ER DISPOSITION

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 are responsive to verbal and tactile stimuli (GCS >13).
- May have cough or rales on pulmonary evaluation.
- Able to maintain oxygenation with low-flow oxygen (typically 2L by nasal canula).

Patients with Grades 3-6 should be admitted to the ICU.1

- Unresponsive patients
- Patients with significant pulmonary edema or respiratory failure
- Patients in shock (hypotension or poor perfusion shown by capillary refill, elevated lactate, organ failure)

Appropriate consults should be made at this time and may include critical care (medical and neurological), cardiology, psychology.