drowning workup medscape

5/24/2015 DrowningWorkup

http://emedicine.medscape.com/article/772753workup 1/5

DrowningWorkupAuthor:GPatriciaCantwell,MD,FCCMChiefEditor:JoeAlcock,MD,MSmore...

Updated:Aug25,2014

ApproachConsiderationsManagementofhypoxemiaisthekeytothemanagementofdrowning.Asurprisingdegreeofhypoxiamaybepresentinarelativelyasymptomaticpatient.Obtaincontinuouspulseoximetry.

Obtainarterialbloodgas(ABG)levelsinallpatientswithanyhistoryofsubmersioninjury.ABGanalysisisprobablythemostreliableclinicalparameterinpatientswhoareasymptomaticormildlysymptomatic.ABGanalysisshouldincludecooximetrytodetectmethemoglobinemiaandcarboxyhemoglobinemia.

Rememberthatcervicalspinetraumamaybepresentinanyvictimofshalloworrockywaterimmersioninjury.Ifthevictimisunabletogiveaclearhistoryoftheevents,hasevidenceofheadorfacialinjury,orisfoundunresponsiveinapoolorothershallowbodyofwater,protectthecervicalspineuntilinjuryisexcluded.

Obtainbloodforarapidglucosedetermination,completebloodcount(CBC),electrolytelevels,lactatelevel,andcoagulationprofile,ifindicated.Collecturineforurinalysis,ifindicated.Measureliverenzymes,especiallyaspartateaminotransferaseandalanineaminotransferase.Considerabloodalcohollevelandurinetoxicologyscreenforuseofdrugs.CardiactroponinItestingmaybeusefulasamarkertopredictchildrenwhohaveanelevatedriskofnotsurvivingtohospitaldischarge.

Renalfunctiontests

Ifinitialtestresultsshowelevatedserumcreatininelevel,markedmetabolicacidosis,abnormalurinalysis,orsignificantlymphocytosis,serialestimationsofserumcreatinineshouldbeperformed.

Acuterenalimpairmentisknowntooccurfrequentlyindrowning,and,whileusuallymild(serumcreatininelevel



WilliamHShoff,MD,DTM&HDirector,PENNTravelMedicineAssociateProfessor,DepartmentofEmergencyMedicine,HospitaloftheUniversityofPennsylvania,UniversityofPennsylvaniaSchoolofMedicine

WilliamHShoff,MD,DTM&Hisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,AmericanSocietyofTropicalMedicineandHygiene,InternationalSocietyofTravelMedicine,SocietyforAcademicEmergencyMedicine,andWildernessMedicalSociety

Disclosure:Nothingtodisclose.

ChiefEditorJoeAlcock,MD,MSAssociateProfessor,DepartmentofEmergencyMedicine,UniversityofNewMexicoHealthSciencesCenter

JoeAlcock,MD,MSisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine


AdditionalContributorsBarryJEvans,MDAssistantProfessorofPediatrics,TempleUniversityMedicalSchoolDirectorofPediatricCriticalCareandPulmonology,AssociateChairforPediatricEducation,TempleUniversityChildren'sMedicalCenter

BarryJEvans,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofPediatrics,AmericanCollegeofChestPhysicians,AmericanThoracicSociety,andSocietyofCriticalCareMedicine


EddySLang,MDCM,CCFP(EM),CSPQAssociateProfessor,SeniorResearcher,DivisionofEmergencyMedicine,DepartmentofFamilyMedicine,UniversityofCalgaryFacultyofMedicineAssistantProfessor,DepartmentofFamilyMedicine,McGillUniversityFacultyofMedicine,Canada

EddySLang,MDCM,CCFP(EM),CSPQisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergencyPhysicians,CanadianAssociationofEmergencyPhysicians,andSocietyforAcademicEmergencyMedicine


JamesMartin,MDFellow,DepartmentofEmergencyMedicine,DivisionofHyperbaricMedicine,HospitaloftheUniversityofPennsylvania


RobertLNorris,MDProfessor,DepartmentofSurgery,Chief,DivisionofEmergencyMedicine,StanfordUniversityMedicalCenter

RobertLNorris,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergencyPhysicians,AmericanMedicalAssociation,CaliforniaMedicalAssociation,InternationalSocietyofToxinology,SocietyforAcademicEmergencyMedicine,andWildernessMedicalSociety


SuzanneMooreShepherd,MD,MS,DTM&H,FACEP,FAAEMProfessorofEmergencyMedicine,EducationOfficer,DepartmentofEmergencyMedicine,HospitaloftheUniversityofPennsylvaniaDirectorofEducationandResearch,PENNTravelMedicineMedicalDirector,FastTrack,DepartmentofEmergencyMedicine

SuzanneMooreShepherdisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,AmericanAcademyofEmergencyMedicine,AmericanSocietyofTropicalMedicineandHygiene,InternationalSocietyofTravelMedicine,SocietyforAcademicEmergencyMedicine,andWildernessMedicalSociety


FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollegeofPharmacyEditorinChief,MedscapeDrugReference

Disclosure:MedscapeSalaryEmployment

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