.; Mason, Linda J.; Briggs, Burton A.; Schneider, Sanford; Thompson, James P.

doi:10.1097/00003246-198307000-00001

Cited by 35 publications

(10 citation statements)

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“…Our results concur with others 21,24,[27][28][29][30][31][32][33][34][35] regarding the predictive values of the initial clinical examinations and laboratory results done in the emergency department (Table 2). Initial findings of pulseless, breathless child, GCS of ≤4.0, blood gas pH of ≤7.0 and blood sugar of ≥10 mmol/L predicted significantly bad outcome.…”

Section: Discussionsupporting

confidence: 92%

“…[20][21][22][23][24][25][26] Published factors shown to correlate with bad neardrowning outcome include: submersion duration >10 minutes, normal or high water or patient temperature, delayed rescue at the scene, need for CPR in the emergency department, depth of coma (GCS <4), delayed neurological response to therapy, initial arterial pH <7.0, and initial blood sugar level >12 mmol/L. 21,24,[27][28][29][30][31][32][33][34][35] Our results showed a trend (not statistically significant) for bad near-drowning outcome with children >6 years of age. The likely cause is that they drowned unwitnessed in swimming pools or in dams where rescue was not prompt.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Near Drowning: The Experience of King Khalid University Hospital

Al-Mofadda

Nassar

Alturki

et al. 2001

Annals of Saudi Medicine

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Background:The purpose of the study was to evaluate the outcome of warm pediatric near drowning, and assess possible predictors of the outcome. Subjects and Methods: The study was performed at King Khalid University Hospital, Riyadh, Saudi Arabia. Twenty-eight cases of pediatric near drowning (one to 13 years of age) over a 10-year period ending June 1998, were reviewed retrospectively. Multiple variables during the prehospital and the hospital stages were evaluated to assess their effect on the outcome. Results: None of the patients' families had official training in cardiopulmonary resuscitation. Only one of the 21 private swimming pools had features compatible with swimming pool safely regulations. Eleven patients (39.3%) died in the pediatric intensive care, and 17 (60.7%) were discharged alive. Submersion time of >5 minutes and the emergency room documentation of absence of vital signs, Glasgow Coma Scale of ≤4, arterial pH of ≤7.0 and blood sugar of ≥10 mmol/L all predicted bad outcome, with a statistical significance (P< 0.05). Conclusion: This audit highlighted major concerns about our prehospital medical care, general population basic life support education and our society's adherence to swimming pool safety regulations. It demonstrated that hypothermia on arrival to the emergency department in warm near-drowning victims is likely to be associated with bad outcome. The audit results also agree with the opinion of not aggressively intervening or prolonging aggressive intervention in warm near-drowning cases presenting with bad prognostic outcome. Drowning is a preventable catastrophic accident. It is the fourth leading cause of death for children younger than 19 years of age, and the single leading cause of injury death for children under 5 years of age in the US.1,2 A rate of drowning of between 0.7 and 2.9 per 100,000 children younger than 19 years has been reported. 1,3 Roughly 80% of the children with near-drowning histories are admitted for at least one day, and 40%-50% of the cases die, with as many as 20% of the survivors suffering severe permanent disability. [4][5][6] Residential swimming pools continue to be the most common place for immersion injuries, particularly in preschool children. 2,[6][7][8][9][10][11][12] The total annual economic losses due to swimming pool drowning and near drowning of young children in the United States are estimated to be between $450 and $650 million. 13 Adherence to safety precautions for residential swimming pools, such as four-sided fencing, is estimated to have prevented 50%-90% of swimming pool immersion injuries. 4,[14][15][16][17][18] Near-drowning cases in Saudi Arabia do not get the deserved publicity from the media or from pediatricians. To the best of our knowledge, this is the first audit tackling the issue of neardrowning of children in Saudi Arabia. Subjects and MethodsA retrospective case review study was conducted to evaluate near-drowning cases managed at King Khalid University Hospital (KKUH) Pediatric Intensive Care Unit (PICU) in Riyadh, Saudi...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Pediatric Near Drowning: The Experience of King Khalid University Hospital

Al-Mofadda

Nassar

Alturki

et al. 2001

Annals of Saudi Medicine

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“…The body temperature depends on water temperature, insulation provided by clothing, and the volume of aspirated water. Large volumes of water can cause rapid central cooling 4,5,6 . The implications and consequences of hypothermia in near drowned victims are the subject of significant controversy and confusion.…”

Section: Hypothermiamentioning

confidence: 99%

“…Although severe hypothermia may rarely confer some degree of neurological protection, its pathological implications are more commonly detrimental, if not rapidly corrected. Moderate to severe hypothermia leads to progressive bradycardia and impairs myocardial contractility leading to inadequate perfusion and shock while the central respiratory centre depression results in hypoventilation and eventual apnoea 5,6,7 . Deep coma with fixed dilated pupils and absent reflexes at very low body temperatures, below [25][26][27][28][29] 0 C may be misleading giving the false appearance of death.…”

Section: Hypothermiamentioning

confidence: 99%

Children and the wave of destruction

Punchihewa

2008

Sri Lanka J Child Health

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“…A study by Jacobsen and colleagues [43] of 26 pediatric submersion victims concluded that all patients exhibiting spontaneous respirations immediately after cardiopulmonary resuscitation survived with minimal or no residual neurologic impairment. Those who remained apneic had severe residual neurologic deficits or died.…”

Section: Prognosismentioning

confidence: 99%

Submersion

Olshaker

2004

Emergency Medicine Clinics of North America

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Many thousands of individuals are submersion victims each year in the United States. The majority of victims are young, previously healthy people. There have been no recent breakthroughs in medical technology or treatment modalities that have improved survival rates for submersion victims. The key to their successful outcome and return to productive, full lives is aggressive resuscitation by emergency physicians and prehospital care providers. Most submersion incidents should never take place. Emergency physicians can take the lead in public education and prevention.

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Correlation of spontaneous respiration and neurologic damage in near-drowning

Cited by 35 publications

References 0 publications

Pediatric Near Drowning: The Experience of King Khalid University Hospital

Pediatric Near Drowning: The Experience of King Khalid University Hospital

Children and the wave of destruction

Submersion

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