Hypothermia. Cold-water drowning

Cold-water submersion results in rapidly induced hypothermia. The body's physiologic response to this insult is, in some ways, similar to that of controlled hypothermia employed in the hospital setting, with the time sequencing being greatly enhanced. The application of hypothermic techniques employed with extracorporeal heat exchange on cardiopulmonary bypass to those of cold-water submersion requires careful differentiation, especially during rewarming phases. Conversely, protecting the brain from hypoxic injury (and thus a favorable neurologic recovery) following cold-water submersion can be favorably modified by the co-existence of hypothermia. The protective effects of safe usage of hypothermic without neurologic damage is multifaceted and influenced by age, time, temperature and intracellular pH, metabolic rate, biochemical changes, high-energy storage depots, as well as institution of rewarming techniques. Criteria for brain death established by the President's commission does not apply to the hypothermic patient. According to colleagues, rewarming to between 30 and 34 degrees C is essential before discontinuing resuscitative measures because of the multifactoral influences that the hypothermic state entails. A child who appears asystolic, apneic, and with absence of central nervous system activity after cold-water submersion, requiring intensive resuscitative efforts, may have a favorable outcome. This does not absolutely suggest a devastating outcome as we have seen in those children "frozen alive," who are hypothermic but have been effectively resuscitated, rehabilitated, and allowed to return to normal life activities. Although combined intensive and rehabilitative efforts of the medical team are essential in the care of these children, foremost in our minds should be prevention of these accidents.