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[Drowning and near-drowning in children]
1Emma Kinderziekenhuis/Academisch Medisch Centrum, afd. Intensive Care Kinderen, Amsterdam.
Insights
Drowning and near-drowning in children cause death and brain damage due to hypoxia and impaired gas exchange. Prompt treatment focusing on limiting cerebral damage is crucial for survival and recovery.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Physiology
- Toxicology
Background:
- Drowning and near-drowning are significant pediatric emergencies, leading to mortality and severe neurological deficits.
- The primary pathophysiology involves hypoxia, ischemia, acidosis, and potential hypothermia following liquid aspiration.
- Impaired gas exchange, arrhythmias, and hypovolemia are common complications.
Observation:
- Liquid aspiration in near-drowning incidents causes persistent impairment of gas exchange.
- Arrhythmias and hypovolemia are frequently observed in near-drowning victims.
- Prognosis is strongly linked to submersion duration, with >5 minutes generally unfavorable.
Findings:
- Key treatment objectives include limiting cerebral damage through resuscitation and stabilization.
- Therapeutic interventions involve oxygen with positive end-expiratory pressure, fluid administration, and rewarming.
- In cases of hypothermia from cold water immersion, treatment should continue until core temperature reaches at least 32°C.
Implications:
- Early and aggressive management is vital to improve outcomes for pediatric drowning victims.
- Understanding the pathophysiological cascade aids in targeted therapeutic strategies.
- Further research into prognostic factors, especially in hypothermic near-drowning, is warranted.
Abstract:
Drowning and near-drowning are major causes of death and neurological damage, respectively, in children. The pathophysiological substrate consists of hypoxia, ischaemia, respiratory and metabolic acidosis and sometimes, hypothermia. Most cases involve aspiration of liquid; this leads to a persistent impairment of the gas exchange. Occurrence of arrhythmias and hypovolaemia is very likely. The main objective of treatment of the near-drowned is limiting cerebral damage. Treatment consists of resuscitation and stabilization, administration of oxygen with positive end-expiratory pressure, intravenous administration of liquids and central reheating. The prognosis depends in the first place on the duration of the submersion, which, however, is often difficult to establish. Submersion for over 5 minutes is prognostically unfavourable. In hypothermia due to submersion in ice cold water the prognostic factors are less clear--in these cases the treatment should always be continued until the core temperature is > or = 32 degrees C.