Pulmonary; you have acute hypoxemia. You may develop a severe ARDS. The ARDS will actually end up being the cause of death in some patients with immersion events. The most common cause of death is the neurologic event.
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Cardiac; initially you get the sequelae of the anoxia and ischemia with asystole being by far the most common rhythm. You may transiently have some ventricular fibrillation or tachycardia and you are going to have poor cardiac function. Once you get someone resuscitated, if you are able to get their heart back beating again, the primary cardiac dysfunction is unlikely to be the cause of their demise.
Liver and kidney problems, although they may be transient, are rarely a major long term problem.
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Hypothermia; there is a difference between dying and getting cold and getting cold and dying. If they fish somebody out of a swimming pool who has been there overnight and they bring them into the emergency room, they are not surprisingly going to be cold. It doesn’t mean that they’ve had a cold water drowning and that they are going to be fine. When people talk about cold water drownings they refer to cold, cold water. Like falling through the ice. Southern California really doesn’t have anything approaching cold water drownings. You have to go up in the mountains and fall through some ice somewhere. So if your patient comes in cold from a swimming pool, it’s not a cold water drowning. It’s somebody who has been dead or dying for awhile.
Near drowning therapy is kind of boring to talk about. There is nothing magic about resuscitation a near drowning victim. Advanced cardiac life support; treat their dysrhythmias, treat their asystole. If they are cold you should warm them up. If they are 25 degrees because they have been dead over night, you are not going to be able to warm them up because they’ve been dead. So the old adage that you are not dead until you are warm and dead I think is a big misnomer. If they fall in through the ice and they have primary hypothermia it’s worth trying to warm them up with invasive warming techniques, maybe even cardiopulmonary bypass.
Supportive care. They should be observed, with a significant immersion event, at least eight hours. ICP monitoring has not been shown to alter outcome in anoxic ischemic events, such as near drowning, and is not advocated and not carried out at most institutions.
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