Drowning – Emergency management in children – Flowchart
Child presents to ED following a drowning event
ASSESSMENT
Remove wet clothes and apply warm blankets. C-spine precautions if head or neck trauma
Consider NAI and underlying contributory/causative conditions such as epilepsy, cardiac dysrhythmias, hypoglycaemia
Normal respiratory status Respiratory compromise
(GCS 15, SpO2 > 95%, (SpO2 < 95%, increased work of Apnoea or cardiac arrest
no increased work of breathing) breathing)
• Observation period for 4-8 hours to Resuscitate using ABCD
• Oxygen +/- HFNC/ NIV
identify secondary deterioration due Follow APLS Algorithms
• CXR
to pulmonary oedema • Intubate and ventilate
• +/- ECG
• Consider admission to SSU where (cuffed tube, NGT and PEEP)
• FBC, UEC, Glucose, VBG, LFT
available • VBG/ABG, Glucose as priority
• +/- prophylactic antibiotics (Box A)
• +/- prophylactic antibiotics (Box A) • FBC, UEC, LFT, coags, CK
• Cardiorespiratory monitoring
• Measure core temperature using rectal
• +/- measure core temperature
thermometer
• +/- fluids IV or IO
• Fluids IV or IO
Sodium Chloride 0.9% 20 mL/kg
• IDC for fluid balance
Return of
Normal vital signs Responding to
No spontaneous
& oximetry? treatment?
circulation?
Yes No Yes No
Yes
Consider • Neuro protective
intubation & measures Discuss cessation
ventilation if (normothermia, of life support
worsening hypoxia, normoglycemia) with paediatric
respiratory distress • +/- core rewarming critical care and
or decreased measures on family
conscious level. critical care advice
• +/- prophylactic
antibiotics (Box A)
• +/- CT head
• +/- sputum culture
Consider Refer to inpatient Refer to Paediatric Consider cessation of
discharge service Critical Care life support
Box A: Prophylactic antibiotic dosing
Following a drowning event in grossly contaminated water administer Ciprofloxacin 10 mg/kg/dose IV (Max 400 mg/dose) 8-hourly and
seek Infectious Diseases specialist advice within 24 hours.
Prophylactic antibiotics are not recommended following submersions in other water types.
Consider seeking senior emergency/ Seek senior emergency/ Seek urgent paediatric critical care
paediatric advice as per local paediatric advice as per local advice (onsite or via Retrieval Services
practices practices Queensland (RSQ) on 1300 799 127)
CHQ-GDL-60013-Appendix 1 V1.0
For more information refer to CHQ-GDL-60013 - Drowning – Emergency management in children
