This case comes from Drs. Katie Maguire and Nicole Holm.
Dr. Maguire is a PGY5 Emergency Medicine resident at the University of British Columbia. Her interests include medical education, disaster medicine and simulation. She is particularly interested in simulation as an educational technique to develop communication and crisis resource management skills. She completed her undergraduate degree at Queen’s University and her medical degree at the University of Manitoba.
Dr. Holm is an emergency physician in Vancouver and Squamish. She completed her residency at UBC and her simulation fellowship at the Centre for Excellence in Simulation Education and Innovation in Vancouver.
WHY IT MATTERS
Every year as the weather warms and more people take advantage of water sports and outdoor activities there is increased risk of drowning. When it comes to pediatric drowning, prevention is the best medicine. However, if you find yourself treating a drowning patient in the ED, this case will have you well prepared.
CLINICAL VIGNETTE
3-year-old female previously healthy presents post-submersion in a backyard pool with respiratory distress.
CASE SUMMARY
A three-year-old child was swimming with their family, when they wandered into the deep end and submerged under water. The parents noticed the child was below the surface. When the child was brought to the surface, they were unconscious and coughing up foam. EHS arrived, provided oxygen supplementation, and brought them to your tertiary emergency department, with access to PICU. In the ED, the child is unconscious with increasing respiratory distress, requiring intubation. Despite intubation, the child remains hypoxemic and the team works through an approach to post-intubation hypoxemia. Unfortunately, the child becomes bradycardic. The team should begin CPR and follow the PALS pediatric bradycardia algorithm. PICU should be called if not already involved. After one round of CPR, the patient’s heart rate will increase and the consulting team should arrive.
Hon, K. , So, K. , Wong, W. , Cheung, H. & Cheung, K. (2016). Radiologic, Neurologic and Cardiopulmonary Aspects of Submersion Injury. Pediatric Emergency Care,32(9), 623-626. doi: 10.1097/PEC.0000000000000477.
EM Sim Cases 