INITIAL ER ASSESSMENT AND INTERVENTIONS
Upon arrival to the Emergency Room (ER), rapidly evaluate the patient and rule out traumatic injury. Perform primary (ABCDE) and secondary assessment with specific focus on the following: secure airway, provide adequate oxygenation, ensure hemodynamic stability, gastric decompression, thermal insulation, and identifying concomitant traumatic injury. 10,11,19,22 Following initial ER resuscitation, specific systems-based interventions may be applied as noted in the ICU Management section. Additional immediate interventions below (does not substitute for ER standards of care):
Once the patient is stabilized from a respiratory and hemodynamic standpoint, disposition should be determined. Figure 1 below helps to establish guidelines for ICU admission versus observation and safe discharge based drowning mortality risk and drowning grade (Table 3).
Patients with a Grade 2 or lower may safely be observed either in the ER or non-intensive care inpatient observation for 4-6 hours.1
Patients with Grades 3-6 should be admitted to the ICU.1
Appropriate consults should be made at this time and may include critical care (medical and neurological), cardiology, psychology.