Emergency Medicine

Answer 3 Up to 20% of patients who arrive in the ED comatose and flaccid with dilated pupils can be expected to fully recover. 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. REFERENCE 2. Weinstein MD, Krieger BP. Near-drowning: epidemiology, pathophysiology, and initial treatment. J Emerg Med 1996;14:461–7. Click here to return to the questions

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