Near Drowning (Case Study Analysis)

Running head: NEAR DROWNING
Near Drowning (Case Study Analysis)
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Introduction
This paper introduces a 4-year old boy who suffered near drowning. The young male was
submerged for 20 minutes before he was rescued. After he was transferred to the emergency
department, the initial observations indicated hemoglobin instability which was characterized by
variable systolic BP (80-120) and HR (30-120). The boy’s temperature was found to be 27.9
degrees Celsius, and he portrayed unreportable oxygen saturation. The pupils were initially equal
but sluggish, and all limps were moving. The boy’s condition deteriorated to a Glasgow Coma
Scale (GCS) of 6, and he was administered with fluid together with adrenaline. The boy has then
admitted in the intensive care unit were intubation, and mechanical ventilation was required. He
was managed with antibiotic therapy to help in the treatment of bacteria from the aspirated lake
water. Extracorporeal membrane oxygenation was required for rewarming and cardiac support.
After the transesophageal echocardiogram was performed, it was identified that the left ventricle
was underfilled. Vasopressin together with fluids was administered to fill the ventricle. While
receiving ongoing care in the ICU, the boy responded to warm fluid resuscitation, inotropes, and
other rewarming techniques before ECMO was found necessary. However, his responsiveness
improved and he was capable of obeying the commands with all four limbs.
Assessment Data
The boy was in good health until he fell and drowned in the lake. This led to
hemodynamic instability which was characterized by systolic blood which varied between 80
and 120. The heart rate was observed to be between 30 and 120 while the temperature was found

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to be 27.9 degrees Celsius. The abnormal body temperature, heart rate, and blood pressure were
associated to the long period of breathing problems and restlessness. This also led to
unrecordable oxygen saturations indicating that the boy was in a critical condition threatening his
life. The initial observation paved the way for action in the emergency department (Omar et al.,
2017).
The face of the boy turned bluish, especially around the lips. Although the pupils were
equal, they were sluggish. During the administration of the first aid, the body successfully moved
all the limbs, but after some time he deteriorated to a Glasgow Coma Scale of 6. This indicates
his level of consciousness was low and he had experienced a severe traumatic brain injury. The
eye-opening became a problem as well as verbal response, and motor response. It was therefore
evident that the boy had suffered a severe brain injury since the GCS was below 8. This indicated
that a rigorous and effective treatment was required to ensure that the boy does not lose his life
(Bierens, Lunetta & Tipton, 2014). Improper treatment handling could also expose the boy to
future mental problems as the drowning had led to severe brain injuries. This may lead to long
term impairments in cognition, physical skills, and emotional functioning.
After the transesophageal echocardiogram was performed, the right ventricle was found
to be underfilled. This indicates that the boy was still undergoing breathing problems and heart
rate was still below the average level as result blood was not flowing adequately to all parts of
the body (Ughetto et al., 2015). The skin turned out to be cold and appeared pale. The boy’s
respiration was gasping and shallow. The fact that he never gained conscious during first aid
indicates that he needed quick attention and it is necessary that he is admitted in the intensive
care unit for life support and adequate medication.

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Pathophysiology
Near drowning is a term used to refer almost dying condition from suffocating under
water. It is the last stage before fatal drowning which results to death. This condition usually
occurs among children, but since it is an accident, it can happen to people of all ages. Near
drowning, patients require medical attention to prevent health complications and loss of lives.
The initial treatment by the rescue team should involve airway breathing and circulation (ABCs)
(Kim, Lee, Kim, Jeong & Ko, 2014). In case the victim is associated with mental problems, the
airway should be checked for foreign materials and vomitus. Finger-sweep maneuver should be
used to remove visible debris in the oropharynx (Buggia, Canham, Tibbles, & Landry, 2014).
The boy should also be administered with supplemental oxygen and continuous pulse oximetry.
When low levels of oxygen saturation persist, it is recommended that constant positive airway
pressure (CPAP) is used or early intubation with appropriate use of positive end-expiratory
pressure (PEEP) (Bierens, Lunetta & Tipton, 2014). This process improves the health condition
of the victim. Adequate oxygen enables the patient to rectify the heart rate, blood pressure and
temperature to normal standards. The GCS is also brought to normal level enhancing proper
functioning of the body parts. Adequate pathophysiology ensures that near drowning victims
recover fully from the condition (Omar et al., 2017).
Medical Management
For the boy to recover from the condition, it is necessary that appropriate healthcare is
provided. The first approach in delivering medication to the boy includes the prehospital care.
This aspect of medical management is an essential determinant of the outcome of drowned
victims. After the boy was rescued from the water the type of water should be determined, the