DIC, and endocrine disorders. The number

one factor that contributes to the morbidity and mortality of

heat illness is the severity of underlying comorbid illnesses,

not the absolute height of the core body temperature.

DISPOSITION

..... Admission

If the patient has any serious comorbid conditions or illnesses, admission may be necessary. Patients with heat

HEAT-RELATED I LLNESS

Heat exhaustion

IV or PO

hydration with

electrolyte

containing

solutions and

ambient cooling

Discharge if no

serious comorbid il lness

Heat stroke

Rule-out 2° causes

of AMS and

hyperthermia

IVF bolus and

begin evaporative

cool ing measures

to 40°( (1 04°F)

ICU admission

.&. Figure 63-1. Heat-related ill ness diagnostic algorithm. ABCs, airway,

breathing, and circu lation; AMS, altered mental status; ICU, intensive care

unit; IV, intravenous; IVF, intravenous flu id; PO, by mouth.

stroke should be admitted to the intensive care unit for

continued monitoring of temperature and mental status.

� Discharge

Discharge home is appropriate for patients with heat

exhaustion if their symptoms resolve, vital signs normalize,

and there are no serious derangements found in laboratory

values.

SUGGESTED READING

Howe AS, Boden BP. Heat-related illness in athletes. Am J Sports

Med. 2007;35: 1384.

Smith JE. Cooling methods used in the t reatment of exertional

heat illness. Br J Sports Med. 2005;39:503.

Waters TE, Al-Salamah MA. Heat emergencies. In: Tintinalli JE,

Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD.

Tintinalli's Emergency Medicine: A Comprehensive Study

Guide. 7th ed. New York, NY: McGraw-Hill, 20 l l, pp. 1339-1344.

Drowning Incidents

Corey R. Heitz, MD

Key Points

• Drowning is defined as the process of experiencing

respiratory impairment from submersion/immersion in

liquid.

• Consider that drown ing may have resulted from a

primary medical or traumatic insult.

INTRODUCTION

The term "drowning incident" encompasses a variety of

clinical entities. A 2005 report from the World Health

Organization recommends that the term "near-drowning"

be abandoned and instead to use the term "drowning incident" with a description of the outcome (death, morbidity,

no morbidity). Drowning itself should be described as "the

process of experiencing respiratory impairment from

submersion/immersion in liquid."

Nonfatal incidents are more common than fatal incidents; in 2009, 6,5 19 nonfatal drowning incidents were

reported, whereas 4,211 incidents resulted in death. One

estimate states that there is 1 death per 13 drowning inci ­

dents, suggesting that underreporting likely occurs.

Children make up the majority of fatal incidents, with peak

ages of 1-4 years and seasonal variability. Freshwater

drowning is more common than saltwater, with bathtubs

and pool as the most common locations. Accomplished

swimmers make up 35o/o of deaths.

CLINICAL PRESENTATION

Wide variability exists in the presentation of drowningrelated injury, both in terms of time of submersion/

immersion as well as how the patient is found. Children are

often found face-down in small depths of water (bathtub,

• Treatment is largely supportive and stabilizing.

• Patients who present and remain asymptomatic for

6 hours may be discharged from the emergency

department.

5-gallon bucket, toilet).