IMMERSION INJURY

see also Hypothermia

RESUSCITATION

• Beware of Cx spine (full neck precautions)

• Consider early intubation and ventilation if altered mental state, use PEEP

• May have cardiac failure/arrhythmias, shock (rare)

• Check BSL

• Warming measures if hypothermia

• NGT/IDC

INVESTIGATE FOR COMPLICATIONS

• ARDS - ABG/CXR

• Acute tubular necrosis EUC

• DIC - DIC screen/Platelets

• Haemolysis (rare) - Hb/LD/Bilirubin/Haptoglobin

DEFINITIVE MANAGEMENT

Supportive

Treat DIC

DISPOSAL

Discharge at 4 hours if:

• Asymptomatic

• CXR normal

• ABG normal

Admit any patient with

• Any symptoms

• Apnoea

• LOC

• Hypoxia

• Arrhythmias

Admit all intubated patients to ICU

PROGNOSTIC INDICATORS

Good

• Hypothermic children

• ROSC (Return of spontaneous circulation) < 1-3 min

Poor

• Prolonged immersion (3-8 min)

• Delayed CPR (60% mortality with no BLS)

• pH < 7 pO2 < 60 (with supplemental oxygen)

• GCS < 5, fixed dilated pupils (44% survival, 17-24% neurological deficit)

• Asytole, ROSC > 40 min, First gasp > 40min

PROGNOSIS

Neurological deficit

• 70% none

• 20% mild

• 10% vegetative