UMEM Educational Pearls

Category: Pediatrics

Title: Submersion injuries (submitted by Floyd Howell, MD)

Keywords: drowning, submersion, seizure, intubation (PubMed Search)

Posted: 4/27/2012 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

Submersion injuries are the 2nd leading cause of accidental death in children with 1/3 of survivors sustaining significant neurologic sequelae.  50% of drownings occur from May to August.

40% of all drowning victims are children under age 4, with males affected 3 times as often as females.  Most drownings occur with 10 feet of safety.  Infants and toddlers drown most often in bathtubs (especially if <1 year old), buckets, toilets, pools and hot tubs (most often the pools are in-ground).  Those with seizure disorders have a 10-14 fold higher likelihood of drowning.

Aspiration of as little as 1-3ml/kg of fluid may cause pulmonary edema, surfactant inactivation or washout, pulmonary shunting with resulting V/Q mismatching, or direct injury to the alveolar membrane. 

Immediate and adequate resuscitation, including intubation, is the single most important factor determining survival.  Always check body temperature as hypothermia is common.  In general, prophylactic antibiotics and steroids are not indicated unless drowning occurred in grossly contaminated water/sewage.  

1. Stewart, C. Pediatric Submersion Injuries: New Definitions and Protocols. Pediatric Emergency Medicine Practice, Apr 2006;3:1-20.
2. Burford, AE, et al. Drowning and Near-Drowning in Children and Adolescents. Pediatric Emergency Care, 2005. 21:9.