From the Guidelines
The 17-year-old male who experienced a near-drowning event should be immediately transported to the nearest emergency department for evaluation, even if he appears stable, as delayed pulmonary edema can develop up to 24 hours after the incident. The patient's current clear lung sounds and normal vital signs do not rule out the possibility of future complications, and medical evaluation is essential to monitor for potential respiratory issues 1.
Emergency Care Protocol
The recommended emergency care protocol includes:
- Immediate transport to the nearest emergency department for evaluation
- Placement on supplemental oxygen during transport, typically via nasal cannula at 2-4 liters per minute, to ensure adequate oxygenation
- Continuous monitoring of vital signs, including oxygen saturation, heart rate, blood pressure, and respiratory rate, throughout transport
- Assessment of pulmonary status, including severity of lung injury, at the first EMS assessment 2
Hospital Evaluation
At the hospital, the patient should undergo:
- Chest X-ray
- Arterial blood gas analysis
- Observation for at least 6-8 hours, with some cases warranting 24-hour observation depending on clinical findings Prophylactic antibiotics are not routinely recommended unless signs of infection develop 1.
Transportation
The patient should be transported by paramedics or ambulance BLS, as all persons requiring any level of resuscitation following drowning should be transported to the emergency department 1. The decision to transport by paramedics or ambulance BLS should be based on the patient's clinical condition and the availability of resources.
Key Considerations
- Delayed pulmonary edema can develop up to 24 hours after a submersion incident due to chemical pneumonitis from aspirated water or secondary infection
- The seemingly stable presentation can be deceptive in drowning cases, as respiratory complications may develop hours after the incident
- Medical evaluation is essential even when initial assessment appears reassuring 3
From the Research
Emergency Care and Transportation Protocol
The patient, a 17-year-old male, experienced a near-drowning event, gulped lake water, but has clear lung sounds and normal vital signs. The following are considerations for emergency care and transportation:
- Observation and Monitoring: The patient should be closely monitored for any signs of respiratory distress, cardiac issues, or other complications that may arise from the near-drowning event 4.
- Transportation: If the patient is stable and shows no signs of distress, transportation by paramedics or ambulance BLS (Basic Life Support) may be sufficient. However, if the patient's condition worsens or shows signs of respiratory or cardiac complications, advanced life support (ALS) may be necessary 5.
- Assessment of Lung Function: The patient's clear lung sounds are a good indicator, but it's essential to continue monitoring for any changes. Arterial blood gas analysis can help assess the patient's oxygenation status and identify any potential issues 6.
- Risk of Pulmonary Complications: Although the patient has clear lung sounds, there is still a risk of pulmonary complications, such as pulmonary edema or acute respiratory distress syndrome (ARDS) 7, 8. Close monitoring and prompt medical attention are crucial if any symptoms arise.
Decision to Transport by Paramedics or Ambulance BLS
The decision to transport the patient by paramedics or ambulance BLS should be based on the patient's condition and the level of care required. Considerations include:
- Stability of the Patient: If the patient is stable and shows no signs of distress, transportation by paramedics or ambulance BLS may be sufficient.
- Level of Care Required: If the patient requires advanced life support (ALS) or has a high risk of complications, transportation by a higher-level emergency medical services (EMS) team may be necessary.
- Distance and Time to Medical Facility: The distance and time to the nearest medical facility should also be considered when deciding on the mode of transportation.