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):

- Chest X-Ray – regardless of patient’s clinical appearance. Used to establish a baseline.
- Electrocardiogram (EKG)
- Volume resuscitation as appropriate for hemodynamic support. Urinary catheter placement. Invasive monitoring (e.g., arterial line) and central access at the discretion of the treating physician.
- CT head and neck is recommended in the persistently unconscious patient to look for evidence of traumatic injury.
- It is important to note, that in the military setting, particularly during combat or other high risk military operations to look for and rule out traumatic injury and hemorrhage in patients with suspected drowning and hypotension. At a minimum an ultrasound FAST (Focused Assessment Sonography for Trauma) should be performed in all drowning victims without evidence of trauma. In unconscious patients, in addition to a CT head and neck, perform a pelvic X-ray as pelvic fracture can be a significant source of bleeding. In drowning victims with persistent hypotension without evidence of trauma, CT torso (chest, abdomen, and pelvis) should be performed to rule out solid organ injury, retroperitoneal bleeding or other occult traumatic injury.