NEAR-DROWNING IN BRITISH COLUMBIA
| Autor: | Judith G. Hall, Robert J. Adderley, David Wensley, Gordon E. Pirie, Andrew J. Macnab |
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| Rok vydání: | 1987 |
| Předmět: | |
| Zdroj: | Pediatric Research. 21:203A-203A |
| ISSN: | 1530-0447 0031-3998 |
| Popis: | Near-drowning is a cause of major neurological damage in children. Following reports of unexpected survival, vigorous measures to control intracranial pressure and minimize cerebral metabolic requirements became popular (the “HYPER” regimen). Our approach has been supportive (no barbituate coma or hypothermia) to achieve optimal oxygenation and cerebral perfusion while minimizing potential insults which raise intracranial pressure. We stress prompt resuscitation with re-warming to normothermia, fluid restriction, and diuresis. Head elevation and judicious sedation are used to avoid adverse effects on intracranial pressure from noxious stimuli. Our results are comparable to other centers. Sixty-one percent drowned in baths, hot-tubs or swimming pools, 36% in lakes or streams, and one child in the sea. The age range was from 5 months to 12 years (mean 3.2 years). Of 31 patients admitted over 46 months, 71% survived. Using Conn's classification, 10 Group A (awake) patients had a 100% intact survival. Of 5 Group B (blunted) patients, 4 survived and 1 died. From 16 Group C (comatose) patients, 4 survived (all C-1) with good neurological function, 4 were handicapped and 8 died. Important prognostic factors include cold water submersion, early resuscitation at the scene, short duration of resuscitation, transport which avoids secondary insult and meticulous intensive care. |
| Databáze: | OpenAIRE |
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