Category Archives: Hypothermia

Survival After Prolonged Submersion in Freshwater in Florida: Conclusion

Survival After Prolonged Submersion in Freshwater in Florida: ConclusionAlthough the ambient temperature was colder than normal for Florida, on interview his mother stated there was no ice formation evident. While the temperature of the water was not obtained, it can be presumed that it was sufficiently cold to have produced rapid cooling of the victim. The fact that his body temperature, as measured rectally, could not have been > 26.7°C at the time of admission to the ED corroborates this assumption. This decreased body temperature likely produced a very significant protective effect from the cerebral hypoxia that undoubtedly occurred during the submersion episode. The efficiency and promptness of bystander basic CPR by persons certified in CPR, and the transfer of the victim via air ambulance with advanced life support to a facility that has physicians with considerable experience in treating drowning victims, no doubt was key to the outcome as well.

Survival After Prolonged Submersion in Freshwater in Florida: Cardiac arrest

Because circulation is still present for a short time after submersion occurs during drowning, and inhalation of water may be delayed by breath-holding and/or laryngo-spasm, reoxygenation of blood can occur until the alveolar oxygen tension falls to dangerous levels. It has been shown in anesthetized animals that with total tracheal obstruction, the average Pa02 dropped to 40 mm Hg after 1 min of obstruction and to 10 mm Hg after 3 min. Thus, the length of time that one can be submerged before irreversible cerebral hypoxia occurs may be longer in drowning victims than in other victims of cardiac arrest.

Survival After Prolonged Submersion in Freshwater in Florida: CPR

Survival After Prolonged Submersion in Freshwater in Florida: CPRRapid cooling of the victim occurs not only because of the large gradient between the water temperature and body temperature, but also because of three physiologic considerations. A small child has a very large body surface area to weight ratio, thus resulting in more surface exposed to cold water than would exist with an adult. Secondly, when a significant volume of cold water is breathed or aspirated, the very large surface area of the alveoli and their immediate proximity to the pulmonary capillary circulation causes the lungs to act as a heat exchanger.

Survival After Prolonged Submersion in Freshwater in Florida: Discussion

Four days after hospital admission, the patient began to emerge from his deep coma, after which his cerebral status progressively improved. Initial evaluation by occupational and physical therapy personnel showed an inability of the patient to bear weight, drink, or eat. He appeared to hear but did not verbalize, did not follow commands, and demonstrated no eye contact. He had generalized weakness. He showed rapid recovery during the 2 weeks following the initial evaluation. He recovered his balance, was able to bear weight with full joint compression, and began to ambulate. He became more interactive, with some verbalization. He regained fine motor skills, with the ability to play “pat-a-cake,” open and close doors, and turn pages in a book. He was totally removed from all support devices and medications over a 3-week period.

Survival After Prolonged Submersion in Freshwater in Florida: Hemolysis

Survival After Prolonged Submersion in Freshwater in Florida: HemolysisArterial blood gas levels on admission to the ED while receiving mechanical ventilation with 100% oxygen and positive end-expiratory pressure were pH 7.06; Pao2, 219 mm Hg; Paco2, 31 mm Hg; HCO3~, 8.8 mEq/L; and base deficit, 21 mEq/L. His initial hemoglobin concentration was 12.8 g/dL, which, subsequently, fell to a low of 9.8 g/dL approximately 13 h after admission and his initial WBC count was 1,200/μL, which spontaneously returned to normal by the third hospital day. His admission serum sodium concentration was 128 mEq/L, his chloride was 98 mEq/L, and his potassium was 4.6 mEq/L. A chest radiograph showed pulmonary markings consistent with water aspiration. canadian neightbor pharmacy

Survival After Prolonged Submersion in Freshwater in Florida: Emergency medical technicians

The child’s mother, a certified nursing assistant, and aunt, a registered nurse, both of whom were certified in basic cardiopulmonary resuscitation (CPR), began performing two-person CPR, which they continued until the ground-based emergency medical services team arrived. The air ambulance also received a call at 12:13 pm and arrived at the scene at 12:45 pm. On arrival at the scene, the emergency medical technicians (EMTs) took over CPR and assigned the child a Glasgow coma scale score of 3, with no pupillary, no motor, and no verbal responses. The ground-based EMTs then thought they felt a weak pulse, and the child moved his arm. When the air ambulance EMTs arrived, they felt no palpable radial, carotid, or other pulse; his pupils were fixed and dilated; and they did not observe any other signs of life. CPR was continued in the air ambulance, and the child was intubated. As the patient did not have an IV line in place at that time, 0.1 mg of epinephrine 1:10,000 was administered via the endotracheal tube on five separate occasions, and 0.5 mg of atropine sulfate was administered on two occasions between 12:47 pm and 1:09 pm before a faint pulse and agonal respirations were noted. CPR was continued until arrival at the emergency department (ED), a distance of approximately 30 miles. canadian drug mall

Survival After Prolonged Submersion in Freshwater in Florida

Survival After Prolonged Submersion in Freshwater in FloridaIn 1963, Kvittingen and Naess reported on a child in Norway who recovered after being submerged for 22 min in fresh water. Since then, a number of case reports have appeared in the literature reporting normal survival after submersion for substantial periods of time in cold water. For the most part, these cases have originated from Scandinavia, Canada, and the northernmost parts of the United States, with the victims falling through ice. To our knowledge, there has never been such a case report from a location with a more moderate climate such as Florida. We report the case of a 2-year-old (24 months) child who was found after being submerged for at least 20 min in a creek in rural Union County, FL, during an unusual brief period of cold weather, and who was resuscitated and survived without residual neurologic damage.