PEM Chatt

21 | Submersion Injuries with Dr Sarah Lazarus

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21 | Submersion Injuries with Dr. Sarah Lazarus

In this episode of PEM CHATT, host Toni Dobson is joined by pediatric emergency physician Dr. Sarah Lazarus to break down the critical topic of pediatric drowning and submersion injuries. Together, they explore real-world clinical scenarios, debunk common myths, and provide practical guidance for both clinicians and caregivers.

Drowning remains one of the leading causes of death in children, particularly ages 1–4, and even non-fatal events can result in devastating long-term consequences. This episode emphasizes both clinical management and prevention strategies—highlighting how quickly these events occur and how often they happen despite close supervision.

 

🔑 Key Takeaways

  • Drowning is fast and silent
    • Often occurs in seconds with little to no splashing or noise
    • Terminology matters
      • “Dry drowning” and “secondary drowning” are outdated and misleading
      • Pathophysiology is respiratory
        • Water aspiration → surfactant washout → impaired gas exchange → hypoxia
        • Observation is critical
          • True aspiration events should be monitored for ~6 hours from the time of incident
          • Imaging isn’t always helpful
            • Chest X-rays can lead to unnecessary admissions without changing outcomes
            • Management is symptom-driven
              • Asymptomatic → observe
              • Symptomatic → oxygen support, VBG, imaging, admission
              • Cardiac arrest cases are severe
                • Focus on oxygenation, ventilation, rewarming, and consider ECMO early
                • Prevention requires layers
                  • No single strategy (including swim lessons) is sufficient

                    • ⚠️ Clinical Pearls

                    • Drowning is an evolving process, not a single moment event
                    • Patients should be observed for 6 hours after the event
                    • Symptoms appearing days later are NOT due to drowning
                    • Pediatric arrests are often respiratory in origin → prioritize ventilation
                    • Antibiotics and steroids are not routinely indicated
                    • Most toddler submersion injuries do NOT require C-spine immobilization

                      • 🧠 Myth Busting

                      “Dry drowning” isn’t real.

                      This term originated from outdated medical concepts but is no longer used. If a child had a true submersion injury, symptoms will present within 6 hours—not days later.

                      🛟 Prevention Insights

                      • Use “arms reach, eyes reach” supervision
                      • Perform a home swim test (can the child swim 2 pool lengths?)
                      • Understand that:
                        • Swim lessons ≠ drowning proof
                        • Life jackets ≠ guaranteed safety
                        • Drowning prevention requires multiple overlapping layers of safety

                          • Resources and references:

                          • Brenner’s article: https://pubmed.ncbi.nlm.nih.gov/19255386/
                          • CHOA Algorithm: https://www.choa.org/-/media/Files/Childrens/medical-professionals/clinical-practice-guidelines/submersion-event-ed.pdf
                          • NEJM Article: https://www.nejm.org/doi/full/10.1056/NEJMra1013317#figures_media

                            • Timeline

                            00:00 Welcome to PEM CHATT

                            00:19 Why Drowning Matters

                            01:12 Meet Dr. Sarah Lazarus

                            02:14 Bread Pudding is my favorite

                            03:34 Drowning Terminology

                            04:38 Who Is Most at Risk

                            06:08 Silent Drowning Explained

                            09:15 Systemic Effects Checklist

                            11:03 Fresh vs Salt vs Cold

                            11:46 Three Patient Categories

                            12:36 Case One Asymptomatic Kid

                            14:12 Avoiding Unneeded X-Rays

                            16:12 Case Two Symptomatic Infant

                            18:40 Imaging and Labs Strategy

                            18:58 When to Skip Antibiotics

                            20:02 Arrest Scenario Walkthrough

                            20:30 Resuscitation Priorities And ECMO

                            21:54 When Resuscitation Is Futile

                            22:40 C-Spine Immobilization Debate

                            23:24 Drowning CPR Starts with Breaths

                            25:29 Injury Prevention Work and Stats

                            27:14 Layers of Drowning Prevention

                            30:01 Dry Drowning Myth Busting

                            33:16 Key Pearls and Closing

                             

                             

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                            PEM ChattBy Toni Dobson