NEUROLOGIC 

The majority of long term sequalae of drowning events are secondary to neurologic injury. Early efforts should be made to improve central nervous system oxygen delivery while providing evidence-based neuroprotection in the post-resuscitative period.

In patients who are still rewarming, aggressive shivering control should be implemented (See Figure 2 on right for an example of shivering management protocol). Significant adverse effects from prolonged shivering include lactic acidosis, elevated intracranial pressure, rhabdomyolysis, discomfort, and interference with monitoring devices.24