The appearance of a patient after a near-drowning accident cannot reliably predict the outcome.2 Patients who are hypothermic must be warmed to at least 32°C (90°F) before they can be declared dead. Not all patients require admission, but patients must be observed. Patients with a history of apnea, unconsciousness, hypoxia, or dysrhythmias; those with an abnormal electrocardiogram or chest radiograph; and those who remain symptomatic in the ED require admission. Cervical spine injuries should be suspected in all near-drowning patients with altered mental status because a diving injury may have precipitated the near-drowning episode. Most near-drowning victims do not aspirate enough fluid to cause mechanical difficulties in ventilation. However, aspiration of both water and waterborne contaminants can cause damage to pulmonary surfactant.
- Up to 20% of patients who arrive in the ED comatose and flaccid with dilated pupils can be expected to fully recover.
2. Weinstein MD, Krieger BP. Near-drowning: epidemiology, pathophysiology, and initial treatment. J Emerg Med 1996;14:4617.
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